Vito Andrea Capozzi1, Ceni Valentina2, Sozzi Giulio3, Cianciolo Alessandra2, Gambino Giulia2, Armano Giulia2, Chiantera Vito3, Berretta Roberto2. 1. Department of Gynecology and Obstetrics, University of Parma, Via Gramsci, 14, 43125, Parma, Italy. Electronic address: vitoandrea.capozzi@studenti.unipr.it. 2. Department of Gynecology and Obstetrics, University of Parma, Via Gramsci, 14, 43125, Parma, Italy. 3. Department of Gynecologic Oncology, University of Palermo, Piazza Nicola Leotta, 4, 90127, Palermo, Italy.
Abstract
OBJECTIVE: The objective of the study is to show some small tricks for bilateral sentinel lymph node (SLN) uptake in endometrial cancer. MATERIALS AND METHODS: Each step of the sentinel lymph node technique was analyzed. The cervix was exposed through the use of vaginal valves and by Martin pliers stapling of the anterior cervical lip. Fifty mg Indocyanine Green (ICG) powder was diluted with 10 ml of physiological solution. The spinal needle was marked at 15 mm with a steri-strip. After 20 min from the administration, in case of no LNS identification, an additional 1 ml in the non-detected side was administered in the superficial cervical area. All cervical injections were made by a single (BR) surgeon experienced in oncological gynecology. RESULTS: Fifty patients undergoing sentinel lymph node research for endometrial cancer. The uptake of at least one side of the sentinel node was 98% (49 cases). Forty-six (92%) patients had bilateral lymph node uptake and 3 patients (6%) had unilateral uptake. Only one patient with pelvic and metastatic aortic lymph nodes had no sentinel nodal uptake. CONCLUSIONS: Little tricks can increase the bilateral uptake of the SLN up to 92%. The reinjection could be a key element for the success of the SLN technique. Experienced surgeons could certainly play a fundamental role in raising bilateral SLN detection. Further prospective randomized studies are needed to achieve the best SLN infiltration strategy.
OBJECTIVE: The objective of the study is to show some small tricks for bilateral sentinel lymph node (SLN) uptake in endometrial cancer. MATERIALS AND METHODS: Each step of the sentinel lymph node technique was analyzed. The cervix was exposed through the use of vaginal valves and by Martin pliers stapling of the anterior cervical lip. Fifty mg Indocyanine Green (ICG) powder was diluted with 10 ml of physiological solution. The spinal needle was marked at 15 mm with a steri-strip. After 20 min from the administration, in case of no LNS identification, an additional 1 ml in the non-detected side was administered in the superficial cervical area. All cervical injections were made by a single (BR) surgeon experienced in oncological gynecology. RESULTS: Fifty patients undergoing sentinel lymph node research for endometrial cancer. The uptake of at least one side of the sentinel node was 98% (49 cases). Forty-six (92%) patients had bilateral lymph node uptake and 3 patients (6%) had unilateral uptake. Only one patient with pelvic and metastatic aortic lymph nodes had no sentinel nodal uptake. CONCLUSIONS: Little tricks can increase the bilateral uptake of the SLN up to 92%. The reinjection could be a key element for the success of the SLN technique. Experienced surgeons could certainly play a fundamental role in raising bilateral SLN detection. Further prospective randomized studies are needed to achieve the best SLN infiltration strategy.