Risk of empty lymph node packets in sentinel lymph node mapping for endometrial cancer using indocyanine green

2019 ◽  
Vol 29 (3) ◽  
pp. 513-517 ◽  
Author(s):  
Lauren Thomaier ◽  
Leah Jager ◽  
Rebecca Stone ◽  
Stephanie Wethington ◽  
Amanda Fader ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Minimally Invasive ◽  
Indocyanine Green ◽  
Atypical Hyperplasia ◽  
Indocyanine Green Dye ◽  
Surgeon Experience ◽  
Additional Procedure ◽  
Minimally Invasive Hysterectomy

ObjectiveTo determine whether the rate of sentinel lymph node (SLN) dissections that do not yield a lymph node on pathological analysis ('empty packet dissection') changes with increasing surgeon experience in the setting of patients undergoing minimally invasive hysterectomy and SLN mapping using indocyanine green dye for endometrial cancer.MethodsAll patients undergoing SLN mapping using indocyanine green dye at the time of minimally invasive hysterectomy for endometrial cancer or complex atypical hyperplasia were identified between January 2013 and September 2017 at our institution. All surgeons had prior experience performing SLN mapping for endometrial cancer using other methods. The rate of empty packet dissections and SLN counts were evaluated using a logistic regression model analysis.ResultsIn total, 236 patients undergoing SLN mapping for either endometrial cancer (85%) or complex atypical hyperplasia (15%) were identified from a prospectively maintained database. When examining all six surgeons together, the percentage of empty packet dissections decreased with increasing number of procedures performed. Each additional procedure was associated with a 3.6% reduction in the odds of an empty packet SLN dissection. After adjusting for individual surgeons, each additional procedure was associated with a 4.9% reduction in the odds of an empty packet. The expected odds of an empty packet after 10 additional procedures decreased by 40.1% (95% CI 12.4% to 58.6%). The addition of two covariates (age and body mass index) did not contribute significantly to the model (likelihood ratio test: X2=2.75, p=0.25). The rate of empty packets appeared to stabilize after approximately 30 procedures. The number of SLNs removed did not change with increasing surgeon experience.ConclusionThe rate of empty packet SLN dissections using indocyanine green dye decreases with increasing number of procedures. This stabilizes after 30 procedures, suggesting completion of a learning curve.

Adipose-only sentinel lymph nodes: a finding during the adaptation of a sentinel lymph node mapping algorithm with indocyanine green in women with endometrial cancer

2019 ◽  
Vol 29 (1) ◽  
pp. 53-59
Author(s):  
J A Harold ◽  
D Uyar ◽  
J S Rader ◽  
E Bishop ◽  
M Nugent ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Indocyanine Green ◽  
Sentinel Lymph Node Mapping ◽  
Sentinel Lymph Nodes ◽  
Lymph Node Mapping ◽  
Sentinel Lymph Node Identification ◽  
Surgeon Experience

ObjectiveTo identify factors that affect successful adaptation of sentinel lymph node mapping and those that lead to unintended adipose-only sentinel lymph node identification.MethodsSurgical and pathological data were prospectively collected on patients with endometrial cancer who underwent sentinel lymph node mapping with indocyanine green with or without pelvic and/or para-aortic lymph node dissection between November 2013 and April 2017. All mapping cases were performed with the robotic system. Adipose-only specimens were defined as a sentinel lymph node without a pathologically identified lymph node after ultrastaging.ResultsA total of 202 patients were included: 83% had endometrioid pathology, 12% serous, 3% carcinosarcoma, and 2% clear cell, with mixed pathology noted in 2%. The bilateral sentinel lymph node detection rate was 66%, and the rate of mapping at least a unilateral sentinel lymph node was 86%. Neither the bilateral nor the unilateral sentinel lymph node mapping rate changed with increased surgeon experience. The rate of adipose-only sentinel lymph node identification was more frequent when comparing the first 10 cases (37%), cases 11 – 30 (28%), and > 30 cases (9%) (P = 0.006). Body mass index > 30 kg/m2, uterine fibroids, The International Federation of Gynecology and Obstetrics (FIGO) grade, and histology were not found to have a statistically significant impact on either sentinel lymph node identification or adipose-only sentinel lymph node identification. Adipose-only sentinel lymph nodes were more likely with increased time from cervical injection to identification of the sentinel lymph node in the right hemipelvis. The median range was 28 min (14–73) for true sentinel lymph node identification vs 33 min (23–74) for adipose-only sentinel lymph node identification (P = 0.02).ConclusionPatient and surgeon factors did not impact the identification of sentinel lymph nodes over time. Adipose-only sentinel lymph nodes were more frequently identified in the initial cases and represent a potential complication to adapting sentinel lymph node biopsy without lymphadenectomy. The increase in adipose-only sentinel lymph node identification that was associated with time from cervical injection may represent delayed or disrupted uptake of indocyanine green.

scholarly journals Sentinel lymph node biopsy guided by indocyanine green dye in endometrial cancer patients: literature review and clinical experience

2019 ◽  
Vol 18 (2) ◽  
pp. 52-57
Author(s):  
A. V. Kochatkov ◽  
N. S. Kharlov
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Indocyanine Green ◽  
Cancer Patients ◽  
Lymph Node Dissection ◽  
Node Dissection ◽  
Indocyanine Green Dye ◽  
Duration Of Surgery ◽  
Aortic Lymph Node

The purpose of the study was to assess the feasibility and safety of using the technique of intraoperative sentinel lymph node (slN) detection guided by indocyanine green dye in endometrial cancer patients.Material and methods. The study included 10 patients with stage i–ii/g1–2 endometrial cancer. the mean age of the patients was 66.2 years. laser-assisted indocyanine green (icg) fluorescent dye was used for slN mapping. icgwas injected into the uterine cervix immediately before surgery. the concentration used for icgwas 1.25 mg/ml (a 25 mg vial with icgpowder was diluted into 20 cc of aqueous sterile water. icgwas injected intracervically at 3 and 9 o’clock positions: 0.5 ml at 5 mm depth and 0.5 ml at 10 mm depth. the pinpoint endoscopic fluorescence imaging system (Novadaq, canada) was used for slN mapping.Results. SLNs were identified and removed in all patients. SLNs were located along the external iliac vessels in 6 patients and in the obturator fossa and in the hypogastric vessels in 4 patients. an additional para-aortic lymph node was visualized in one case. Both urgent and planned histological examinations showed no evidence of metastases in all patients. pelvic lymph node dissection was performed in 4 patients. combined pelvic and para-aortic lymph node dissection was performed in one case.Conclusion. Lymph node involvement is an important prognostic factor in deciding whether neoadjuvant chemotherapy is necessary for endometrial cancer patients. the technique of slN detection using indocyanine green dye appears promising in ensuring adequate intraoperative staging and optimization of the extent and duration of surgery. the use of this algorithm for the treatment of endometrial cancer will significantly reduce the risk of perioperative complications associated with lymphadenectomy, not negatively influencing the disease outcome.

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