Anna L Beavis1, Sergio Salazar-Marioni2, Abdulrahman K Sinno1, Rebecca L Stone1, Amanda N Fader1, Antonio Santillan-Gomez3, Edward J Tanner4. 1. The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA. 2. Texas Oncology, San Antonio, Texas, USA; University of Monterrey, San Pedro Garza Garcia, Mexico. 3. The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA; Texas Oncology, San Antonio, Texas, USA. 4. The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA. Electronic address: etanner4@jhmi.edu.
Abstract
OBJECTIVE: Our study objective was to determine feasibility and mapping rates using indocyanine green (ICG) for sentinel lymph node (SLN) mapping in early-stage cervical cancer. METHODS: We performed a retrospective review of all women who underwent SLN mapping with ICG during primary surgical management of early-stage cervical cancer by robotic-assisted radical hysterectomy (RA-RH) or fertility-sparing surgery. Patients were treated at two high-volume centers from 10/2012 to 02/2016. Completion pelvic lymphadenectomy was performed after SLN biopsy; additionally, removal of clinically enlarged/suspicious nodes was part of the SLN treatment algorithm. RESULTS: Thirty women with a median age of 42.5 and BMI of 26.5 were included. Most (90%) had stage IB disease, and 67% had squamous histology. RA-RH was performed in 86.7% of cases. One patient underwent fertility-sparing surgery. Median cervical tumor size was 2.0cm. At least one SLN was detected in all cases (100%), with bilateral mapping achieved in 87%. SLN detection was not impacted by tumor size and was most commonly identified in the hypogastric (40.3%), obturator (26.0%), and external iliac (20.8%) regions. Five cases of lymphatic metastasis were identified (16.7%): three in clinically enlarged SLNs, one in a clinically enlarged non-SLN, and one case with cytokeratin positive cells in an SLN. All metastatic disease would have been detected even if full lymphadenectomy had been omitted from our treatment algorithm, CONCLUSIONS: SLN mapping with ICG is feasible and results in high detection rates in women with early-stage cervical cancer. Prospective studies are needed to determine if SLN mapping can replace lymphadenectomy in this setting.
OBJECTIVE: Our study objective was to determine feasibility and mapping rates using indocyanine green (ICG) for sentinel lymph node (SLN) mapping in early-stage cervical cancer. METHODS: We performed a retrospective review of all women who underwent SLN mapping with ICG during primary surgical management of early-stage cervical cancer by robotic-assisted radical hysterectomy (RA-RH) or fertility-sparing surgery. Patients were treated at two high-volume centers from 10/2012 to 02/2016. Completion pelvic lymphadenectomy was performed after SLN biopsy; additionally, removal of clinically enlarged/suspicious nodes was part of the SLN treatment algorithm. RESULTS: Thirty women with a median age of 42.5 and BMI of 26.5 were included. Most (90%) had stage IB disease, and 67% had squamous histology. RA-RH was performed in 86.7% of cases. One patient underwent fertility-sparing surgery. Median cervical tumor size was 2.0cm. At least one SLN was detected in all cases (100%), with bilateral mapping achieved in 87%. SLN detection was not impacted by tumor size and was most commonly identified in the hypogastric (40.3%), obturator (26.0%), and external iliac (20.8%) regions. Five cases of lymphatic metastasis were identified (16.7%): three in clinically enlarged SLNs, one in a clinically enlarged non-SLN, and one case with cytokeratin positive cells in an SLN. All metastatic disease would have been detected even if full lymphadenectomy had been omitted from our treatment algorithm, CONCLUSIONS: SLN mapping with ICG is feasible and results in high detection rates in women with early-stage cervical cancer. Prospective studies are needed to determine if SLN mapping can replace lymphadenectomy in this setting.
Authors: D Cibula; N R Abu-Rustum; L Dusek; M Zikán; A Zaal; L Sevcik; G G Kenter; D Querleu; R Jach; A S Bats; G Dyduch; P Graf; J Klat; J Lacheta; C J L M Meijer; E Mery; R Verheijen; R P Zweemer Journal: Gynecol Oncol Date: 2011-11-25 Impact factor: 5.482
Authors: Edward J Tanner; Abdulrahman K Sinno; Rebecca L Stone; Kimberly L Levinson; Kara C Long; Amanda N Fader Journal: Gynecol Oncol Date: 2015-06-19 Impact factor: 5.482
Authors: Laura J Havrilesky; Charles A Leath; Warner Huh; Brian Calingaert; Rex C Bentley; John T Soper; Angeles Alvarez Secord Journal: Gynecol Oncol Date: 2004-05 Impact factor: 5.482
Authors: Abdulrahman K Sinno; Amanda Nickles Fader; Kara Long Roche; Robert L Giuntoli; Edward J Tanner Journal: Gynecol Oncol Date: 2014-06-02 Impact factor: 5.482
Authors: David Cibula; Nadeem R Abu-Rustum; Ladislav Dusek; Jiri Slama; Michal Zikán; Afra Zaal; Libor Sevcik; Gemma Kenter; Denis Querleu; Robert Jach; Anne-Sophie Bats; Grzegorz Dyduch; Peter Graf; Jaroslav Klat; Chris J L M Meijer; Eliane Mery; Rene Verheijen; Ronald P Zweemer Journal: Gynecol Oncol Date: 2012-08-31 Impact factor: 5.482
Authors: Nadeem R Abu-Rustum; Roberto Angioli; Arthur E Bailey; Vance Broach; Alessandro Buda; Michelle R Coriddi; Joseph H Dayan; Michael Frumovitz; Yong Man Kim; Rainer Kimmig; Mario M Leitao; Mustafa Zelal Muallem; Matt McKittrick; Babak Mehrara; Roberto Montera; Lea A Moukarzel; Raj Naik; Silvana Pedra Nobre; Marie Plante; Francesco Plotti; Oliver Zivanovic Journal: Int J Gynecol Cancer Date: 2020-03-30 Impact factor: 3.437
Authors: Thomas Papathemelis; Anton Scharl; Michael Anapolski; Elisabeth C Inwald; Atanas Ignatov; Olaf Ortmann; Michael Gerken; Monika Klinkhammer-Schalke; Sophia Scharl Journal: Arch Gynecol Obstet Date: 2020-02-11 Impact factor: 2.493