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van Oosterom MN, Diaz-Feijóo B, Santisteban MI, Sánchez-Izquierdo N, Perissinotti A, Glickman A, Marina T, Torné A, van Leeuwen FWB, Vidal-Sicart S. Steerable DROP-IN radioguidance during minimal-invasive non-robotic cervical and endometrial sentinel lymph node surgery. Eur J Nucl Med Mol Imaging 2024; 51:3089-3097. [PMID: 38233608 PMCID: PMC11300633 DOI: 10.1007/s00259-023-06589-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE The recently introduced tethered DROP-IN gamma probe has revolutionized the way robotic radioguided surgery is performed, fully exploiting the nature of steerable robotic instruments. Given this success, the current first-in-human study investigates if the DROP-IN can also provide benefit in combination with steerable non-robotic instruments during conventional laparoscopic surgery, showing equivalence or even benefit over a traditional rigid gamma probe. METHODS The evaluation was performed in ten patients during laparoscopic cervical (n = 4) and endometrial (n = 6) cancer sentinel lymph node (SLN) procedures. Surgical guidance was provided using the hybrid, or bi-modal, SLN tracer ICG-99mTc-nanocolloid. SLN detection was compared between the traditional rigid laparoscopic gamma probe, the combination of a DROP-IN gamma probe and a steerable laparoscopic instrument (LaproFlex), and fluorescence imaging. RESULTS The gynecologists experienced an enlarged freedom of movement when using the DROP-IN + LaproFlex combination compared to the rigid laparoscopic probe, making it possible to better isolate the SLN signal from background signals. This did not translate into a change in the SLN find rate yet. In both cervical and endometrial cancer combined, the rigid probe and DROP-IN + LaproFlex combination provided an equivalent detection rate of 96%, while fluorescence provided 85%. CONCLUSION We have successfully demonstrated the in-human use of steerable DROP-IN radioguidance during laparoscopic cervical and endometrial cancer SLN procedures, expanding the utility beyond robotic procedures. Indicating an improved surgical experience, these findings encourage further investigation and consideration on a path towards routine clinical practice and improved patient outcome. TRIAL REGISTRATION HCB/2021/0777 and NCT04492995; https://clinicaltrials.gov/study/NCT04492995.
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Affiliation(s)
- Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Berta Diaz-Feijóo
- Gynecology Oncology Unit, Institute Clínic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Maria Isabel Santisteban
- Nuclear Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain
- Nuclear Medicine Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Núria Sánchez-Izquierdo
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Nuclear Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Andrés Perissinotti
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Nuclear Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Ariel Glickman
- Gynecology Oncology Unit, Institute Clínic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Tiermes Marina
- Gynecology Oncology Unit, Institute Clínic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Aureli Torné
- Gynecology Oncology Unit, Institute Clínic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sergi Vidal-Sicart
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Nuclear Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain
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Fan MS, Qiu KX, Wang DY, Wang H, Zhang WW, Yan L. Risk factors associated with false negative rate of sentinel lymph node biopsy in endometrial cancer: a systematic review and meta-analysis. Front Oncol 2024; 14:1391267. [PMID: 38634055 PMCID: PMC11021692 DOI: 10.3389/fonc.2024.1391267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Objective Currently, sentinel lymph node biopsy (SLNB) is increasingly used in endometrial cancer, but the rate of missed metastatic lymph nodes compared to systemic lymph node dissection has been a concern. We conducted a systematic review and meta-analysis to evaluate the false negative rate (FNR) of SLNB in patients with endometrial cancer and to explore the risk factors associated with this FNR. Data sources Three databases (PubMed, Embase, Web of Science) were searched from initial database build to January 2023 by two independent reviewers. Research eligibility criteria Studies were included if they included 10 or more women diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage I or higher endometrial cancer, the study technique used sentinel lymph node localization biopsy, and the reported outcome metrics included false negative and/or FNR. Study appraisal and synthesis methods Two authors independently reviewed the abstracts and full articles. The FNR and factors associated with FNR were synthesized through random-effects meta-analyses and meta-regression. The results We identified 62 eligible studies. The overall FNR for the 62 articles was 4% (95% CL 3-5).There was no significant difference in the FNR in patients with high-risk endometrial cancer compared to patients with low-risk endometrial cancer. There was no difference in the FNR for whether frozen sections were used intraoperatively. The type of dye used intraoperatively (indocyanine green/blue dye) were not significantly associated with the false negative rate. Cervical injection reduced the FNR compared with alternative injection techniques. Indocyanine green reduced the FNR compared with alternative Tc-99m. Postoperative pathologic ultrastaging reduced the FNR. Conclusions Alternative injection techniques (other than the cervix), Tc-99m dye tracer, and the absence of postoperative pathologic ultrastaging are risk factors for a high FNR in endometrial cancer patients who undergo SLNB; therefore, we should be vigilant for missed diagnosis of metastatic lymph nodes after SLNB in such populations. Systematic review registration http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023433637.
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Affiliation(s)
- Meng-si Fan
- Department of Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong Second Medical University, Key Laboratory of Laparoscopic Technology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Ke-xin Qiu
- Department of Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong Second Medical University, Key Laboratory of Laparoscopic Technology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Dong-yue Wang
- School of Clinical Medicine, Shandong First Medical University, Jinan, China
| | - Hao Wang
- School of Clinical Medicine, Shandong First Medical University, Jinan, China
| | - Wei-wei Zhang
- Department of Gynecology, Tengzhou Maternal and Child Health Hospital, Tengzhou, Shandong, China
| | - Li Yan
- Department of Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong Second Medical University, Key Laboratory of Laparoscopic Technology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- Department of Gynecology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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Xu JY, Yu TX, Guan XM, Ding B, Ren ML, Shen Y. Long-term outcomes of vulvar or vaginal cancer patients undergoing laparoendoscopic single-site inguinal lymphadenectomy. J Minim Access Surg 2024; 20:180-186. [PMID: 37706409 PMCID: PMC11095814 DOI: 10.4103/jmas.jmas_268_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/28/2023] [Accepted: 04/04/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Laparoendoscopic single-site inguinal lymphadenectomy (LESS-IL), a minimally invasive technique, has been reported in patients with vulvar or vaginal cancer regarding its safety and feasibility. However, the long-term outcomes, especially oncologic outcomes, are still lacking. We aimed to evaluate the long-term outcomes of LESS-IL to confirm its safety further. PATIENTS AND METHODS Data were prospectively collected from patients with vulvar or vaginal cancer who underwent LESS-IL at our institution between July 2018 and June 2021. The patients were followed up for at least 12 months. All procedures were performed according to treatment standards. Short- and long-term complications and oncologic outcomes were analysed. RESULTS A total of 16 patients undergoing 28 LESS-IL procedures were identified, amongst whom 4 underwent unilateral LESS-IL. The median numbers of excised groin lymph nodes were 9.0 (6.5-11.8) and 10.5 (8.3-12.0) in each left and right groin, respectively. Short-term complications occurred in 4 (25%) patients, including 18.7% lymphocele and 6.3% wound infection. Long-term complications regarding lower-limb lymphoedema appeared in 6 (37.5%) patients. Most short- and long-term complications were Clavien-Dindo 1 or 2, accounting for 90% of all post-operative issues. After a median follow-up of 27 (21.3-35.8) months, only 1 (6.3%) patient had isolated inguinal recurrence at 13 months postoperatively. No local or distant recurrence occurred. CONCLUSION Our results suggest that LESS-IL is associated with little incidence of complications and promising oncologic outcomes, further demonstrating the safety and feasibility of the LESS-IL technique in patients requiring IL.
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Affiliation(s)
- Jing-Yun Xu
- Department of Obstetrics and Gynecology, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China
| | - Tian-Xiang Yu
- Department of Obstetrics and Gynecology, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Xiao-Ming Guan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Bo Ding
- Department of Obstetrics and Gynecology, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China
| | - Mu-Lan Ren
- Department of Obstetrics and Gynecology, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China
| | - Yang Shen
- Department of Obstetrics and Gynecology, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China
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Puppo A, Migliaretti G, Landoni F, Uccella S, Camanni M, Ceccaroni M, Delpiano EM, Mantovani G, Roviglione G, Bianchi T, Grassi T, Maggi V, Garzon S, Galli L, Calandra V, Olearo E. SUrgical Access and Pattern of Recurrence of Endometrial Cancer: The SUPeR Study, a Multicenter Retrospective Observational Study. J Minim Invasive Gynecol 2024; 31:321-329. [PMID: 38301845 DOI: 10.1016/j.jmig.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/27/2023] [Accepted: 01/26/2024] [Indexed: 02/03/2024]
Abstract
STUDY OBJECTIVE To evaluate recurrence rate and pattern in apparently early-stage endometrial cancer (EC) treated with minimally invasive surgery (MIS) and compare it to the "historical" populations treated by laparotomy. Secondary outcomes were to establish if, among MIS recurrent patients, intermediate-high/high-risk patients presented the same recurrence pattern compared to those at low/intermediate-risk and to evaluate time to first recurrence (TTR) of the study population. DESIGN Multicenter retrospective observational study. SETTING Five Italian Gynecologic Oncology referral centers. PATIENTS All patients with proven recurrence of apparently early-stage EC treated with MIS from January 2017 to June 2022 . The laparotomic historical cohort was obtained from Laparoscopy Compared With Laparotomy for Comprehensive Surgical Staging of Uterine Cancer: Gynecologic Oncology Group Study (LAP2) and Laparoscopic Approach to Cancer of the Endometrium trials. INTERVENTIONS Evaluation of recurrence rate and pattern. MEASUREMENTS AND MAIN RESULTS Seventy-seven recurrences occurred on the total of 1028 patients treated with MIS for apparently early-stage EC during a median follow-up time of 36 months. The rate of recurrence in our cohort did not differ significantly from the rate of the historical cohort (7.4% vs 7.9%, odds ratio 0.9395, 95% CI 0.6901-1.2792). No significant differences were noticed for local, abdominal, nodal, and multiple site recurrence patterns; distant site recurrence appeared more likely in patients from the historical cohort. Postoperative low/intermediate risk patients had a higher likelihood of local recurrence compared to intermediate-high/high risk patients. Mean TTR was 19 months. No significant difference of TTR was observed for each pattern of recurrence compared to others. CONCLUSION MIS appears to be safe for the treatment of early-stage EC. We did not identify any recurrence pattern specifically associated with MIS in early-stage EC.
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Affiliation(s)
- Andrea Puppo
- Department of Obstetrics and Gynecology Ospedale Santa Croce e Carle Cuneo (Drs. Puppo, Galli, Calandra, and Olearo)
| | - Giuseppe Migliaretti
- Department of Public Health and Pediatric Sciences, Università of Turin (Dr. Migliaretti)
| | - Fabio Landoni
- Department of Medicine and Surgery, University of Milan Bicocca (Drs. Landoni and Bianchi), Milan, Italy; Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori (Drs. Landoni, Bianchi, and Grassi), Monza, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona (Drs. Uccella, Maggi, Garzon, Galli, and Calandra)
| | - Marco Camanni
- Department of Obstetrics and Gynecology, Ospedale Martini, Azienda Sanitaria Locale Citta' di Torino (Drs. Camanni and Delpiano)
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital (Drs. Ceccaroni, Mantovani, and Roviglione), Negrar, Verona
| | - Elena M Delpiano
- Department of Obstetrics and Gynecology, Ospedale Martini, Azienda Sanitaria Locale Citta' di Torino (Drs. Camanni and Delpiano)
| | - Giulia Mantovani
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital (Drs. Ceccaroni, Mantovani, and Roviglione), Negrar, Verona
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital (Drs. Ceccaroni, Mantovani, and Roviglione), Negrar, Verona
| | - Tommaso Bianchi
- Department of Medicine and Surgery, University of Milan Bicocca (Drs. Landoni and Bianchi), Milan, Italy; Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori (Drs. Landoni, Bianchi, and Grassi), Monza, Italy
| | - Tommaso Grassi
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori (Drs. Landoni, Bianchi, and Grassi), Monza, Italy
| | - Veronica Maggi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona (Drs. Uccella, Maggi, Garzon, Galli, and Calandra)
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona (Drs. Uccella, Maggi, Garzon, Galli, and Calandra)
| | - Liliana Galli
- Department of Obstetrics and Gynecology Ospedale Santa Croce e Carle Cuneo (Drs. Puppo, Galli, Calandra, and Olearo); Department of Obstetrics and Gynecology, AOUI Verona, University of Verona (Drs. Uccella, Maggi, Garzon, Galli, and Calandra)
| | - Valerio Calandra
- Department of Obstetrics and Gynecology Ospedale Santa Croce e Carle Cuneo (Drs. Puppo, Galli, Calandra, and Olearo); Department of Obstetrics and Gynecology, AOUI Verona, University of Verona (Drs. Uccella, Maggi, Garzon, Galli, and Calandra)
| | - Elena Olearo
- Department of Obstetrics and Gynecology Ospedale Santa Croce e Carle Cuneo (Drs. Puppo, Galli, Calandra, and Olearo).
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Margioula-Siarkou C, Almperis A, Gullo G, Almperi EA, Margioula-Siarkou G, Nixarlidou E, Mponiou K, Papakotoulas P, Sardeli C, Guyon F, Dinas K, Petousis S. Sentinel Lymph Node Staging in Early-Stage Cervical Cancer: A Comprehensive Review. J Clin Med 2023; 13:27. [PMID: 38202034 PMCID: PMC10779478 DOI: 10.3390/jcm13010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/05/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Cervical cancer (CC) continues to be a significant global public health concern, even with preventive measures in place. In women with early-stage CC, the status of lymph nodes is of paramount importance, not only for the final prognosis but also for determining the best therapeutic strategy. According to main international guidelines, pelvic full lymphadenectomy (PLND) is recommended for lymph node staging. However, in these early stages of CC, sentinel lymph node biopsy (SLNB) has emerged as a precise technique for evaluating lymph node involvement, improving its morbidity profile. We performed a literature review through PubMed articles about progress on the application of SLNB in women with early-stage CC focusing on the comparison with PET/CT and PLND in terms of oncological outcomes and diagnostic accuracy. While the superiority of SLNB is clear compared to radiologic modalities, it demonstrates no clear oncologic inferiority over PLND, given the higher detection rate of positive lymph nodes and predominance of no lymph node recurrences. However, due to a lack of prospective evidence, particularly concerning long-term oncological safety, SLNB is not the current gold standard. With careful patient selection and adherence to straightforward protocols, a low false-negative rate can be ensured. The aim of the ongoing prospective trials is to address these issues.
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Affiliation(s)
- Chrysoula Margioula-Siarkou
- 2nd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Aristarchos Almperis
- 2nd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Giuseppe Gullo
- Department of Obstetrics and Gynaecology, University of Palermo, 90133 Palermo, Italy
| | - Emmanouela-Aliki Almperi
- 2nd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Georgia Margioula-Siarkou
- 2nd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Eleni Nixarlidou
- 2nd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Konstantina Mponiou
- Radiation Oncology Unit, Theageneio Anticancer Hospital, 546 39 Thessaloniki, Greece
| | - Pavlos Papakotoulas
- 1st Medical Oncology Unit, Theageneio Anticancer Hospital, 546 39 Thessaloniki, Greece
| | - Chrysanthi Sardeli
- Department of Pharmacology & Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Frederic Guyon
- Gynaecologic Oncology Unit, Institut Bergonie, 33000 Bordeaux, France
| | - Konstantinos Dinas
- 2nd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Stamatios Petousis
- 2nd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
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Rundle S, Korompelis P, Ralte A, Bewick D, Ratnavelu N. A comparison of ICG-NIR with blue dye and technetium for the detection of sentinel lymph nodes in vulvar cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:481-485. [PMID: 36207232 DOI: 10.1016/j.ejso.2022.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The sentinel lymph node (SLN) procedure for vulva cancer is a safe alternative to a radical inguino-femoral lymphadenectomy (IFLN) for small unifocal tumours. SLN evaluation through biopsy and ultra-staging has helped gynaecological oncology surgeons improve operative morbidity with no cost to oncologic safety. Established techniques for groin SLN detection and excision in vulvar cancer use 99mTc-nanocolloid radiotracer and blue dye (BD) for identification of the SLN. Indocyanine green (ICG)-near infrared (ICG-NIR) techniques for SLN mapping have proven utility in other gynaecological cancer sites and is gaining interest as a technique for SLN mapping in vulvar cancer METHODS: Fifty consecutive patients with unifocal vulvar squamous cell cancers of <40 mm lateral diameter and with depth of invasion > 1 mm underwent SLN mapping and excision using a combination of 99mTc-nanocolloid, BD and ICG. SLN detection results were recorded on a per-patient and per-groin basis. The success rates SLN for detection by individual tracer substance or combinations of tracer were determined by presence of one or more tracer, detectable in the SLN specimen. RESULTS 92% of patients had a successful SLN procedure. The per-groin detection rate was 84%. All successfully mapped SLN were identified with the combination of ICG-NIR and 99mTc-nanocolloid compared to 69% with BD 99mTc-nanocolloid. Success rates for the SLN procedure were not dependent on prior excision of the primary lesion or operator experience. CONCLUSIONS Incorporation of ICG-NIR into standard SLN mapping protocols may allow for the abandonment of routine use of BD and its poor side effect profile.
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Affiliation(s)
- Stuart Rundle
- Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Sherif Hill, Gateshead, Tyne and Wear, NE9 6SX, UK.
| | - Porfyrios Korompelis
- Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Sherif Hill, Gateshead, Tyne and Wear, NE9 6SX, UK.
| | - Angela Ralte
- Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Sherif Hill, Gateshead, Tyne and Wear, NE9 6SX, UK.
| | - Diane Bewick
- Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Sherif Hill, Gateshead, Tyne and Wear, NE9 6SX, UK.
| | - Nithya Ratnavelu
- Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Sherif Hill, Gateshead, Tyne and Wear, NE9 6SX, UK.
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Pedrão PG, Guimarães YM, Godoy LR, Possati-Resende JC, Bovo AC, Andrade CEMC, Longatto-Filho A, dos Reis R. Management of Early-Stage Vulvar Cancer. Cancers (Basel) 2022; 14:cancers14174184. [PMID: 36077719 PMCID: PMC9454625 DOI: 10.3390/cancers14174184] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Vulvar cancer is a rare gynecological malignancy that affects mainly postmenopausal women. Recently, however, an alarming increase in the rates among young women has been observed due to human papillomavirus infection. The standard treatment for vulvar cancer is surgery with or without radiotherapy as adjuvant treatment. In recent decades, sentinel lymph node biopsy has been included as part of the surgical treatment. Thus, our objective was to review and discuss the advances found in the literature about early-stage vulvar cancer. For this, we searched PubMed for publications in the English language. Relevant articles, such as the GROINS-V studies, and the GOG protocols, are presented in this review exhibiting the evolution of early-stage vulvar cancer treatment and the decrease in surgical morbidity rates. Abstract Vulvar cancer is a rare gynecological malignancy since it represents 4% of all cancers of the female genital tract. The most common histological type is squamous cell carcinoma (90%). This type can be classified into two clinicopathological subtypes according to the etiology. The first subtype is associated with persistent human papillomavirus infection and is usually diagnosed in younger women. The second subtype is associated with lichen sclerosus condition, and in most cases is diagnosed in postmenopausal women. Currently, an increase in first subtype cases has been observed, which raised the concern about associated mortality and treatment morbidity among young women. Vulvar cancer treatment depends on histopathology grade and staging, but surgery with or without radiotherapy as adjuvant treatment is considered the gold standard. In recent decades, sentinel lymph node biopsy has been incorporated as part of the treatment. Therefore, we sought to review and discuss the advances documented in the literature about vulvar cancer focusing on the treatment of early-stage disease. Relevant articles, such as the GROINS-V studies and the GOG protocols, are presented in this review. Additionally, we discuss key points such as the evolution of treatment from invasive surgery with high morbidity, to more conservative approaches without compromising oncologic safety; the role of sentinel lymph node mapping in the initial staging, since it reduces the complications caused by inguinofemoral lymphadenectomy; the recurrences rates, since local recurrence is common and curable, however, groin-associated, or distant recurrences have a poor prognosis; and, finally, the long-term follow-up that is essential for all patients.
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Affiliation(s)
- Priscila Grecca Pedrão
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
| | | | - Luani Rezende Godoy
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
| | | | - Adriane Cristina Bovo
- Department of Prevention Oncology, Barretos Cancer Hospital, Mato Grosso do Sul 79085-040, Brazil
| | - Carlos Eduardo Mattos Cunha Andrade
- Department of Gynecologic Oncology, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
- Barretos School of Health Sciences, Dr. Paulo Prata-FACISB, Barretos, São Paulo 14785-002, Brazil
| | - Adhemar Longatto-Filho
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
- Medical Laboratory of Medical Investigation (LIM) 14, Department of Pathology, Medical School, University of São Paulo, São Paulo 01246-903, Brazil
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
| | - Ricardo dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
- Correspondence: ; Tel.: +55-3321-6600 (ext. 7126)
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Koutroumpa I, Diakosavvas M, Sotiropoulou M, Pergialiotis V, Angelou K, Liontos M, Haidopoulos D, Bamias A, Rodolakis A, Thomakos N. Identification and Biopsy of Sentinel Lymph Node in Early-Stage Cervical Carcinoma: Diagnostic Accuracy and Clinical Utility. Cureus 2022; 14:e23838. [PMID: 35530888 PMCID: PMC9070105 DOI: 10.7759/cureus.23838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background Due to the subsequent complications of pelvic lymphadenectomy in patients with early-stage cervical cancer, the sentinel lymph node (SLN) technique has been increasingly employed. This study aimed to investigate the detectability of SLN using methylene blue and explore the diagnostic accuracy of SLN biopsy. Methodology A study was conducted from September 2015 to August 2018 and included 90 women with cervical cancer, FIGO (International Federation of Gynecology and Obstetrics-2009) stage IA1-IIA1. Methylene blue was injected intracervically. Any detected dyed nodes were sent for frozen section biopsy, followed by bilateral pelvic lymphadenectomy. The predictive ability of SLN was evaluated in statistical terms after comparison of intraoperative biopsy and final histopathology. Results The sensitivity, specificity, false-negative rate, positive predictive value, and negative predictive value (NPV) were 55.6%, 95.1%, 4.9%, 55.6%, and 95.1%, respectively. The SLN performance in patients with tumor size ≤2.2 cm, negative lymphovascular space involvement, and depth of stromal invasion ≤5 mm was superior (sensitivity 100%, specificity 93.5%, NPV 100%). Conclusions The SLN technique with blue dye alone is a feasible and adequate alternative to systematic lymphadenectomy in early-stage cervical cancer in selected patients, given that a strict algorithm is applied.
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Affiliation(s)
- Ioanna Koutroumpa
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Michail Diakosavvas
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Maria Sotiropoulou
- Department of Pathology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Vasilios Pergialiotis
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Kyveli Angelou
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Michalis Liontos
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitrios Haidopoulos
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Aristotelis Bamias
- 2nd Propaedeutic Department of Internal Medicine, Attikon Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Alexandros Rodolakis
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Nikolaos Thomakos
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
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9
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Sentinel Lymph Node Mapping in High-Grade Endometrial Cancer. Curr Oncol 2022; 29:1123-1135. [PMID: 35200595 PMCID: PMC8870608 DOI: 10.3390/curroncol29020096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 01/11/2023] Open
Abstract
Sentinel lymph node (SLN) mapping is becoming an acceptable alternative to full lymphadenectomy for evaluating lymphatic spread in clinical stage I endometrial cancer (EC). While the assessment of pelvic and para-aortic lymph nodes is part of the surgical staging of EC, there is a long-standing debate over the therapeutic value of full lymphadenectomy in this setting. Although lymphadenectomy offers critical information on lymphatic spread and prognosis, most patients will not derive oncologic benefit from this procedure as the majority of patients do not have lymph node involvement. SLN mapping offers prognostic information while simultaneously avoiding the morbidity associated with an extensive and often unnecessary lymphadenectomy. A key factor in the decision making when planning for EC surgery is the histologic subtype. Since the risk of lymphatic spread is less than 5% in low-grade EC, these patients might not benefit from lymph node assessment. Nonetheless, in high-grade EC, the risk for lymph node metastases is much higher (20–30%); therefore, it is crucial to determine the spread of disease both for determining prognosis and for tailoring the appropriate adjuvant treatment. Studies on the accuracy of SLN mapping in high-grade EC have shown a detection rate of over 90%. The available evidence supports adopting the SLN approach as an accurate method for surgical staging. However, there is a paucity of prospective data on the long-term oncologic outcome for patients undergoing SLN mapping in high-grade EC, and more trials are warranted to answer this question.
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10
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Restaino S, Buda A, Puppo A, Capozzi VA, Sozzi G, Casarin J, Gallitelli V, Murgia F, Vizzielli G, Baroni A, Corrado G, Pasciuto T, Ferrari D, Novelli A, Berretta R, Legge F, Vizza E, Chiantera V, Ghezzi F, Landoni F, Scambia G, Fanfani F. Anatomical distribution of sentinel lymph nodes in patients with endometrial cancer: a multicenter study. Int J Gynecol Cancer 2022; 32:517-524. [PMID: 35110375 DOI: 10.1136/ijgc-2021-003253] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Sentinel lymph node (SLN) mapping represents the standard approach in uterine confined endometrial cancer patients. The aim of this study was to evaluate the anatomical distribution of SLNs and the most frequent locations of nodal metastasis. METHODS This was an observational retrospective multicenter study involving eight high volume gynecologic cancer centers in Italy. We reviewed 1576 patients with a histologically confirmed diagnosis of endometrial cancer from September 2015 to June 2020. All patients underwent total hysterectomy with salpingo-ophorectomy and SLN mapping. RESULTS A total of 3105 SLNs were mapped and removed, 2809 (90.5%) of these were bilateral and 296 (9.5%) unilateral. The overall detection rate was 93.4% (77.9% bilateral and 15.5% unilateral). The majority of SLNs (80%) and positive SLNs (77.8%) were found at the external iliac and obturator level in both endometrioid and non-endometrioid endometrial cancer. Negative SLNs were more frequent in patients with endometrioid compared with non-endometrioid cancer (91.9% vs 86.1%, p<0.0001). Older patients, a higher body mass index, and non-endometrioid histology were more likely to have 'no mapping' (p<0.0001). Univariate and multivariate analysis showed that higher body mass index and age at surgery were independent predictive factors of empty node packet and fat tissue (p=0.029 and p<0.01, respectively). CONCLUSION The most frequent sites of SLNs and metastases were located in the pelvic area below the iliac vessel bifurcation. Our findings showed that older age, a higher body mass index, and non-endometrioid histology had a negative impact on mapping.
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Affiliation(s)
- Stefano Restaino
- Department of Obstetrics, Gynecology, and Pediatrics, Obstetrics and Gynecology Unit, Udine University Hospital, DAME, Udine, Italy
| | - Alessandro Buda
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.,Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | - Andrea Puppo
- Clinic of Obstetrics and Gynecology, Santa Croce e Carle Hospital, Cuneo, Italy
| | | | - Giulio Sozzi
- Department of Gynecologic Oncology, Università di Palermo, Palermo, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, University of Insubria, Women's and Children's Del Ponte Hospital, Varese, Italy
| | | | - Ferdinando Murgia
- Obstetrics and Gynecology Unit, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Giuseppe Vizzielli
- Department of Obstetrics, Gynecology, and Pediatrics, Obstetrics and Gynecology Unit, Udine University Hospital, DAME, Udine, Italy.,Department of Medicine, University of Udine, Gynecology and Obstetrics Clinic, Udine, Italy
| | | | | | - Tina Pasciuto
- Research Core Facilty Data Collection G-STeP, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Largo Agostino Gemelli 8, Rome, Italy
| | - Debora Ferrari
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Antonia Novelli
- Department of Gynaecology and Obstetrics, Regina Montis Regalis Hospital, Mondovì, Italy
| | - Roberto Berretta
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Legge
- Obstetrics and Gynecology Unit, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Enrico Vizza
- Department of Experimental Clinical Oncology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, Università di Palermo, Palermo, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Women's and Children's Del Ponte Hospital, Varese, Italy
| | - Fabio Landoni
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, University of Insubria, Women's and Children's Del Ponte Hospital, Varese, Italy.,UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Francesco Fanfani
- Department of Obstetrics and Gynecology, University of Insubria, Women's and Children's Del Ponte Hospital, Varese, Italy .,UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
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11
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Chargari C, Arbyn M, Leary A, Abu-Rustum NR, Basu P, Bray F, Chopra S, Nout R, Tanderup K, Viswanathan AN, Zacharopoulou C, Soria JC, Deutsch E, Gouy S, Morice P. Increasing global accessibility to high-level treatments for cervical cancers. Gynecol Oncol 2022; 164:231-241. [PMID: 34716024 PMCID: PMC9496636 DOI: 10.1016/j.ygyno.2021.10.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 01/03/2023]
Abstract
Human papillomaviruses (HPV)-related gynecological cancers are a major health care issue, and a leading cause of cancer death in low- and middle-income countries (LMIC). In 2020, the World Health Organization launched a program aimed at cervical cancer elimination, by screening and vaccination strategies. Offering the best possible care to women diagnosed with invasive cancer is a complementary objective. Treatment of cervical cancer as per modern standards is complex and multimodal, mainly relying on surgery, external-beam radiotherapy (+/-chemotherapy) and brachytherapy. In parallel with the pivotal role of multidisciplinary discussion, international societies provide guidance to define the most effective and least toxic anti-cancer strategy, homogenize treatment protocols and provide benchmark quality indicators as a basis for accreditation processes. The challenge is to offer the appropriate diagnostic workup and treatment upfront and to avoid non- evidence-based treatment that consumes resources, impairs quality of life (QoL), and compromises oncological outcome. Various strategies may be applied for improving treatment quality: development of surgical mentorship, companion-training programs and international cooperation. The lack of radiotherapy/brachytherapy facilities is a major concern in LMIC. Reinforcing international support in terms of education, training, research and development and technical cooperation with national projects is required to increase access to minimum requirements but also introduce modern techniques, upgrade radiotherapy/brachytherapy services, and expand access to modern systemic treatments. In countries with robust economies, compliance to standards should also be increased. Integrative cancer care and multidisciplinary approaches are needed to tackle the dual challenge of increasing cure rates while minimizing QoL impairment. Appropriate dimensioning of the resources to avoid harmful treatment delays and access to expert referral centers is also a priority.
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Affiliation(s)
- C Chargari
- Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France; Inserm U-1030, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
| | - M Arbyn
- Unit Cancer Epidemiology - Belgian Cancer Centre, Brussels, Belgium
| | - A Leary
- Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - N R Abu-Rustum
- Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, United States; European Society of Gynecological Oncology, Geneva, Switzerland
| | - P Basu
- Early Detection, Prevention & Infection Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - F Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, UK
| | - S Chopra
- Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, Homi Bhabha National Institute, Maharashtra, India
| | - R Nout
- Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - K Tanderup
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - A N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, MD, United States
| | - C Zacharopoulou
- European Parliament, Committee on the Environment, Public Health and Food Safety, France
| | - J C Soria
- Governance, Gustave Roussy Cancer Campus, Villejuif, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - E Deutsch
- Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France; Inserm U-1030, Université Paris-Saclay, Le Kremlin-Bicêtre, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - S Gouy
- Inserm U-1030, Université Paris-Saclay, Le Kremlin-Bicêtre, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France; Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - P Morice
- Inserm U-1030, Université Paris-Saclay, Le Kremlin-Bicêtre, France; European Society of Gynecological Oncology, Geneva, Switzerland; Université Paris-Saclay, Le Kremlin-Bicêtre, France; Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
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12
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Giannini A, D'Oria O, Chiofalo B, Bruno V, Baiocco E, Mancini E, Mancari R, Vincenzoni C, Cutillo G, Vizza E. The giant steps in surgical downsizing toward a personalized treatment of vulvar cancer. J Obstet Gynaecol Res 2021; 48:533-540. [PMID: 34962334 PMCID: PMC9302990 DOI: 10.1111/jog.15103] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/15/2021] [Accepted: 11/07/2021] [Indexed: 12/01/2022]
Abstract
The present article aims to highlight the importance of changes of personalized surgical treatment for vulvar cancer. Current international literature regarding surgical treatment of vulvar cancer was evaluated. This included several studies and systematic reviews. Radical surgery approach, such as en bloc resection, was the first therapeutic option and the standard care for many years, even if burdened with a high complication rate and frequently disfiguring. Taussing and Way introduced radical vulvectomy approach with en bloc bilateral inguinal-femoral lymphadenectomy; modified radical vulvectomy was developed, with a wide radical excision of the primary tumor. The role of inguinofemoral lymphadenectomy (mono or bilateral) changed in the years too, particularly with the advent of SLN biopsy as minimally invasive surgical approach for lymph node staging, in patients with unifocal cancer <4 cm, without suspicious groin nodes. More personalized and conservative surgical approach, consisting of wide local or wide radical excisions, is necessary to reduce complications as lymphedema or sexual disfunction. The optimal surgical management of vulvar cancer needs to consider dimensions, staging, depth of invasion, presence of carcinoma at the surgical margins of resection and grading, with the goal of making the treatment as individualized as possible.
