BACKGROUND: Lymph node metastasis is a critical prognostic factor in cervical cancer. Considering the potential complications of lymphadenectomy and desirability of avoiding systemic lymphadenectomy, accurate intraoperative prediction of the existence of lymph node metastasis is important in patients undergoing surgery for cervical cancer. We evaluated the feasibility and value of indocyanine green (ICG) use for sentinel lymph node (SLN) mapping during laparoscopic surgery performed for cervical cancer. METHODS: This single-center cohort study included 77 patients undergoing a new laparoscopic radical surgery method with pelvic lymphadenectomy for early-stage cervical cancer. The surgery, performed without using a uterine manipulator, included creation of a vaginal cuff. Bilateral ICG-guided SLN mapping and rapid histopathological examination were performed, and results were analyzed in relation to final histopathologic diagnoses. RESULTS: The SLN pelvic side-specific detection rate was 93.5%, sensitivity (SLN-positive cases/SLN-detected pelvic lymph node-positive cases) was 100%, intraoperative negative predictive value (NPV) was 97.8%, and final pathological NPV was 100%. The detection rate was significantly lower for tumors ≥ 2 cm in diameter than for tumors < 2 cm in diameter. Micrometastases were missed by intraoperative examination in 3 cases. CONCLUSION: The high NPV suggests the feasibility and usefulness of ICG-based SLN mapping plus rapid intraoperative examination for identification of metastatic SLNs. Use of ICG-based mapping for intraoperative identification of SLNs in patients undergoing this new laparoscopic surgery method for early-stage cervical cancer was particularly effective for tumors < 2 cm in diameter. However, incorporating a search for micrometastases into rapid intraoperative histopathologic examination may be necessary.
BACKGROUND: Lymph node metastasis is a critical prognostic factor in cervical cancer. Considering the potential complications of lymphadenectomy and desirability of avoiding systemic lymphadenectomy, accurate intraoperative prediction of the existence of lymph node metastasis is important in patients undergoing surgery for cervical cancer. We evaluated the feasibility and value of indocyanine green (ICG) use for sentinel lymph node (SLN) mapping during laparoscopic surgery performed for cervical cancer. METHODS: This single-center cohort study included 77 patients undergoing a new laparoscopic radical surgery method with pelvic lymphadenectomy for early-stage cervical cancer. The surgery, performed without using a uterine manipulator, included creation of a vaginal cuff. Bilateral ICG-guided SLN mapping and rapid histopathological examination were performed, and results were analyzed in relation to final histopathologic diagnoses. RESULTS: The SLN pelvic side-specific detection rate was 93.5%, sensitivity (SLN-positive cases/SLN-detected pelvic lymph node-positive cases) was 100%, intraoperative negative predictive value (NPV) was 97.8%, and final pathological NPV was 100%. The detection rate was significantly lower for tumors ≥ 2 cm in diameter than for tumors < 2 cm in diameter. Micrometastases were missed by intraoperative examination in 3 cases. CONCLUSION: The high NPV suggests the feasibility and usefulness of ICG-based SLN mapping plus rapid intraoperative examination for identification of metastatic SLNs. Use of ICG-based mapping for intraoperative identification of SLNs in patients undergoing this new laparoscopic surgery method for early-stage cervical cancer was particularly effective for tumors < 2 cm in diameter. However, incorporating a search for micrometastases into rapid intraoperative histopathologic examination may be necessary.
Authors: Christhardt Kohler; Hermann Hertel; Jörg Herrmann; Simone Marnitz; Peter Mallmann; Giovanni Favero; Andrea Plaikner; Peter Martus; Mieczyslaw Gajda; Achim Schneider Journal: Int J Gynecol Cancer Date: 2019-06 Impact factor: 3.437
Authors: David Cibula; Richard Pötter; François Planchamp; Elisabeth Avall-Lundqvist; Daniela Fischerova; Christine Haie Meder; Christhardt Köhler; Fabio Landoni; Sigurd Lax; Jacob Christian Lindegaard; Umesh Mahantshetty; Patrice Mathevet; W Glenn McCluggage; Mary McCormack; Raj Naik; Remi Nout; Sandro Pignata; Jordi Ponce; Denis Querleu; Francesco Raspagliesi; Alexandros Rodolakis; Karl Tamussino; Pauline Wimberger; Maria Rosaria Raspollini Journal: Int J Gynecol Cancer Date: 2018-05 Impact factor: 3.437
Authors: G Delgado; B N Bundy; W C Fowler; F B Stehman; B Sevin; W T Creasman; F Major; P DiSaia; R Zaino Journal: Gynecol Oncol Date: 1989-12 Impact factor: 5.482
Authors: Pedro T Ramirez; Michael Frumovitz; Rene Pareja; Aldo Lopez; Marcelo Vieira; Reitan Ribeiro; Alessandro Buda; Xiaojian Yan; Yao Shuzhong; Naven Chetty; David Isla; Mariano Tamura; Tao Zhu; Kristy P Robledo; Val Gebski; Rebecca Asher; Vanessa Behan; James L Nicklin; Robert L Coleman; Andreas Obermair Journal: N Engl J Med Date: 2018-10-31 Impact factor: 91.245