Giampaolo Di Martino1, Cinzia Crivellaro2, Elena De Ponti3, Beatrice Bussi1, Andrea Papadia4, Ignacio Zapardiel5, Enrico Vizza6, Federica Elisei2, Maria Dolores Diestro5, Luca Locatelli1, Maria Luisa Gasparri4, Paolo Di Lorenzo1, Michael Mueller4, Alessandro Buda7. 1. Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy. 2. Tecnomed Foundation, University of Milano-Bicocca, Monza, Italy. 3. Department of Medical Physics, ASST Monza, San Gerardo Hospital, Monza, Italy. 4. Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland. 5. Gynecologic Oncology Unit, La Paz University Hospital-IdiPAZ, Madrid, Spain. 6. Department of Oncological Surgery, Gynecologic Oncologic Unit "Regina Elena", National Cancer Institute, Rome, Italy. 7. Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy. Electronic address: alebuda1972@gmail.com.
Abstract
STUDY OBJECTIVE: To compare sentinel lymph node (SLN) mapping in women with cervical cancer stage >IB1 (tumor size >2 cm) using indocyanine green (ICG) versus the standard technique using radioisotope technetium 99m radiocolloid (Tc99m) radiotracer with or without blue dye. DESIGN: European multicenter, retrospective observational study (Canadian Task Force classification II-2). SETTING: Four academic medical centers. PATIENTS: Ninety-five women with stage IB1 cervical cancer (>2 cm) who underwent SLN mapping with Tc99m with or without blue dye or ICG and radical hysterectomy. INTERVENTION: The detection rate and bilateral mapping rate were compared between ICG and standard Tc99m radiotracer with or without blue dye. Lymphadenectomy was performed, and the false-negative rate was assessed. MEASUREMENTS AND MAIN RESULTS: Forty-seven patients underwent SLN mapping with Tc99m with or without blue dye, and 48 did so with ICG. All patients underwent radical hysterectomy with or without bilateral salpingo-oophorectomy between 2008 and 2016. The overall detection rate of SLN mapping was 91.5% for Tc99m with or without blue dye and 100% for ICG. A 91.7% rate of bilateral migration was achieved for ICG, significantly higher than the 66% obtained with Tc99m with or without blue dye (p = .025). Nine of the 23 SLN-positive patients (39.1%) were diagnosed exclusively as a result of the ultrastaging used to identify micrometastases or isolated tumor cells only. CONCLUSIONS: In advanced cervical cancer (stage IB1 >2 cm), the detection rate and bilateral migration rate on real-time fluorescent SLN mapping were higher with ICG than with Tc99m radiotracer with or without blue dye. SLN mapping and ultrastaging can provide additional information for nodal staging in advanced cervical cancer. In this setting, ICG is a promising tool for mapping, appearing less affected by higher disease stage compared with traditional methods.
STUDY OBJECTIVE: To compare sentinel lymph node (SLN) mapping in women with cervical cancer stage >IB1 (tumor size >2 cm) using indocyanine green (ICG) versus the standard technique using radioisotope technetium 99m radiocolloid (Tc99m) radiotracer with or without blue dye. DESIGN: European multicenter, retrospective observational study (Canadian Task Force classification II-2). SETTING: Four academic medical centers. PATIENTS: Ninety-five women with stage IB1cervical cancer (>2 cm) who underwent SLN mapping with Tc99m with or without blue dye or ICG and radical hysterectomy. INTERVENTION: The detection rate and bilateral mapping rate were compared between ICG and standard Tc99m radiotracer with or without blue dye. Lymphadenectomy was performed, and the false-negative rate was assessed. MEASUREMENTS AND MAIN RESULTS: Forty-seven patients underwent SLN mapping with Tc99m with or without blue dye, and 48 did so with ICG. All patients underwent radical hysterectomy with or without bilateral salpingo-oophorectomy between 2008 and 2016. The overall detection rate of SLN mapping was 91.5% for Tc99m with or without blue dye and 100% for ICG. A 91.7% rate of bilateral migration was achieved for ICG, significantly higher than the 66% obtained with Tc99m with or without blue dye (p = .025). Nine of the 23 SLN-positive patients (39.1%) were diagnosed exclusively as a result of the ultrastaging used to identify micrometastases or isolated tumor cells only. CONCLUSIONS: In advanced cervical cancer (stage IB1 >2 cm), the detection rate and bilateral migration rate on real-time fluorescent SLN mapping were higher with ICG than with Tc99m radiotracer with or without blue dye. SLN mapping and ultrastaging can provide additional information for nodal staging in advanced cervical cancer. In this setting, ICG is a promising tool for mapping, appearing less affected by higher disease stage compared with traditional methods.
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Authors: Nicolò Bizzarri; Pedone Anchora Luigi; Gabriella Ferrandina; Gian Franco Zannoni; Maria Vittoria Carbone; Camilla Fedele; Elena Teodorico; Valerio Gallotta; Salvatore Gueli Alletti; Vito Chiantera; Anna Fagotti; Giovanni Scambia; Francesco Fanfani Journal: J Cancer Res Clin Oncol Date: 2020-09-30 Impact factor: 4.553
Authors: Ilse G T Baeten; Jacob P Hoogendam; Bernadette Jeremiasse; Arthur J A T Braat; Wouter B Veldhuis; Geertruida N Jonges; Ina M Jürgenliemk-Schulz; Carla H van Gils; Ronald P Zweemer; Cornelis G Gerestein Journal: Cancer Rep (Hoboken) Date: 2021-05-11