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Affiliation(s)
- Andrea Giannini
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy.,Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in "Translational Medicine and Oncology", Sapienza University, Rome, Italy
| | - Ottavia D'Oria
- Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in "Translational Medicine and Oncology", Sapienza University, Rome, Italy
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
| | - Valentina Bruno
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
| | - Ermelinda Baiocco
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
| | - Emanuela Mancini
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
| | - Rosanna Mancari
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
| | - Cristina Vincenzoni
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
| | - Giuseppe Cutillo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
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13
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Nagar H, Wietek N, Goodall RJ, Hughes W, Schmidt-Hansen M, Morrison J. Sentinel node biopsy for diagnosis of lymph node involvement in endometrial cancer. Cochrane Database Syst Rev 2021; 6:CD013021. [PMID: 34106467 PMCID: PMC8189170 DOI: 10.1002/14651858.cd013021.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pelvic lymphadenectomy provides prognostic information for those diagnosed with endometrial (womb) cancer and provides information that may influence decisions regarding adjuvant treatment. However, studies have not shown a therapeutic benefit, and lymphadenectomy causes significant morbidity. The technique of sentinel lymph node biopsy (SLNB), allows the first draining node from a cancer to be identified and examined histologically for involvement with cancer cells. SLNB is commonly used in other cancers, including breast and vulval cancer. Different tracers, including colloid labelled with radioactive technetium-99, blue dyes, e.g. patent or methylene blue, and near infra-red fluorescent dyes, e.g. indocyanine green (ICG), have been used singly or in combination for detection of sentinel lymph nodes (SLN). OBJECTIVES To assess the diagnostic accuracy of sentinel lymph node biopsy (SLNB) in the identification of pelvic lymph node involvement in women with endometrial cancer, presumed to be at an early stage prior to surgery, including consideration of the detection rate. SEARCH METHODS We searched MEDLINE (1946 to July 2019), Embase (1974 to July 2019) and the relevant Cochrane trial registers. SELECTION CRITERIA We included studies that evaluated the diagnostic accuracy of tracers for SLN assessment (involving the identification of a SLN plus histological examination) against a reference standard of histological examination of removed pelvic +/- para-aortic lymph nodes following systematic pelvic +/- para-aortic lymphadenectomy (PLND/PPALND) in women with endometrial cancer, where there were sufficient data for the construction of two-by-two tables. DATA COLLECTION AND ANALYSIS Two review authors (a combination of HN, JM, NW, RG, and WH) independently screened titles and abstracts for relevance, classified studies for inclusion/exclusion and extracted data. We assessed the methodological quality of studies using the QUADAS-2 tool. We calculated the detection rate as the arithmetic mean of the total number of SLNs detected out of the total number of women included in the included studies with the woman as the unit of analysis, used univariate meta-analytical methods to estimate pooled sensitivity estimates, and summarised the results using GRADE. MAIN RESULTS The search revealed 6259 unique records after removal of duplicates. After screening 232 studies in full text, we found 73 potentially includable records (for 52 studies), although we were only able to extract 2x2 table data for 33 studies, including 2237 women (46 records) for inclusion in the review, despite writing to trial authors for additional information. We found 11 studies that analysed results for blue dye alone, four studies for technetium-99m alone, 12 studies that used a combination of blue dye and technetium-99m, nine studies that used indocyanine green (ICG) and near infra-red immunofluorescence, and one study that used a combination of ICG and technetium-99m. Overall, the methodological reporting in most of the studies was poor, which resulted in a very large proportion of 'unclear risk of bias' ratings. Overall, the mean SLN detection rate was 86.9% (95% CI 82.9% to 90.8%; 2237 women; 33 studies; moderate-certainty evidence). In studies that reported bilateral detection the mean rate was 65.4% (95% CI 57.8% to 73.0%) . When considered according to which tracer was used, the SLN detection rate ranged from 77.8% (95% CI 70.0% to 85.6%) for blue dye alone (559 women; 11 studies; low-certainty evidence) to 100% for ICG and technetium-99m (32 women; 1 study; very low-certainty evidence). The rates of positive lymph nodes ranged from 5.2% to 34.4% with a mean of 20.1% (95% CI 17.7% to 22.3%). The pooled sensitivity of SLNB was 91.8% (95% CI 86.5% to 95.1%; total 2237 women, of whom 409 had SLN involvement; moderate-certainty evidence). The sensitivity for of SLNB for the different tracers were: blue dye alone 95.2% (95% CI 77.2% to 99.2%; 559 women; 11 studies; low-certainty evidence); Technetium-99m alone 90.5% (95% CI 67.7% to 97.7%; 257 women; 4 studies; low-certainty evidence); technetium-99m and blue dye 91.9% (95% CI 74.4% to 97.8%; 548 women; 12 studies; low-certainty evidence); ICG alone 92.5% (95% CI 81.8% to 97.1%; 953 women; 9 studies; moderate-certainty evidence); ICG and blue dye 90.5% (95% CI 63.2.6% to 98.1%; 215 women; 2 studies; low-certainty evidence); and ICG and technetium-99m 100% (95% CI 63% to 100%; 32 women; 1 study; very low-certainty evidence). Meta-regression analyses found that the sensitivities did not differ between the different tracers used, between studies with a majority of women with FIGO stage 1A versus 1B or above; between studies assessing the pelvic lymph node basin alone versus the pelvic and para-aortic lymph node basin; or between studies that used subserosal alone versus subserosal and cervical injection. It should be noted that a false-positive result cannot occur, as the histological examination of the SLN is unchanged by the results from any additional nodes removed at systematic lymphadenectomy. AUTHORS' CONCLUSIONS The diagnostic test accuracy for SLNB using either ICG alone or a combination of a dye (blue or ICG) and technetium-99m is probably good, with high sensitivity, where a SLN could be detected. Detection rates with ICG or a combination of dye (ICG or blue) and technetium-99m may be higher. The value of a SLNB approach in a treatment pathway, over adjuvant treatment decisions based on uterine factors and molecular profiling, requires examination in a high-quality intervention study.
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Affiliation(s)
- Hans Nagar
- Belfast Health and Social Care Trust, Belfast City Hospital and the Royal Maternity Hospital, Belfast, UK
| | - Nina Wietek
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Richard J Goodall
- Department of Surgery and Cancer , Imperial College London, London, UK
| | - Will Hughes
- Department of Plastic Surgery, Addenbrookes Hospital, Cambridge, UK
| | - Mia Schmidt-Hansen
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Jo Morrison
- Department of Gynaecological Oncology, GRACE Centre, Musgrove Park Hospital, Taunton, UK
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14
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Höhn AK, Brambs CE, Erber R, Hiller GGR, Mayr D, Schmidt D, Schmoeckel E, Horn LC. [Reporting and handling of lymphonodectomy specimens in gynecologic malignancies and sentinel lymph nodes]. DER PATHOLOGE 2021; 42:319-327. [PMID: 32700061 PMCID: PMC8084808 DOI: 10.1007/s00292-020-00805-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Die Aufarbeitung von Lymphonodektomiepräparaten gynäkologischer Malignome orientiert sich an den nationalen AWMF-Leitlinien und internationalen Empfehlungen. Die Definition von Mikrometastasen und isolierten Tumorzellen entspricht den Festlegungen der UICC(Union Internationale Contre le Cancer)/TNM(TNM-Klassifikation maligner Tumoren). Deren Nachweis soll im Befundbericht erwähnt werden sowie in die Tumorklassifikation einfließen. Alle übersandten Lymphknoten (LK) sollen untersucht werden mit vollständiger Einbettung aller LK bis 0,3 cm und Lamellierung aller größeren Lymphknoten parallel zu ihrer kurzen Achse in ca. 0,2 cm dicken Scheiben. Bestandteile des histologischen Befundberichtes sind: Zahl der befallenen LK im Verhältnis zur Zahl der entfernten/untersuchten LK entsprechend der Entnahmelokalisationen, metrische Ausdehnung der größten LK-Metastase, Fehlen/Nachweis einer extrakapsulären Ausbreitung. Zuschnitt und Einbettung von Sentinel-LK mit oder ohne Schnellschnittuntersuchung erfolgt in Analogie zu Nicht-Sentinel-LK mit Anfertigung von ca. 3 HE-gefärbten Stufenschnitten in einem Abstand von ca. 200 µm sowohl vom Gefrier- als auch Paraffinblock. Stellen sich die Sentinel-LK in der HE-Färbung negativ dar, soll ein immunhistochemisches Ultrastaging erfolgen.
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Affiliation(s)
- Anne Kathrin Höhn
- Institut für Pathologie, Arbeitsgruppe Mamma‑, Gynäko- & Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland.
| | - Christine E Brambs
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München, Deutschland
| | - Ramona Erber
- Pathologisches Institut, Universitätsklinikum Erlangen, Comprehensive Cancer Center EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Grit Gesine Ruth Hiller
- Institut für Pathologie, Arbeitsgruppe Mamma‑, Gynäko- & Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland
| | - Doris Mayr
- Pathologisches Institut, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Dietmar Schmidt
- MVZ für Histologie, Zytologie und Molekulare Diagnostik Trier, Trier, Deutschland
| | - Elisa Schmoeckel
- Pathologisches Institut, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Lars-Christian Horn
- Institut für Pathologie, Arbeitsgruppe Mamma‑, Gynäko- & Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland
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Siegenthaler F, Imboden S, Knabben L, Mohr S, Papadia A, Mueller MD. Exploratory Study of the Clinical Value of Near-Infrared Sentinel Lymph Node Mapping With Indocyanine Green in Vulvar Cancer Patients. Front Oncol 2021; 11:652458. [PMID: 33968754 PMCID: PMC8100341 DOI: 10.3389/fonc.2021.652458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background This study aimed to evaluate the clinical value of indocyanine green sentinel lymph node (SLN) mapping in patients with vulvar cancer. The conventional procedure of SLN mapping in vulvar cancer includes peritumoral injection of technetium-99m nanocolloid before surgery and intraoperative injection of a blue dye. However, these techniques harbor some limitations. Near-infrared fluorescence imaging with indocyanine green has gained popularity in SLN mapping in different types of cancer. Methods We analyzed retrospectively vulvar cancer patients at our institution between 2013 and 2020 undergoing indocyanine green SLN mapping by applying video telescope operating microscope system technology. Results 64 groins of 34 patients were analyzed. In 53 groins we used technetium-99m nanocolloid, in four patent blue, and in five both techniques, additionally to indocyanine green for SLN detection. In total, 120 SLNs were identified and removed. The SLN detection rate of indocyanine green was comparable to technetium-99m nanocolloid (p=.143) and higher than patent blue (p=.003). The best results were achieved using a combination of ICG and technetium-99m nanocolloid (detection rate of 96.9%). SLN detection rates of indocyanine green were significantly higher in patients with positive lymph nodes (p=.035) and lymphatic space invasion (p=.004) compared to technetium-99m nanocolloid. Conclusion Indocyanine green SLN mapping in vulvar cancer is feasible and safe, with reasonable detection rates. Due to its easy application and few side effects, it offers a sound alternative to the conventional SLN mapping techniques in vulvar cancer. In patients with lymph node metastasis, indocyanine green even outperformed technetium-99m nanocolloid in terms of detection rate.
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Affiliation(s)
- Franziska Siegenthaler
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Laura Knabben
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Stefan Mohr
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, Ente Ospedaliere Cantonale, University of the Italian Switzerland, Lugano, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
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16
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[Interdisciplinary S2k guidelines on the diagnosis and treatment of vaginal carcinoma and its precursors-recommendations on surgical pathology for histopathological workup, diagnostics, and reporting]. DER PATHOLOGE 2021; 42:116-124. [PMID: 33346872 DOI: 10.1007/s00292-020-00876-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Primary vaginal carcinoma is rare. There are two pathogenetic pathways, one associated with HPV high-risk infection and another one with inactivation of p53. Vaginal Paget's disease is rare and mostly associated with vulvar disease or represents intravaginal spread of associated locoregional cancer. Diagnostic vaginal biopsies should be examined by step sections on H&E. Sentinel lymph nodes should be processed completely using ultrastaging. Morphology-based prognostic factors with good clinical evidence are tumour stage and lymph node status. Molecular markers are not currently relevant for treatment decision and prognosis.
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17
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Ya X, Qian W, Huiqing L, Haixiao W, Weiwei Z, Jing B, Lei C, Jianping Y, Shuping Y, Jiaya M, Dong W, Ruixia G. Role of carbon nanoparticle suspension in sentinel lymph node biopsy for early-stage cervical cancer: a prospective study. BJOG 2020; 128:890-898. [PMID: 32930483 DOI: 10.1111/1471-0528.16504] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the clinical diagnostic validity of carbon nanoparticle suspension (CNS) in sentinel lymph node biopsy (SLNB) for assessing lymphatic spread of early-stage cervical cancer. DESIGN A prospective study. SETTING AND POPULATION 356 cases. METHODS We enrolled 356 stage Ia2-IIa2 cervical cancer patients to undergo SLNB using CNS, followed by systematic pelvic lymphadenectomy. All lymph node specimens were assessed using conventional histopathologic ± pathologic ultrastaging analyses. MAIN OUTCOME MEASURES Sentinel lymph node detection rate (DR), clinical diagnostic validity and various related factors were analysed. RESULTS CNS identified 1456 SLNs in 325 patients. The overall SLN DR was 91.29%. A significantly higher DR was found for patients with tumours <20 mm (97.75% versus 71.91%; P < 0.001). Two patients had false-negative results. SLNB with CNS had sensitivity of 96.65%, false-negative rate (FNR) of 4.35% and negative predictive value (NPV) of 99.29%. Importantly, sensitivity (100%), NPV (100%) and FNR (0%) were improved when testing the subgroup of patients with tumours <20 mm (267 cases). There were no observed differences in DR based on pathological type or grade, stage, depth of stromal invasion, surgical approach, menopausal status or prior treatment with chemotherapy (P > 0.05). CONCLUSIONS Sentinel lymph node biopsy with CNS results in favourable DR, sensitivity and NPV for women with early-stage cervical cancer with small tumour sizes. SLNB with CNS is safe, feasible and relatively effective for guiding precise surgical treatment of early-stage cervical cancer. TWEETABLE ABSTRACT Sentinel lymph node biopsy with carbon nanoparticle suspension is safe and feasible for early-stage cervical cancer.
