A Prospective Cohort Study Comparing Colorimetric and Fluorescent Imaging for Sentinel Lymph Node Mapping in Endometrial Cancer

• Published in: Annals of surgical oncology Vol. 24; no. 7; pp. 1972 - 1979
• Main Authors: Holloway, Robert W., Ahmad, Sarfraz, Kendrick, James E., Bigsby, Glenn E., Brudie, Lorna A., Ghurani, Giselle B., Stavitzski, Nicole M., Gise, Jasmine L., Ingersoll, Susan B., Pepe, Julie W.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.07.2017; Springer Nature B.V
• Subjects: Adenocarcinoma, Clear Cell - diagnostic imaging; Adenocarcinoma, Clear Cell - pathology; Adenocarcinoma, Clear Cell - surgery; Aged; Aorta; Biopsy; Body mass; Body mass index; Cancer; Carcinoma, Papillary - diagnostic imaging; Carcinoma, Papillary - pathology; Carcinoma, Papillary - surgery; Cohort analysis; Colorimetry; Colorimetry - methods; Coloring Agents; Cystadenocarcinoma, Serous - diagnostic imaging; Cystadenocarcinoma, Serous - pathology; Cystadenocarcinoma, Serous - surgery; Dyes; Endometrial cancer; Endometrial Neoplasms - diagnostic imaging; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Endometrium; Female; Fluorescence; Follow-Up Studies; Gynecologic Oncology; Health risk assessment; Humans; Hysterectomy; I.R. radiation; Indocyanine Green; Lymph; Lymph Nodes; Lymphatic system; Male; Mapping; Medicine; Medicine & Public Health; Metastases; Metastasis; Molecular Imaging - methods; Oncology; Pelvis; Prognosis; Prospective Studies; Sentinel Lymph Node - diagnostic imaging; Sentinel Lymph Node - pathology; Sentinel Lymph Node - surgery; Sentinel Lymph Node Biopsy; Surgery; Surgical Oncology; Tumor cells; Sentinel Lymph Node; Endometrial Cancer; National Comprehensive Cancer Network; Sentinel Lymph Node Mapping; Isolate Tumor Cell
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-017-5825-3

Background This prospective cohort study aimed to assess sentinel lymph node (SLN) mapping using isosulfan blue (ISB) compared with ISB plus indocyanine green (ICG) and near-infrared imaging (NIR) for patients with endometrial cancer. Methods In this study, 200 patients with endometrial cancer underwent SLN assessments and were randomized to ISB + ICG ( n  = 180) or ISB alone ( n  = 20). Blue dye determinations were recorded for all 200 cases followed by NIR imaging of ICG for 180 randomized subjects. All the patients underwent robotically assisted hysterectomy with pelvic ± aortic lymphadenectomy. Results The mean age of the patients was 64.5 ± 8.4 years, and the mean body mass index (BMI) was 33 ± 7.6 kg/m 2 . The histologies were endometrioid G1 (43%), G2 (30%), G3 (7%), and type 2 (20%). The mean time from dye injection to initiation of mapping was 13.4 ± 6.2 min, and the time to removal of SLN was 17.4 ± 11.2 min. Detection of SLN for the 20 ISB control cases did not differ from that for the 180 ISB + ICG cases ( p  > 0.05). The rates of SLN detection for ISB + ICG/NIR ( n  = 180) versus ISB ( n  = 200) were as follows: bilateral (83.9 vs. 40%), unilateral (12.2 vs. 36%), and none (3.9 vs. 24%) ( p  < 0.001). The median SLN per case was 2 (range 0–4). Positive SLNs were found in 21.1% ( n  = 38) of the ISB + ICG cases compared with 13.5% ( n  = 27) of the ISB cases ( p  = 0.056). The false-negative rate for SLN biopsy was 2.5% (95% confidence interval, 0.1–14.7%). In 61% (25/41) of the node-positive cases, SLN was the only positive lymph node (LN). Isolated tumor cells were found in 39.5% (15/38) of the SLN metastasis cases compared with 26.7% (4/15) of the non-SLN metastasis cases ( p  = 0.528). Conclusions In this prospective study, ISB + ICG and NIR detected more SLNs and more LN metastases than ISB alone. Assessment of SLN with ICG + ISB/NIR imaging had excellent sensitivity for detection of metastasis and no safety issues.