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Cea García J, de la Riva Pérez PA, Rodríguez Jiménez I, Márquez Maraver F, Polo Velasco A, Jiménez Gallardo J, Aguilar Martín MV, Cambil Molina T, Cabezas Palacios MN. Selective biopsy of the sentinel node in cancer of cervix: Experience in validation phase. Rev Esp Med Nucl Imagen Mol 2018; 37:359-365. [PMID: 29941339 DOI: 10.1016/j.remn.2018.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/07/2018] [Accepted: 04/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Sentinel lymph node biopsy (SLNB) was created to reduce the morbidity associated with pelvic lymphadenectomy in the early stages of cervical cancer (CC), preserving its prognostic information. The goal is to assess the diagnostic validity of SLNB in CC in initial stages (IA1 with lymphovascular infiltration (LVI) +, IA2, IB1 and IIA1), thus avoiding unnecessary lymphadenectomies in many of the cases. MATERIAL AND METHOD From January 2012 to April 2017, 23 patients with initial stages of CC were included in a cross-sectional study to evaluate the effectiveness of the SLNB in CC with a mixed technique of cervical injection of 99mTc-nanocolloid of albumin and methylene blue, using combined planar lymphoscintigraphy with multimodality SPECT/CT image and subsequent removal of the sentinel node (SN) by laparoscopy. RESULTS The detection rate of SLNB with the mixed technique was 95.65%, with a negative predictive value (NPV) of 95.45% and sensitivity (S) of 100% in the case of bilateral drainage. The mean of excised SN was 3 (range 1-5). The bilateral detection rate in laparoscopy was 85.35%. The concordance between SPECT/CT and laparoscopy for the number and bilaterality of the SN using the Pearson coefficient was r = 0.727 and r = 0.833, respectively; p = 0.01. We only found one SN with a deferred result of micrometástasis and one false negative was detected. CONCLUSIONS SLNB in CC using a mixed technique has a high detection and bilateral drainage rate, but S is still low if we include cases of unilateral drainage. A greater number of cases and the development of intraoperative ultrastaging could increase the S of the technique and to reduce the number of false negatives.
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Affiliation(s)
- J Cea García
- Unidad de Gestión Clínica Obstetricia y Ginecología, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - P A de la Riva Pérez
- Unidad de Gestión Clínica, Radiodiagnóstico y Medicina Nuclear, Hospital Universitario Virgen Macarena, Sevilla, España
| | - I Rodríguez Jiménez
- Unidad de Gestión Clínica Obstetricia y Ginecología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - F Márquez Maraver
- Unidad de Gestión Clínica Obstetricia y Ginecología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - A Polo Velasco
- Unidad de Gestión Clínica Obstetricia y Ginecología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J Jiménez Gallardo
- Unidad de Gestión Clínica Obstetricia y Ginecología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M V Aguilar Martín
- Unidad de Gestión Clínica Obstetricia y Ginecología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - T Cambil Molina
- Unidad de Gestión Clínica, Radiodiagnóstico y Medicina Nuclear, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M N Cabezas Palacios
- Unidad de Gestión Clínica Obstetricia y Ginecología, Hospital Universitario Virgen Macarena, Sevilla, España
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How J, Gauthier C, Abitbol J, Lau S, Salvador S, Gotlieb R, Pelmus M, Ferenczy A, Probst S, Brin S, Fatnassi A, Gotlieb W. Impact of sentinel lymph node mapping on recurrence patterns in endometrial cancer. Gynecol Oncol 2017; 144:503-509. [PMID: 28104296 DOI: 10.1016/j.ygyno.2017.01.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/08/2017] [Accepted: 01/10/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sentinel lymph node (SLN) mapping has emerged as a promising solution to the ongoing debate regarding lymphadenectomy in the initial surgical management of endometrial cancer. Currently, little is known about its possible impact on location of disease recurrence compared to systematic lymphadenectomy. METHODS In this retrospective study, 472 consecutive patients with endometrial cancer who underwent either SLN mapping (SLN cohort, n=275) or systematic lymphadenectomy (LND cohort, n=197) from sequential, non-overlapping historical time points were compared. Clinical characteristics were extracted from a prospectively gathered electronic database. Both overall and pelvic sidewall recurrence free survival (RFS) were evaluated at 48-month post-operative follow-up. RESULTS No significant difference in overall RFS could be identified between the cohorts at 48months (HR 0.74, 95% CI 0.43-1.28, p=0.29). However, the SLN cohort had improved pelvic sidewall RFS compared to the LND cohort (HR 0.32, 95% CI 0.14-0.74, p=0.007). The pelvic sidewall recurrences accounted for 30% of recurrences in the SLN cohort (8 out of 26 recurrences) compared to 71.4% in the LND cohort (20 out of 28 recurrences). CONCLUSIONS SLN mapping may enable more efficient detection of the LNs at greatest risk of metastasis and help to guide adjuvant therapy, which in turn seems to decrease the risk of pelvic sidewall recurrences.