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Affiliation(s)
- X Ya
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - W Qian
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - L Huiqing
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - W Haixiao
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zh Weiwei
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - B Jing
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - C Lei
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Y Jianping
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Y Shuping
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - M Jiaya
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - W Dong
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - G Ruixia
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Soderini A, Depietri V, Crespe M, Rodriguez Y, Aragona A. The role of sentinel lymph node mapping in endometrial carcinoma. ACTA ACUST UNITED AC 2020; 72:367-383. [PMID: 32921021 DOI: 10.23736/s0026-4784.20.04626-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endometrial cancer is the most commonly diagnosed gynecological malignancy in developing countries, and the second malignancy after cervical cancer in developing countries. The primary treatment is based on surgical and pathologic staging including extrafascial type A radical hysterectomy bilateral salpingo-oophorectomy and pelvic and latero-aortic lymphadenectomy. Minimally invasive surgery is the most widely used technique. Sentinel node biopsy is part of this concept and has reached the management of endometrial cancer. The aim of this review was to describe the history, the different injection techniques and results of sentinel node biopsy, and analyze the future role of this technique in endometrial carcinoma.
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Affiliation(s)
- Alejandro Soderini
- Unit of Gynecologic Oncology, Marie Curie Oncologic Hospital, University of Buenos Aires, Buenos Aires, Argentina -
| | - Valeria Depietri
- Unit of Gynecologic Oncology, Marie Curie Oncologic Hospital, University of Buenos Aires, Buenos Aires, Argentina
| | - Martin Crespe
- Unit of Gynecologic Oncology, Marie Curie Oncologic Hospital, University of Buenos Aires, Buenos Aires, Argentina
| | - Yanina Rodriguez
- Unit of Gynecologic Oncology, Marie Curie Oncologic Hospital, University of Buenos Aires, Buenos Aires, Argentina
| | - Alejandro Aragona
- Unit of Gynecologic Oncology, Marie Curie Oncologic Hospital, University of Buenos Aires, Buenos Aires, Argentina
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Tranoulis A, Georgiou D, Sayasneh Mrcog A, Inetianbor E, Papadopoulos AJ, Devaja O, Montalto SA. A meta-analysis evaluating the intra-operative use of collagen-fibrin sealants during inguino-femoral lymphadenectomy: A new direction in reducing post-operative morbidity or another disappointment? Eur J Surg Oncol 2020; 46:1795-1806. [PMID: 32788096 DOI: 10.1016/j.ejso.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/22/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The intra-operative application of collagen-fibrin sealants (CFS) has emerged as a promising intervention to reduce post-operative morbidity associated with inguino-femoral lymph node dissection (IFLND). AIM The purpose of this systematic review was to ascertain the efficacy and safety of CFS to reduce lymphatic morbidity after IFLND. DESIGN We systematically searched MEDLINE, SCOPUS, ClinicalTrials.gov, and Cochrane Database to identify all registered articles pertaining to the use of CFS during IFLND spanning the period Jan 1975 to April 2020. A direct-comparison meta-analysis was performed. Odds ratios (OR), standartised mean difference (SMD) and 95%| confidence intervals were calculated using the random-effect model. RESULTS A total of six randomised control trials (RCTs) and four observational studies were included in this study. The studies were characterised by significant clinical heterogeneity. The meta-analysis of RCTs showed that the application of CFS did neither decrease the length of drainage [SDM -0.55 (95% CI -1.34 to 0.23), p = 0.17] nor the amount of drained output [SMD 0.46 (95% CI -0.29 to 1.20), p = 0.23]. No significant different was found concerning the incidence of lymphocele(s) formation [OR 0.96 (95% CI 0.56-1.65), p = 0.88] or other wound complications. The safety profile of CFS was favourable. CONCLUSIONS Our findings suggest that the use of CFS was not associated with difference in the incidence of lymphatic morbidity related to IFLND. In light of the limited data available and the high inter-study heterogeneity, this evidence should be interpreted with caution. More high quality RCTs are warranted to draw firmer conclusions.
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Affiliation(s)
- Anastasios Tranoulis
- Department of Gynaecological Oncology, Pan-Birmingham Gynaecological Cancer Centre, University of Birmingham, United Kingdom.
| | - Dimitra Georgiou
- Department of Gynaecological Oncology, Chelsea and Westminster NHS Trust, Imperial College, London, United Kingdom
| | - Ahmad Sayasneh Mrcog
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College, London and Department of Gynaecological Oncology, Guy's and St Thomas' NHS Foundation, King's College, London, United Kingdom
| | - Edmund Inetianbor
- Department of Gynaecological Oncology, Maidstone and Turnbridge Wells NHS Trust, Maidstone, United Kingdom
| | - Andreas John Papadopoulos
- Department of Gynaecological Oncology, Maidstone and Turnbridge Wells NHS Trust, Maidstone, United Kingdom
| | - Omer Devaja
- Department of Gynaecological Oncology, Maidstone and Turnbridge Wells NHS Trust, Maidstone, United Kingdom
| | - Stephen Attard Montalto
- Department of Gynaecological Oncology, Maidstone and Turnbridge Wells NHS Trust, Maidstone, United Kingdom
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20
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Devaja O, Papadopoulos AJ, Bharathan R, Montalto SA, Coutts M, Tan A, Corrigan A, Perovic M, Lalami SZR. Sentinel lymph node biopsy alone in the management of early cervical carcinoma. Int J Gynecol Cancer 2020; 32:15-20. [PMID: 32546643 DOI: 10.1136/ijgc-2019-001082] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Sentinel lymph node (SLN) biopsy aims to assess lymph node status with reduced surgical morbidity. The aim of the study was to determine the accuracy and safety of SLN biopsy in the management of early cervical carcinoma using a double technique (technetium-99m (Tc-99m) nanocolloid and methylene blue dye injection). METHODS This was a 10-year study from January 2009 to January 2019 that recruited 103 consecutive women undergoing surgery for early cervical carcinoma, FIGO 2009 stage IA1 (grade 3, and grade 2 with lymphovascular space invasion) to IB1 (<2 cm), at the West Kent Gynaecological Oncology Centre, Maidstone, UK. All patients were given the choice of pelvic node dissection and SLN mapping or SLN only. All patients elected to undergo SLN only. In total 97 patients had SLN mapping performed laparoscopically. We used the combined method (Tc-99m nanocolloid and/or methylene blue dye). All SLN routinely underwent ultrastaging. RESULTS At least one SLN was detected in all 103 patients, using at least one of the combined methods (Tc-99m nanocolloid or blue dye). Bilaterally SLN were removed in 85/103 women with an 83% bilateral detection rate. The median SLN count was 2.3 (range 1-6) nodes. Of 103 patients, 7 (6.7%) patients had lymph node involvement. There were no pelvic or para-aortic lymph node recurrences with a median follow-up of 53 (range 8-120) months. The specificity and negative predictive value of a negative SLN was 100%. None of our 103 patients reported lower extremity lymphedema. CONCLUSION In carefully selected patients with early cervical carcinoma, SLN biopsy alone appears to be a safe method for lymph node assessment of women undergoing surgical staging. Ultrastaging is an essential part of histologic examination of SLN.
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Affiliation(s)
- Omer Devaja
- Gynaecological Oncology, Maidstone Hospital, Maidstone, Kent, UK
| | | | - Rasiah Bharathan
- Gynaecological Oncology, Maidstone Hospital, Maidstone, Kent, UK
| | | | | | - Alex Tan
- Gynaecological Oncology, Maidstone Hospital, Maidstone, Kent, UK
| | | | - Milica Perovic
- Gynaecological Oncology, Maidstone Hospital, Maidstone, Kent, UK
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21
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Dundr P, Cibula D, Němejcová K, Tichá I, Bártů M, Jakša R. Pathologic Protocols for Sentinel Lymph Nodes Ultrastaging in Cervical Cancer. Arch Pathol Lab Med 2019; 144:1011-1020. [PMID: 31869245 DOI: 10.5858/arpa.2019-0249-ra] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Ultrastaging of sentinel lymph nodes (SLNs) is a crucial aspect in the approach to SLN processing. No consensual protocol for pathologic ultrastaging has been approved by international societies to date. OBJECTIVE.— To provide a review of the ultrastaging protocol and all its aspects related to the processing of SLNs in patients with cervical cancer. DATA SOURCES.— In total, 127 publications reporting data from 9085 cases were identified in the literature. In 24% of studies, the information about SLN processing is entirely missing. No ultrastaging protocol was used in 7% of publications. When described, the differences in all aspects of SLN processing among the studies and institutions are substantial. This includes grossing of the SLN, which is not completely sliced and processed in almost 20% of studies. The reported protocols varied in all aspects of SLN processing, including the thickness of slices (range, 1-5 mm), the number of levels (range, 0-cut out until no tissue left), distance between the levels (range, 40-1000 μm), and number of sections per level (range, 1-5). CONCLUSIONS.— We found substantial differences in protocols used for SLN pathologic ultrastaging, which can impact sensitivity for detection of micrometastases and even small macrometastases. Since the involvement of pelvic lymph nodes is the most important negative prognostic factor, such profound discrepancies influence the referral of patients to adjuvant radiotherapy and could potentially cause treatment failure. It is urgent that international societies agree on a consensual protocol before SLN biopsy without pelvic lymphadenectomy is introduced into routine clinical practice.
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Affiliation(s)
- Pavel Dundr
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - David Cibula
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Kristýna Němejcová
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Ivana Tichá
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Michaela Bártů
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Radek Jakša
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
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22
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The Basics of Sentinel Lymph Node Biopsy: Anatomical and Pathophysiological Considerations and Clinical Aspects. JOURNAL OF ONCOLOGY 2019; 2019:3415630. [PMID: 31467535 PMCID: PMC6699370 DOI: 10.1155/2019/3415630] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 01/31/2023]
Abstract
Sentinel lymph node (SLN) is the first node to receive the drainage directly from a tumor. Detection and pathological examination of the SLN is an important oncological procedure that minimizes morbidity related to extensive nodal dissection. SLN biopsy was first reported in 1960 but took approximately 40 years to come into general practice following reports of good outcomes in patients with melanoma. After many years of observation and research on its use in various malignancies SLN biopsy has become the standard surgical treatment in patients with malignant melanoma, breast, vulvar, and cervical cancers. Along with the introduction of new technologies, such as the fluorescent dyes indocyanine green (ICG) and near-infrared fluorescence (NIR), and pathologic ultrastaging, SLN detection rate has increased and false-negative rate has decreased. This literature review aimed to present an overview of the basic concepts and clinical aspects of SLN biopsy in the light of the current research.
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23
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Bogani G, Raspagliesi F, Leone Roberti Maggiore U, Mariani A. Current landscape and future perspective of sentinel node mapping in endometrial cancer. J Gynecol Oncol 2019; 29:e94. [PMID: 30207102 PMCID: PMC6189438 DOI: 10.3802/jgo.2018.29.e94] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 07/24/2018] [Accepted: 08/01/2018] [Indexed: 01/01/2023] Open
Abstract
Endometrial cancer (EC) represents the most common gynecological neoplasm in developed countries. Surgery is the mainstay of treatment for EC. Although EC is characterized by a high prevalence several features regarding its management are still unclear. In particular the execution of lymphadenectomy is controversial. The recent introduction of sentinel node mapping represents the mid-way between the execution and omission of node dissection in EC patients. In the present review we discuss the emerging role of sentinel node mapping in EC. In addition, we discussed how type of tracers utilized and site of injection impacted on sentinel node detection rates. Future perspective regarding EC management are also discussed.
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Affiliation(s)
- Giorgio Bogani
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
| | | | | | - Andrea Mariani
- Department of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
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Clinical significance of the pattern-based classification in endocervical adenocarcinoma, usual and variants. Int J Clin Oncol 2019; 24:1264-1272. [PMID: 31140099 DOI: 10.1007/s10147-019-01472-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/14/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND The Silva system is a pattern-based classification system that stratifies endocervical adenocarcinomas (AC) into 3 categories to assess the risk of lymph node (LN) metastasis. This study aimed to evaluate whether this novel risk stratification system is applicable to all endocervical AC, including usual and variant, and to suggest a suitable management plan for cervical AC. METHODS We retrospectively retrieved consecutive pathology cases with a final diagnosis of endocervical AC treated via radical hysterectomy and pelvic lymphadenectomy. Specimens were classified by consensus according to the Silva system based on "pattern of invasion" as A, B, or C, further clinical/pathologic features were assessed according to pattern-based classification. RESULTS A total of 76 cases of invasive cervical AC were evaluated. Of these, 63 (82.9%) were categorized as usual-type endocervical AC and 13 (17.1%) as special types. Among those with usual and variants, all patients with pattern A tumor had no LN metastasis and did not develop recurrence. Likewise, multivariate analysis revealed that LN metastasis and pattern C or B tumors are significant independent predictors of disease-free survival (DFS). Although pattern A tumors had no LN metastasis, they also developed complications after surgery, similar to pattern B or C tumors. CONCLUSION Regardless of histologic subtypes, pattern A tumors had no LN metastasis and no recurrence. Thus, the Silva classification system can influence the clinical management of all types of endocervical AC. Conservative management is reasonable in all patients with endocervical AC with pattern A tumors.
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25
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Kosťun J, Pešta M, Sláma J, Slunéčko R, Vlasák P, Bouda J, Novotný Z, Topolčan O, Kučera R, Kulda V, Houfková K, Berezovskiy D, Bartáková A, Presl J. One-step nucleic acid amplification vs ultrastaging in the detection of sentinel lymph node metastasis in endometrial cancer patients. J Surg Oncol 2018; 119:361-369. [DOI: 10.1002/jso.25322] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 11/13/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Jan Kosťun
- Department of Gynaecology and Obstetrics; University Hospital Pilsen, Charles University; Prague Czech Republic
| | - Martin Pešta
- Department of Biology; Faculty of Medicine in Pilsen, Charles University; Pilsen Czech Republic
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University; Pilsen Czech Republic
- Department of Immunochemistry; University Hospital and Faculty of Medicine in Pilsen, Charles University; Pilsen Czech Republic
| | - Jiří Sláma
- Department of Obstetrics and Gynaecology; First Faculty of Medicine, Charles University, General University Hospital; Prague Czech Republic
| | - Robert Slunéčko
- Sikl’s Department of Pathology; University Hospital Pilsen, Charles University; Prague Czech Republic
| | - Pavel Vlasák
- Department of Gynaecology and Obstetrics; University Hospital Pilsen, Charles University; Prague Czech Republic
| | - Jiří Bouda
- Department of Gynaecology and Obstetrics; University Hospital Pilsen, Charles University; Prague Czech Republic
| | - Zdeněk Novotný
- Department of Gynaecology and Obstetrics; University Hospital Pilsen, Charles University; Prague Czech Republic
| | - Ondřej Topolčan
- Department of Immunochemistry; University Hospital and Faculty of Medicine in Pilsen, Charles University; Pilsen Czech Republic
| | - Radek Kučera
- Department of Immunochemistry; University Hospital and Faculty of Medicine in Pilsen, Charles University; Pilsen Czech Republic
| | - Vlastimil Kulda
- Department of Medical Chemistry and Biochemistry; Faculty of Medicine in Pilsen, Charles University; Prague Czech Republic
| | - Kateřina Houfková
- Department of Biology; Faculty of Medicine in Pilsen, Charles University; Pilsen Czech Republic
| | - Denis Berezovskiy
- Department of Gynaecology and Obstetrics; University Hospital Pilsen, Charles University; Prague Czech Republic
| | - Alena Bartáková
- Department of Gynaecology and Obstetrics; University Hospital Pilsen, Charles University; Prague Czech Republic
| | - Jiří Presl
- Department of Gynaecology and Obstetrics; University Hospital Pilsen, Charles University; Prague Czech Republic
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26
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Cibula D, McCluggage WG. Sentinel lymph node (SLN) concept in cervical cancer: Current limitations and unanswered questions. Gynecol Oncol 2018; 152:202-207. [PMID: 30318103 DOI: 10.1016/j.ygyno.2018.10.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/02/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
Abstract
Sentinel lymph node (SLN) biopsy has been increasingly used in the management of early-stages cervical cancer instead of systematic pelvic lymph node dissection (PLND). The aim of this article is to give a critical overview of key aspects related to this concept, such as a necessity for reliable detection of micrometastases (MIC) in SLN and the requirements for SLN pathologic ultrastaging, low accuracy of intraoperative detection of SLN involvement, and still a limited evidence of oncological safety of the replacement of PLND by SLN biopsy only in ≥IB1 tumours due to unknown risk of MIC in non-SLN pelvic lymph nodes in patients with negative SLN, and absence of any prospective evidence.
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Affiliation(s)
- David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, United Kingdom
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27
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Rodríguez-Trujillo A, Fusté P, Paredes P, Mensión E, Agustí N, Gil-Ibáñez B, Del Pino M, González-Bosquet E, Torné A. Long-term oncological outcomes of patients with negative sentinel lymph node in vulvar cancer. Comparative study with conventional lymphadenectomy. Acta Obstet Gynecol Scand 2018; 97:1427-1437. [PMID: 30063814 DOI: 10.1111/aogs.13431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The aim of this study was to compare oncological outcomes and morbidity in patients with early-stage vulvar cancer with negative sentinel lymph node (SLN) biopsy vs negative inguinofemoral lymphadenectomy (IFL). MATERIAL AND METHODS Study with retrospectively collected data in patients with squamous cell vulvar carcinomas ≤ 4 cm without suspected inguinofemoral lymph node metastases. Only patients with negative nodes after histopathology procedure were followed. Patients who underwent only SLN were compared with patients who underwent IFL ± SLN to compare recurrences, survival rates and morbidity. RESULTS Ninety-three patients were eligible for follow up: 42 with negative SLN and 51 with negative IFL ± SLN. The median follow-up period was 60.4 months (range 6.7-160.7). The rate of isolated first groin recurrence was 4.8% in patients with negative SLN and 2.0% in patients with negative IFL ± SLN (P = 0.587) and the rates of first isolated local recurrence were 28.6% and 31.4%, respectively (P = 0.823). Only 1 patient (2.4%) in the group of negative SLN had distant recurrence. The disease-specific survival rate at 5 years was 83.3% in the negative SLN group and 92.2% in the negative IFL ± SLN group (P = 0.214). We observed a higher rate of wound breakdown and infection after IFL than SLN biopsy (17.6% vs 10.6%; P = 0.020) and lymphedema (33.3% vs 0%; P < 0.001). CONCLUSIONS We report in the same population of patients with early-stage vulvar cancer that SLN biopsy does not have significantly higher rates of groin recurrences or lower survival rates compared with IFL. Moreover, the SLN procedure has less morbidity, which should encourage gynecologists to abandon IFL.
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Affiliation(s)
- Adriano Rodríguez-Trujillo
- Section of Gynecologic Oncology, Clinical Institute of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clínic, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Pere Fusté
- Section of Gynecologic Oncology, Clinical Institute of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clínic, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Pilar Paredes
- Department of Nuclear Medicine, Hospital Clínic, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Eduard Mensión
- Section of Gynecologic Oncology, Clinical Institute of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clínic, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Núria Agustí
- Section of Gynecologic Oncology, Clinical Institute of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clínic, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Blanca Gil-Ibáñez
- Section of Gynecologic Oncology, Clinical Institute of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clínic, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Marta Del Pino
- Section of Gynecologic Oncology, Clinical Institute of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clínic, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | - Aureli Torné
- Section of Gynecologic Oncology, Clinical Institute of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clínic, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Body N, Grégoire J, Renaud MC, Sebastianelli A, Grondin K, Plante M. Tips and tricks to improve sentinel lymph node mapping with Indocyanin green in endometrial cancer. Gynecol Oncol 2018; 150:267-273. [PMID: 29909967 DOI: 10.1016/j.ygyno.2018.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To determine the validity of sentinel lymph node (SLN) biopsy with ICG in endometrial cancer and to evaluate the factors associated with poor mapping or false negative. METHODS We reviewed all patients who underwent primary surgery for endometrial carcinoma with SLN mapping using ICG followed by pelvic lymphadenectomy from February 2014 to December 2015. SLNs were ultrastaged on final pathology. Patients' demographics, surgical approach and histopathological factors were prospectively collected. Detection rate, sensitivity and negative predictive value (NPV) were calculated and univariate analysis was performed to evaluate factors associated with failed bilateral detection of SLNs. RESULTS A total of 119 patients were included. The overall and bilateral detection rates were 93% and 74%. Sensitivity and NPV were 100% in patients with bilateral detection; 95% and 99% respectively in cases with at least unilateral detection. Advanced FIGO stage (III or IV) was the only factor related to failed bilateral detection (p = 0.01). In 14 hemi-pelvis, the specimen labelled as SLN did not contain nodal tissue on final pathology (only lymphatic channels), which represented 37% of the "failed detection" cases. One false negative occurred in a patient with an ipsilateral clinically suspicious enlarged lymph node. CONCLUSION ICG is an excellent tracer for SLN mapping in endometrial cancer. Advanced FIGO stage correlated with failed bilateral detection (p = 0.01). Suspicious lymph nodes should be removed regardless of the mapping. Care should be taken to ensure that SLN specimen actually contains nodal tissue and not only swollen lymphatic channels, as this represents a significant cause of failed SLN mapping.
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Affiliation(s)
- Noémie Body
- Département de Chirurgie Gynécologique, Hôpital Anne de Bretagne, Centre Hospitalier Universitaire de Rennes, Université de Rennes 1, Rennes, France
| | - Jean Grégoire
- Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada
| | - Marie-Claude Renaud
- Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada
| | - Alexandra Sebastianelli
- Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada
| | - Katherine Grondin
- Pathology Department, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada
| | - Marie Plante
- Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada.
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The safety and feasibility of minimally invasive sentinel lymph node staging using indocyanine green in the management of endometrial cancer. Eur J Obstet Gynecol Reprod Biol 2018. [DOI: 10.1016/j.ejogrb.2018.02.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Crivellaro C, Baratto L, Dolci C, De Ponti E, Magni S, Elisei F, Papadia A, Buda A. Sentinel node biopsy in endometrial cancer: an update. Clin Transl Imaging 2018. [DOI: 10.1007/s40336-018-0268-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Dostálek L, Zikan M, Fischerova D, Kocian R, Germanova A, Frühauf F, Dusek L, Slama J, Dundr P, Nemejcova K, Cibula D. SLN biopsy in cervical cancer patients with tumors larger than 2 cm and 4 cm. Gynecol Oncol 2018; 148:456-460. [DOI: 10.1016/j.ygyno.2018.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/27/2017] [Accepted: 01/02/2018] [Indexed: 12/20/2022]
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Abstract
Background: Cervical cancer is the second most common type of cancer among women. Effective screening programs can help
cancer detection in early phases and reduce death. Metastasis to lymph nodes is one of the most prognostic factors in patients who
underwent surgery. Also, a positive result from pathology report alert oncologist as a cause of death. Sentinel lymph node biopsy has
been widely studied and clinically used for many types of cancer.
Methods: Two techniques exist for detecting sentinel node in cervical cancer, which are Blue dye and gamma probe with radioactive
isotope (99mTc). Moreover, lymphoscintigraphy has many advantages over the stain method. Detecting the sentinel node is performed
via laparoscopy or laparotomy; former method is better and more accurate.
Results: Various researchers have focused on this method and its positive results; its superiority against full lymphadenectomy has
been declared in previous studies. Moreover, the role of sentinel lymph nodes biopsy in cervical cancer is still being extensively studied.
Sentinel lymph nodes (SLN) method has a higher accuracy level to detect metastasis.
Conclusion: Hence, it can be considered as a more appropriate alternative for pelvic lymph node dissection (PLND), which is a
standard technique. Altering the method to a standard clinical method needs in-depth researches and studies.
