title: The detection of sentinel lymph nodes in laparoscopic surgery for uterine cervical cancer using 99m-technetium-tin colloid, indocyanine green, and blue dye.
abstract: OBJECTIVE
  Our objective was to determine the feasibility and detection rates and clarify the most effective combination of injected tracer types for sentinel lymph node (SLN) mapping in uterine cervical cancer in patients who have undergone laparoscopic surgery or neoadjuvant chemotherapy (NAC).
  
  
  METHODS
  A total of 119 patients with cervical cancer underwent SLN biopsy at radical hysterectomy using three types of tracers. The various factors related to side-specific detection rate, sensitivity, and false negative (FN) rate were analyzed.
  
  
  RESULTS
  The SLN detection rates using 99m-technetium ((99m)Tc)-tin colloid, indigo carmine, and indocyanine green (ICG) were 85.8%, 20.2%, and 61.6%, respectively. The patients with ≥2-cm-diameter tumors and those who received NAC had lower detection rates than those with <2-cm-diameter tumors (75.7% vs. 91.5%, p<0.01) and those who did not receive NAC (67.9% vs. 86.3%, p<0.01), respectively. Laparoscopic procedures had a higher detection rate than laparotomy (100.0% vs. 77.1%, p<0.01). No factors significantly affected the sensitivity; however, the patients with ≥2-cm-diameter tumors (86.0% vs. 1.4%, p<0.01), NAC (19.4% vs. 2.2%, p<0.01), and those who underwent laparotomy (7.4% vs. 0%, p<0.01) had an unfavorable FN rate.
  
  
  CONCLUSIONS
  Among the examined tracers, (99m)Tc had the highest detection of SLN mapping in patients with uterine cervical cancer. Patients with local advanced cervical cancer with/without NAC treatment might be unsuited for SLN mapping. SLN mapping is feasible and results in an excellent detection rate in patients with <2-cm-diameter cervical cancer. Laparoscopic surgery is the best procedure for SLN detection in patients with early-stage disease.
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan.
authors.forename: Tomohito
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan. y-terai@osaka-med.ac.jp.
authors.forename: Yoshito
authors.identifier: http://orcid.org/0000-0001-8662-7426
authors.initials: Y
authors.lastname: Terai
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan.
authors.forename: Keisuke
authors.identifier: http://orcid.org/0000-0002-1885-4093
authors.initials: K
authors.lastname: Ashihara
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan.
authors.forename: Satoshi
authors.identifier: http://orcid.org/0000-0002-1931-9498
authors.initials: S
authors.lastname: Tsunetoh
authors.affiliation: Department of Radiology, Osaka Medical College, Osaka, Japan.
authors.forename: Hiroyuki
authors.identifier: http://orcid.org/0000-0002-8174-6191
authors.initials: H
authors.lastname: Akagi
authors.affiliation: Department of Pathology, Osaka Medical College, Osaka, Japan.
authors.forename: Takashi
authors.identifier: http://orcid.org/0000-0003-1797-3880
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Ohmichi
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D010535:Laparoscopy; D008875:Middle Aged; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D017556:Technetium Compounds; D017971:Tin Compounds; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery
chemical_list: D004396:Coloring Agents; D019275:Radiopharmaceuticals; D017556:Technetium Compounds; D017971:Tin Compounds; C033493:technetium Tc 99m tin colloid; D007208:Indocyanine Green
keywords: Cervical Cancer; Laparoscopic Surgery; Lymph Node Metastasis; Pelvic Lymph Node; Sentinel Lymph Node