Oscar Lührs1, Linnea Ekdahl2, Céline Lönnerfors2, Barbara Geppert2, Jan Persson3. 1. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden; Department of Obstetrics and Gynecology, Centralsjukhuset Kristianstad, SE-291 33 Kristianstad, Sweden. 2. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden. 3. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden. Electronic address: Jan.Persson@med.lu.se.
Abstract
OBJECTIVE: To investigate whether combining two independent tracers increases the SLN-detection rate in cervical cancer. METHODS: Consecutive women with early stage cervical cancer planned for a robotic radical hysterectomy or a robotic radical trachelectomy with sentinel lymph node (SLN) detection were included. After cervical injections of Indocyanine green (ICG) and Tc99-nanocolloid (Tc99), near-infrared fluorescence imaging and a gamma probe were used to identify SLNs in the upper and lower paracervical pathways (UPP/LPP). A strict surgical algorithm was adhered to and the SLNs were defined as SLN-ICG, SLN-ICG+Tc99 or SLN-Tc99. In FIGO-stage ≥IA2 cancers a full pelvic lymph node dissection (PLND) was performed after detection of SLNs. The primary endpoint was the SLN detection rate per tracer and combination of tracers. Secondary endpoints were sensitivity and mapping rates of the SLN algorithm per tracer and combination of tracers. RESULTS: In the sixty-five analyzed women, the bilateral mapping rate was 98.5% for ICG and 60% for Tc99 (p < 0.01). Combining the tracers did not increase the bilateral detection rate. In three women (5%) Tc99 identified ICG-negative non-metastatic SLNs without impact on the bilateral detection rate. Eight women (12%) had lymph node metastases (LNMs), all had at least one metastatic SLN. Seven (35%) of the 20 metastatic SLNs were detected by ICG only and 12 (60%) were ICG and Tc99 positive. CONCLUSION: SLN detection rate was significantly higher using ICG compared with Tc99. ICG identified all patients with LNMs. Combining ICG and Tc99 did not improve the bilateral detection rate of SLNs.
OBJECTIVE: To investigate whether combining two independent tracers increases the SLN-detection rate in cervical cancer. METHODS: Consecutive women with early stage cervical cancer planned for a robotic radical hysterectomy or a robotic radical trachelectomy with sentinel lymph node (SLN) detection were included. After cervical injections of Indocyanine green (ICG) and Tc99-nanocolloid (Tc99), near-infrared fluorescence imaging and a gamma probe were used to identify SLNs in the upper and lower paracervical pathways (UPP/LPP). A strict surgical algorithm was adhered to and the SLNs were defined as SLN-ICG, SLN-ICG+Tc99 or SLN-Tc99. In FIGO-stage ≥IA2 cancers a full pelvic lymph node dissection (PLND) was performed after detection of SLNs. The primary endpoint was the SLN detection rate per tracer and combination of tracers. Secondary endpoints were sensitivity and mapping rates of the SLN algorithm per tracer and combination of tracers. RESULTS: In the sixty-five analyzed women, the bilateral mapping rate was 98.5% for ICG and 60% for Tc99 (p < 0.01). Combining the tracers did not increase the bilateral detection rate. In three women (5%) Tc99 identified ICG-negative non-metastatic SLNs without impact on the bilateral detection rate. Eight women (12%) had lymph node metastases (LNMs), all had at least one metastatic SLN. Seven (35%) of the 20 metastatic SLNs were detected by ICG only and 12 (60%) were ICG and Tc99 positive. CONCLUSION: SLN detection rate was significantly higher using ICG compared with Tc99. ICG identified all patients with LNMs. Combining ICG and Tc99 did not improve the bilateral detection rate of SLNs.
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Authors: Ilse G T Baeten; Jacob P Hoogendam; Arthur J A T Braat; Ronald P Zweemer; Cornelis G Gerestein Journal: EJNMMI Res Date: 2022-06-20 Impact factor: 3.434
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Authors: Ilse G T Baeten; Jacob P Hoogendam; Arthur J A T Braat; Wouter B Veldhuis; Geertruida N Jonges; Ina M Jürgenliemk-Schulz; Ronald P Zweemer; Cornelis G Gerestein Journal: BMJ Open Date: 2022-09-13 Impact factor: 3.006
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