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Park KJ, Roma AA. Pattern based classification of endocervical adenocarcinoma: a review. Pathology 2017; 50:134-140. [PMID: 29241973 DOI: 10.1016/j.pathol.2017.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
While endocervical adenocarcinoma is comprised of several histological subtypes, the most common subtype is human papillomavirus-associated usual type, and management of these tumours is primarily determined by FIGO (International Federation of Gynecology and Obstetrics) stage, a clinically based staging system. Early stage cervical cancer is determined by the pathological evaluation of tumour microscopic measurement (depth of invasion), which can be particularly challenging because of the lack of a defined point of origin. Yet important treatment decisions, cone versus radical surgery, are based on this imperfect system, resulting in overtreatment and related morbidities in many patients for whom it may not be necessary. There is a growing consensus, however, for a more conservative approach, one that reduces morbidity and prevents loss of fertility in these (often young) patients. This movement has been supported, in part, by the development of a morphology based risk stratification system which was devised in order to recognise those tumours that, while invasive, could potentially be treated more conservatively. In this review, we provide the reader with the background and rationale for a more conservative approach in treating endocervical adenocarcinoma, summarise the risk stratification system, and review the system's utility and reproducibility. In addition, we comment on recent updates that attempt to further refine the system. The application of this morphology based classification could help identify a subset of patients with endocervical adenocarcinoma (who would otherwise undergo radical surgery based on FIGO staging alone) that have good clinical outcomes and could be treated more conservatively.
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Affiliation(s)
- Kay J Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Andres A Roma
- Department of Anatomic Pathology, University of California San Diego, San Diego, CA, United States
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Cusimano MC, Walker R, Bernardini MQ, Bouchard-Fortier G, Laframboise S, May T, Murphy J, Rosen B, Covens A, Clarke B, Shaw P, Rouzbahman M, Mohan R, Ferguson SE. Implementing a Cervical Sentinel Lymph Node Biopsy Program: Quality Improvement in Gynaecologic Oncology. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:659-667. [DOI: 10.1016/j.jogc.2017.02.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 10/19/2022]
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Menczer J. Is there a revision needed of the current FIGO staging system? Acta Obstet Gynecol Scand 2017; 96:1159-1161. [PMID: 28718876 DOI: 10.1111/aogs.13193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 07/11/2017] [Indexed: 11/28/2022]
Abstract
The FIGO staging system has undergone many modifications since it first appeared in about the middle of the previous century. Due to the use of modern diagnostic tools, namely computed tomography, magnetic resonance imaging, positron emission tomography, sentinel lymph node biopsy and neoadjuvant chemotherapy, certain gynecological cancer cases cannot be allocated to a specific stage if one wishes to adhere strictly to FIGO requirements. In these circumstances such cases actually remain unstaged. This should prompt appropriate modifications of the current FIGO staging system so that it fulfills its aims.
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Affiliation(s)
- Joseph Menczer
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, E. Wolfson Medical Center, Holon, Israel
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Kimmig R, Buderath P, Rusch P, Mach P, Aktas B. Early ovarian cancer surgery with indocyanine-green-guided targeted compartmental lymphadenectomy (TCL, pelvic part). J Gynecol Oncol 2017; 28:e68. [PMID: 28657229 PMCID: PMC5540727 DOI: 10.3802/jgo.2017.28.e68] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/23/2017] [Accepted: 06/02/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Para-aortic indocyanine-green (ICG)-guided targeted compartmental lymphadenectomy is feasible in early ovarian cancer; systematic pelvic and para-aortic lymphadenectomy could potentially be avoided if thoroughly investigated sentinel nodes could predict whether residual nodes will be involved or free of disease. In contrast to advanced ovarian cancer, where the therapeutic potential of lymphadenectomy will soon be clarified by the results of the Arbeitsgemeinschaft Gynäkologische Onkologie lymphadenectomy in ovarian neoplasms (AGO LION) trial, systematic lymphadenectomy seems to be mandatory for diagnostic and also therapeutic purposes in early ovarian cancer. Sentinel node biopsy or resection of the regional lymphatic network may reduce morbidity compared to systematic lymphadenectomy as shown already for other entities. Apart from the ovarian mesonephric pathway, a second Müllerian uterine pathway exists for lymphatic drainage of the ovary. Lymphatic valves apparently do not exist at this level of the utero-ovarian network since injection of radioactivity into the ovarian ligaments also labelled pelvic nodes. METHODS We applied ICG using 4×0.5 mL of a 1.66 mg/mL ICG solution for transcervical injection into the fundal and midcorporal myometrium at each side [10] instead of injection into the infundibulopelvic ligament, since the utero-ovarian drainage was intact. RESULTS In this case a 1.8 cm cancer of the right ovary was removed in continuity with its draining lymphatic vessels and at least the first 2 sentinel nodes in each channel "en bloc" as shown in this video for the pelvic part, consistent with the loco-regional ontogenetic approach. CONCLUSION This could potentially avoid most of systematic lymphadenectomies in early ovarian cancer.
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Affiliation(s)
- Rainer Kimmig
- Department of Gynecology and Obstetrics, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - Paul Buderath
- Department of Gynecology and Obstetrics, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Peter Rusch
- Department of Gynecology and Obstetrics, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Pawel Mach
- Department of Gynecology and Obstetrics, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bahriye Aktas
- Department of Gynecology and Obstetrics, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Abstract
ObjectiveIntraoperative detection of ovarian sentinel nodes has been shown to be feasible. We examined the detection rate and locations of sentinel nodes in patients with ovarian tumors. We also aimed to assess the reliability of sentinel node method in predicting regional lymph node metastasis.MethodsTwenty patients scheduled for laparotomy because of a pelvic mass were recruited to the study. In the beginning of the laparotomy, radioisotope and blue dye were injected under the serosa next to the junction of the ovarian tumor and suspensory ligament. The number and locations of the hot and/or blue nodes/spots were recorded during the operation. If the tumor was malignant according to the frozen section, systematic lymphadenectomies were performed, the sentinel nodes sampled separately, and their status compared with other regional lymph nodes.ResultsEleven patients had a right-sided ovarian tumor, 7 patients a left-sided tumor, and 2 patients had bilateral tumors. A median of 2 sentinel nodes/locations per patient (range, 1–3) were found. Sixty percent of all sentinel nodes were located in the para-aortic region only, compared with 30% in both para-aortic and pelvic areas and 10% in pelvic area only. Both unilateral and bilateral locations were found. In 83% of the cases with more than 1 sentinel node location, they were located in separate anatomical regions. In 3 patients, systematic lymphadenectomies were performed. One of them had nodal metastases in 2 regions and also a metastasis in 1 of her 2 sentinel nodes in 1 of those regions.ConclusionsIn patients with ovarian tumor(s), the detection of sentinel nodes is feasible. They are located in different anatomic areas both ipsilaterally and contralaterally, although most of them are found in the para-aortic region. The reliability of the sentinel node concept should be evaluated in the framework of a multicenter trial.
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Sentinel lymph node mapping reduces practice pattern variations in surgical staging for endometrial adenocarcinoma: A before and after study. Gynecol Oncol 2017; 145:248-255. [PMID: 28363672 DOI: 10.1016/j.ygyno.2017.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/08/2017] [Accepted: 03/15/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine the effects of universal sentinel lymph node mapping on the use of nodal staging in endometrial adenocarcinoma. METHODS Two approaches to laparoscopic staging for endometrial adenocarcinoma were compared using a before and after study design. The before cohort underwent selective lymphadenectomy from January 1, 2014-October 1, 2015 while the after cohort underwent universal sentinel lymph node (SLN) mapping from October 2, 2015-September 29, 2016. RESULTS The before cohort comprised 215 patients and the after cohort 166 patients. In women undergoing SLN mapping, a sentinel node was identified at least unilaterally in 146/153 cases (95.4%), and bilaterally in 114/153 (74.5%) of cases. Pelvic nodes were removed in 35.8% of the before cohort versus 92.2% of the after cohort (p<0.0001) with more nodal evaluation among both low risk (9.6% vs. 91%, p<0.0001) and high risk cases (66% vs. 94%, p<0.0001). While the proportion of low risk cases diagnosed with nodal involvement did not significantly change (0.9% to 3.1%, p=0.32), there was a trend toward more diagnoses of nodal involvement in high risk cases (5% to 13.2%, p=0.06). Mean number of pelvic lymph nodes removed (15 vs. 4, p<0.0001), mean operative time (181min vs. 137min, p<0.0001), estimated blood loss (80ml vs. 56ml, p=0.004), and rate of post-operative complications (13% vs. 5.2%, p=0.04) all decreased after the adoption of SLN dissection. CONCLUSIONS Universal sentinel lymph node dissection for laparoscopic endometrial cancer staging reduces heterogeneity in surgeon staging practice, increases nodal detection, and lowers post-operative complications.
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Kimmig R, Buderath P, Mach P, Rusch P, Aktas B. Surgical treatment of early ovarian cancer with compartmental resection of regional lymphatic network and indocyanine-green-guided targeted compartmental lymphadenectomy (TCL, paraaortic part). J Gynecol Oncol 2017; 28:e41. [PMID: 28382801 PMCID: PMC5391397 DOI: 10.3802/jgo.2017.28.e41] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/28/2017] [Accepted: 03/05/2017] [Indexed: 11/30/2022] Open
Abstract
Objective Whether pelvic and para-aortic lymphadenectomy is of therapeutic benefit in advanced ovarian cancer will remain unclear until the publication of the Arbeitsgemeinschaft Gynäkologische Onkologie lymphadenectomy in ovarian neoplasms (AGO LION) trial. In early ovarian cancer, however, lymphadenectomy seems mandatory for diagnostic and also therapeutic reasons [123]. Methods Complete systematic lymphadenectomy is accompanied by morbidity which may be reduced by sentinel node biopsy already established for several solid tumors [456]. In ovarian cancer there are 2 main pathways in lymphatic drainage: along the ovarian vessels to the para-aortic nodes and the uterine vessels to the iliac lymph compartments [7]. Following injection of radioactive dye into the ovarian ligaments this could be confirmed suggesting that there is bidirectional flow at this level of the ovarian and uterine lymphatic pathways [8]. Indocyanine-green-guided (ICG) injection to the uterine corpus seems to be equally effective in labelling the “uterine Müllerian” and the “ovarian mesonephric” lymphatic drainage of the ovary [910]. Results This technique [9] was applied and will be outlined in the video showing the procedure with respect to the para-aortic lymphatic drainage. Isolated sentinel node biopsy and tumor excision will not resect the organ compartment together with its super-ordinated draining lymphatic system at risk. Conclusion Thus, the authors suggest to remove the malignancy together with its draining lymphatic vessels and at least the first 2 sentinel nodes in each channel en bloc; we propose to analyze this procedure consistent with the ontogenetic approach [1112] with respect to diagnostic accuracy and loco-regional control. This could potentially avoid most of systematic lymphadenectomies in early ovarian cancer.
