Robotically assisted fluorescence-guided lymph node mapping with ICG for gynecologic malignancies: A feasibility study

• Published in: Gynecologic oncology Vol. 124; no. 1; pp. 78 - 82
• Main Authors: Rossi, Emma C., Ivanova, Anastasia, Boggess, John F.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2012
• Subjects: Adult; Aged; Aged, 80 and over; Coloring Agents; Endometrial Neoplasms - diagnosis; Endometrial Neoplasms - pathology; Feasibility Studies; Female; Fluorescence imaging; Hematology, Oncology and Palliative Medicine; Humans; Indocyanine Green; Lymph Nodes - pathology; Lymphatic Metastasis; Middle Aged; Obstetrics and Gynecology; Prospective Studies; Robotic; Robotics - methods; Sentinel Lymph Node Biopsy - methods; Sentinel lymph nodes; Spectroscopy, Near-Infrared - methods; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - pathology; Robotic; Sentinel lymph nodes; Fluorescence imaging
• ISSN: 0090-8258; 1095-6859; 1095-6859
• DOI: 10.1016/j.ygyno.2011.09.025

Traditional techniques of sentinel lymph node (SLN) mapping for endometrial and cervical cancer present challenges which may be overcome with newer technologies such as near infrared (NIR) imaging of the fluorescent dye Indocyanine green (ICG). We performed a feasibility and dose-finding study to define the dose of ICG required to identify pelvic and para-aortic sentinel lymph nodes with robotically assisted endoscopic NIR imaging after cervical injection. 20 subjects with cervical or endometrial carcinoma were prospectively enrolled for SLN mapping. ICG was injected into the cervical stroma at 3 o'clock and 9 o'clock Data was collected for the number of nodes identified, the location of SLN's, the duration of procedure and the pathology characteristics of the SLN's compared to the non-sentinel lymph nodes. 20 subjects received cervical injection with at least one SLN observed in 17 subjects. 15 of the 17 subjects who received 1mg injections of ICG mapped a SLN for an observed detection rate of 88% (95% CI is (64%,99%)). A median of 4.5 SLN's was identified per patient. Three patients had lymphatic metastases, one of whom had a positive SLN. No adverse events were identified. A 1mg cervical injection of ICG identified a SLN in 88% of patients (95% CI is (64%, 99%)). Robotically assisted fluorescence imaging is a feasible, safe, time efficient and reliable method for lymphatic mapping in early stage cervical and endometrial cancer. ► This study evaluates a novel technique for robotic lymph node mapping with near infrared imaging. ► A 1mg cervical Indocyanine green injection revealed a fluorescent sentinel lymph node in 88% of patients. ► Operating room times were not increased and no adverse events occurred.