J Gynecol Oncol.  2017 Mar;28(2):e13. 10.3802/jgo.2017.28.e13.

The detection of sentinel lymph nodes in laparoscopic surgery for uterine cervical cancer using 99m-technetium-tin colloid, indocyanine green, and blue dye

• Tanaka T
• Terai Y
• Ashihara K
• Tsunetoh S
• Akagi H
• Yamada T
• Ohmichi M

• KMID: 2413455
• DOI: http://doi.org/10.3802/jgo.2017.28.e13

Abstract

OBJECTIVE
Our objective was to determine the feasibility and detection rates and clarify the most effective combination of injected tracer types for sentinel lymph node (SLN) mapping in uterine cervical cancer in patients who have undergone laparoscopic surgery or neoadjuvant chemotherapy (NAC).
METHODS
A total of 119 patients with cervical cancer underwent SLN biopsy at radical hysterectomy using three types of tracers. The various factors related to side-specific detection rate, sensitivity, and false negative (FN) rate were analyzed.
RESULTS
The SLN detection rates using 99m-technetium ((99m)Tc)-tin colloid, indigo carmine, and indocyanine green (ICG) were 85.8%, 20.2%, and 61.6%, respectively. The patients with ≥2-cm-diameter tumors and those who received NAC had lower detection rates than those with <2-cm-diameter tumors (75.7% vs. 91.5%, p<0.01) and those who did not receive NAC (67.9% vs. 86.3%, p<0.01), respectively. Laparoscopic procedures had a higher detection rate than laparotomy (100.0% vs. 77.1%, p<0.01). No factors significantly affected the sensitivity; however, the patients with ≥2-cm-diameter tumors (86.0% vs. 1.4%, p<0.01), NAC (19.4% vs. 2.2%, p<0.01), and those who underwent laparotomy (7.4% vs. 0%, p<0.01) had an unfavorable FN rate.
CONCLUSION
Among the examined tracers, (99m)Tc had the highest detection of SLN mapping in patients with uterine cervical cancer. