J Gynecol Oncol.
2022 Sep;33(5):e66. 10.3802/jgo.2022.33.e66.
The added value of SLN mapping with indocyanine green in low- and intermediate-risk endometrial cancer management: a systematic review and meta-analysis
- Burg LC
1 - Verheijen S1
- Bekkers RL2,3,4
- IntHout J5
- Holloway RW6
- Taskin S7
- Ferguson SE8,9
- Xue Y10
- Ditto A11
- Baiocchi G12
- Papadia A13,14
- Bogani G15
- Buda A16,17
- Kruitwagen RF1,2,3
- Zusterzeel PL1
- Affiliations
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- 1Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
- 2Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands
- 3GROW – School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- 4Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
- 5Department for Health Evidence, Section Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
- 6Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
- 7Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
- 8Division of Gynecologic Oncology, Princess Margaret Cancer Center, Toronto, Canada
- 9Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
- 10Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- 11Department of Gynecological Oncology, Fondazione IRCCS, Istituto dei Tumori, Milano, Italy
- 12Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, SP, Brazil
- 13Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, Lugano, Switzerland
- 14Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- 15Department of Maternal and Child Health and Urologynecological Sciences, Sapienza University, Rome, Italy
- 16Obstetrics and Gynecology Department, Ospedale San Gerardo di Monza, University of Milano Bicocca, Monza, Italy
- 17Ospedale Michele e Pietro Ferrero, Verduno (cuneo), Italy
- KMID: 2537912
- DOI: http://doi.org/10.3802/jgo.2022.33.e66
Abstract
Objective
The aim of this study was to assess the SLN detection rate in presumed early stage, low- and intermediate-risk endometrial cancers, the incidence of SLN metastases, and the negative predictive value of SLN mapping performed with indocyanine green (ICG).
Methods
A systematic review with meta-analyses was conducted. Study inclusion criteria were A) low- and intermediate-risk endometrial cancer, B) the use of ICG per cervical injection; C) a minimum of twenty included patients per study. To assess the negative predictive value of SLN mapping, D) a subsequent lymphadenectomy was an additional inclusion criterion.
Results
Fourteen studies were selected, involving 2,117 patients. The overall and bilateral SLN detection rates were 95.6% (95% confidence interval [CI]=92.4%–97.9%) and 76.5% (95% CI=68.1%–84.0%), respectively. The incidence of SLN metastases was 9.6% (95% CI=5.1%–15.2%) in patients with grade 1–2 endometrial cancer and 11.8% (95% CI=8.1%–16.1%) in patients with grade 1–3 endometrial cancer. The negative predictive value of SLN mapping was 100% (95% CI=98.8%–100%) in studies that included grade 1–2 endometrial cancer and 99.2% (95% CI=97.9%–99.9%) in studies that also included grade 3.
Conclusion
SLN mapping with ICG is feasible with a high detection rate and negative predictive value in low- and intermediate-risk endometrial cancers. Given the incidence of SLN metastases is approximately 10% in those patients, SLN mapping may lead to stage shifting with potential therapeutic consequences. Given the high negative predictive value with SLN mapping, routine lymphadenectomy should be omitted in low- and intermediate-risk endometrial cancer.
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