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Affiliation(s)
- Jeffrey How
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H2T 1E2, Canada
| | - Caroline Gauthier
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H2T 1E2, Canada
| | - Jeremie Abitbol
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H2T 1E2, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H2T 1E2, Canada
| | - Shannon Salvador
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H2T 1E2, Canada
| | - Raphael Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H2T 1E2, Canada
| | - Manuela Pelmus
- Department of Pathology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H2T 1E2, Canada
| | - Alex Ferenczy
- Department of Pathology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H2T 1E2, Canada
| | - Stephan Probst
- Department of Nuclear Medicine, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H2T 1E2, Canada
| | - Sonya Brin
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H2T 1E2, Canada
| | - Asma Fatnassi
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H2T 1E2, Canada
| | - Walter Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H2T 1E2, Canada.
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Darin MC, Gómez-Hidalgo NR, Westin SN, Soliman PT, Escobar PF, Frumovitz M, Ramirez PT. Role of Indocyanine Green in Sentinel Node Mapping in Gynecologic Cancer: Is Fluorescence Imaging the New Standard? J Minim Invasive Gynecol 2016; 23:186-93. [DOI: 10.1016/j.jmig.2015.10.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 11/29/2022]
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Imboden S, Papadia A, Nauwerk M, McKinnon B, Kollmann Z, Mohr S, Lanz S, Mueller MD. A Comparison of Radiocolloid and Indocyanine Green Fluorescence Imaging, Sentinel Lymph Node Mapping in Patients with Cervical Cancer Undergoing Laparoscopic Surgery. Ann Surg Oncol 2015; 22:4198-203. [PMID: 26122376 PMCID: PMC4644188 DOI: 10.1245/s10434-015-4701-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Indexed: 02/05/2023]
Abstract
Background and Purpose 99TC combined with blue-dye mapping
is considered the best sentinel lymph node (SLN) mapping technique in cervical cancer. Indocyanine green (ICG) with near infrared fluorescence imaging has been introduced as a new methodology for SLN mapping. The aim of this study was to compare these two techniques in the laparoscopic treatment of cervical cancer. Methods Medical records of patients undergoing laparoscopic SLN mapping for cervical cancer with either 99Tc and patent blue dye (Group 1) or ICG (Group 2) from April 2008 until August 2012 were reviewed. Sensitivity, specificity, and overall and bilateral detection rates were calculated and compared. Results Fifty-eight patients were included in the study—36 patients in Group 1 and 22 patients in Group 2. Median tumor diameter was 25 and 29 mm, and mean SLN count was 2.1 and 3.7, for Groups 1 and 2, respectively. Mean non-SLN (NSLN) count was 39 for both groups. SLNs were ninefold more likely to be affected by metastatic disease compared with NSLNs (p < 0.005). Sensitivity and specificity were both 100 %. Overall detection rates were 83 and 95.5 % (p = nonsignificant), and bilateral detection rates were 61 and 95.5 % (p < 0.005), for Groups 1 and 2, respectively. In 75 % of cases, SLNs were located along the external or internal iliac nodal basins. Conclusions ICG SLN mapping in cervical cancer provides high overall and bilateral detection rates that compare favorably with the current standard of care.
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Affiliation(s)
- Sara Imboden
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland.
| | - Mélina Nauwerk
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Brett McKinnon
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Zahraa Kollmann
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Stefan Mohr
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Susanne Lanz
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
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