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Affiliation(s)
- Rainer Kimmig
- Department of Gynecology and Obstetrics, West-German Cancer Center, University of Duisburg-Essen, Essen, Germany.
| | - Paul Buderath
- Department of Gynecology and Obstetrics, West-German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Pawel Mach
- Department of Gynecology and Obstetrics, West-German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Peter Rusch
- Department of Gynecology and Obstetrics, West-German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Bahriye Aktas
- Department of Gynecology and Obstetrics, West-German Cancer Center, University of Duisburg-Essen, Essen, Germany
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Lennox GK, Covens A. Can sentinel lymph node biopsy replace pelvic lymphadenectomy for early cervical cancer? Gynecol Oncol 2017; 144:16-20. [DOI: 10.1016/j.ygyno.2016.08.337] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 08/26/2016] [Accepted: 08/27/2016] [Indexed: 11/25/2022]
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Application of sentinel lymph node dissection in gynecological cancers: results of a survey among German hospitals. Arch Gynecol Obstet 2016; 295:713-720. [DOI: 10.1007/s00404-016-4279-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
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Sentinel-node mapping in endometrial cancer patients: comparing SPECT/CT, gamma-probe and dye. Ann Nucl Med 2016; 31:93-99. [PMID: 27815812 DOI: 10.1007/s12149-016-1137-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to compare preoperative SPECT/CT with gamma-probe and methylene blue-dye (MBD) in the identification of sentinel lymph node (SLN) in early stage endometrial cancer. METHODS 40 stage-I EC patients (66.7 ± 9.7 years) underwent preoperative lymphoscintigraphy. After about 3 h from Tc-99m-albumin nanocolloid cervical injection, all patients underwent SPECT/CT study. MBD was injected into the cervix just before surgery under general anesthesia. All patients underwent SLN biopsy, hysterectomy, bilateral salpingo-oophorectomy, and radical regional lymphadenectomy. SPECT/CT findings were compared to those of gamma-probe and MBD techniques. RESULTS In 2 patients no nodal migration was observed, neither with MBD nor radiotracer. Detection rate of at least one SLN was 90% (36/40 patients) with SPECT/CT, 88% (35/40) intra-operatively with gamma-probe and 80% (32/40) with MBD. Only in 7/40 patients a bilateral migration was obtained with all considered modalities. In particular, bilateral detection was achieved in 26 patients with SPECT/CT, in 24 with gamma-probe and in 10 patients with MBD. The concordance site between SPECT/CT and intraoperative gamma-probe was 73% (29/40 patients: 2 without migration, 21 bilateral and 6 monolateral SLNs); while concordance site with MBD was found in 40% (16/40: 8 bilateral, 6 monolateral SLNs, 2 without SLNs). Overall, 628 LNs were dissected (mean 18 LNs per patient). The median number of SLNs removed was 2 (mean 2.5 per patient). Out of 91 SLNs: 43 were "hot and blue (HB)", 10 were blue only and 38 were hot only. LN metastases rate was 16%: 9/90 SLNs (7 HB, 2 hot only) were positive for metastases in 6 patients. Four non-SLNs were found positive in 3 patients, and all presented concomitant positive SLNs. False negative rate was 0%. CONCLUSIONS SPECT/CT had the highest detection rate and achieved the highest rate of bilateral mapping, compared to gamma-probe and MDB. SPECT/CT had moderate concordance with gamma-probe, and it can help the intraoperative detection of SLNs providing important information about their anatomic location.
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Köhler C, Foiato T, Marnitz S, Schneider A, Le X, Dogan NU, Pfiffer T, Jacob AE, Mölgg A, Hagemann I, Favero G. Potential Surgical and Oncologic Consequences Related to Skin Tattoos in the Treatment of Cervical Cancer. J Minim Invasive Gynecol 2016; 23:1083-1087. [DOI: 10.1016/j.jmig.2016.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 11/30/2022]
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Slama J, Cerny A, Dusek L, Fischerova D, Zikan M, Kocian R, Germanova A, Cibula D. Results of less radical fertility-sparing procedures with omitted parametrectomy for cervical cancer: 5years of experience. Gynecol Oncol 2016; 142:401-4. [DOI: 10.1016/j.ygyno.2016.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 07/02/2016] [Accepted: 07/05/2016] [Indexed: 11/28/2022]
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Bogani G, Martinelli F, Ditto A, Signorelli M, Chiappa V, Recalcati D, Lorusso D, Raspagliesi F. Sentinel lymph node detection in endometrial cancer: does injection site make a difference? J Gynecol Oncol 2016; 27:e23. [PMID: 26768786 PMCID: PMC4717228 DOI: 10.3802/jgo.2016.27.e23] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Giorgio Bogani
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
| | - Fabio Martinelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Antonino Ditto
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Mauro Signorelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Valentina Chiappa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Dario Recalcati
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Domenica Lorusso
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
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McNally LR, Mezera M, Morgan DE, Frederick PJ, Yang ES, Eltoum IE, Grizzle WE. Current and Emerging Clinical Applications of Multispectral Optoacoustic Tomography (MSOT) in Oncology. Clin Cancer Res 2016; 22:3432-9. [PMID: 27208064 PMCID: PMC5046137 DOI: 10.1158/1078-0432.ccr-16-0573] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/13/2016] [Indexed: 01/18/2023]
Abstract
Accurate detection and characterization of cancers are key for providing timely intervention and effective treatments. Current imaging technologies are particularly limited when it comes to detecting very small tumors in vivo, i.e., very early cancers or metastases, differentiating viable tumor from surrounding dead tumor tissue, and evaluating tumor metabolism within tissue. Optoacoustic imaging offers potential solutions to these imaging problems because of its ability to image optical absorption properties of both intrinsic tissue chromophores and exogenous contrast agents without the involvement of ionizing radiation. Optoacoustic imaging uses pulsed laser to induce localized thermoelastic expansion that generates acoustic waves detectable by an ultrasound transducer. To date, multispectral optoacoustic tomography (MSOT) has primarily been used in preclinical research; however, its use in translational and clinical research is expanding. This review focuses on current and emerging applications of optoacoustic imaging for molecular imaging of cancer using both exogenous and endogenous contrast agents and sheds light on potential future clinical applications. Clin Cancer Res; 22(14); 3432-9. ©2016 AACR.
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Affiliation(s)
- Lacey R McNally
- Department of Medicine, University of Louisville, Louisville, Kentucky.
| | - Megan Mezera
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Peter J Frederick
- Department of Gynecology Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Eddy S Yang
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Isam-Eldin Eltoum
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - William E Grizzle
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
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Buda A, Papadia A, Zapardiel I, Vizza E, Ghezzi F, De Ponti E, Lissoni AA, Imboden S, Diestro MD, Verri D, Gasparri ML, Bussi B, Di Martino G, de la Noval BD, Mueller M, Crivellaro C. From Conventional Radiotracer Tc-99(m) with Blue Dye to Indocyanine Green Fluorescence: A Comparison of Methods Towards Optimization of Sentinel Lymph Node Mapping in Early Stage Cervical Cancer for a Laparoscopic Approach. Ann Surg Oncol 2016; 23:2959-65. [PMID: 27126631 DOI: 10.1245/s10434-016-5227-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND The credibility of sentinel lymph node (SLN) mapping is becoming increasingly more established in cervical cancer. We aimed to assess the sensitivity of SLN biopsy in terms of detection rate and bilateral mapping in women with cervical cancer by comparing technetium-99 radiocolloid (Tc-99(m)) and blue dye (BD) versus fluorescence mapping with indocyanine green (ICG). METHODS Data of patients with cervical cancer stage 1A2 to 1B1 from 5 European institutions were retrospectively reviewed. All centers used a laparoscopic approach with the same intracervical dye injection. Detection rate and bilateral mapping of ICG were compared, respectively, with results obtained by standard Tc-99(m) with BD. RESULTS Overall, 76 (53 %) of 144 of women underwent preoperative SLN mapping with radiotracer and intraoperative BD, whereas 68 of (47 %) 144 patients underwent mapping using intraoperative ICG. The detection rate of SLN mapping was 96 % and 100 % for Tc-99(m) with BD and ICG, respectively. Bilateral mapping was achieved in 98.5 % for ICG and 76.3 % for Tc-99(m) with BD; this difference was statistically significant (p < 0.0001). CONCLUSIONS The fluorescence SLN mapping with ICG achieved a significantly higher detection rate and bilateral mapping compared to standard radiocolloid and BD technique in women with early stage cervical cancer. Nodal staging with an intracervical injection of ICG is accurate, safe, and reproducible in patients with cervical cancer. Before replacing lymphadenectomy completely, the additional value of fluorescence SLN mapping on both perioperative morbidity and survival should be explored and confirmed by ongoing controlled trials.
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Affiliation(s)
- Alessandro Buda
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, University of Berne, Bern, Switzerland
| | - Ignacio Zapardiel
- Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Enrico Vizza
- Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Elena De Ponti
- Department of Medical Physics, San Gerardo Hospital, Monza, Italy
| | - Andrea Alberto Lissoni
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Sara Imboden
- Department of Obstetrics and Gynecology, University of Berne, Bern, Switzerland
| | | | - Debora Verri
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Beatrice Bussi
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giampaolo Di Martino
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Michael Mueller
- Department of Obstetrics and Gynecology, University of Berne, Bern, Switzerland
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Buda A, Dell'Anna T, Vecchione F, Verri D, Di Martino G, Milani R. Near-Infrared Sentinel Lymph Node Mapping With Indocyanine Green Using the VITOM II ICG Exoscope for Open Surgery for Gynecologic Malignancies. J Minim Invasive Gynecol 2016; 23:628-32. [PMID: 26921484 DOI: 10.1016/j.jmig.2016.02.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 02/17/2016] [Accepted: 02/17/2016] [Indexed: 02/07/2023]
Abstract
Sentinel lymph node (SLN) mapping is emerging as an effective method for surgical staging of different gynecologic malignancies. Near-infrared (NIR) technology using a fluorescent dye such as indocyanine green (ICG) represents an interesting and feasible method for SLN mapping even in traditional open surgeries by applying video telescope operating microscope (VITOM) system technology. We report our preliminary experience in 12 women who underwent surgical nodal staging for early-stage vulvar and uterine or cervical cancer. Surgical and pathological outcomes are described, and the VITOM II ICG system's intraoperative image quality, handling and docking, and teaching value are assessed. The general impression of the surgical staff was that the VITOM II system is easy to use, and that the image quality of the anatomic structures is impressive. Traditional open SLN mapping with ICG appears to be easy to perform and reproducible, providing a new tool in the management of patients with gynecologic malignancies. Moreover, we believe that this technology has great potential as an operative teaching and learning modality for trainers for open surgical cases. Additional studies involving the VITOM system with a large sample size of patients are needed to confirm these promising results.
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Affiliation(s)
- Alessandro Buda
- Gynecologic Oncology Unit, Dept. Obstet and Gynecol, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
| | - Tiziana Dell'Anna
- Gynecologic Oncology Unit, Dept. Obstet and Gynecol, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Francesca Vecchione
- Gynecologic Oncology Unit, Dept. Obstet and Gynecol, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Debora Verri
- Gynecologic Oncology Unit, Dept. Obstet and Gynecol, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giampaolo Di Martino
- Gynecologic Oncology Unit, Dept. Obstet and Gynecol, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Rodolfo Milani
- Gynecologic Oncology Unit, Dept. Obstet and Gynecol, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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Reproductive and oncologic outcome following robot-assisted laparoscopic radical trachelectomy for early stage cervical cancer. Gynecol Oncol 2016; 141:160-5. [PMID: 26845228 DOI: 10.1016/j.ygyno.2016.01.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/27/2016] [Accepted: 01/31/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the reproductive and oncologic outcome following robotic radical trachelectomy for early stage cervical cancer. METHODS All women with early stage cervical cancer planned for fertility-sparing robotic trachelectomy between December 2007 and April 2015 at two tertiary referral centers in Sweden were identified. Perioperative- and follow-up data was retrieved from prospective databases used for all robotic procedures at the respective institution and an additional review of computerized patient files was performed. Reproductive outcome evaluation was restricted to women with ≥12months follow-up and an active wish to conceive. Oncological outcome was evaluated for all patients. RESULTS Fifty-six women (3 stage IA1, 14 stage IA2 and 39 stage IB1) were included. The median age was 29years (range 23-41). Median follow-up was 24months (range 1-89). Seven trachelectomies were aborted in favor of a radical hysterectomy and/or chemoradiation due to nodal metastases or insufficient margins; two distant recurrences occurred in these women. A local recurrence was seen in two of the 49 women (4%) in whom the procedure was completed as planned. Seventeen of the 21 women (81%) in the reproductive follow-up group conceived - 16 naturally and one following IVF. Sixteen women (94%) delivered in the third trimester, 12 women (71%) in gestational week ≥36. One (6%) second trimester delivery occurred. CONCLUSION The high fertility rate, low rate of premature deliveries and an acceptable rate of recurrence support the feasibility of robotic fertility-sparing radical trachelectomy in women with early stage cervical cancer.
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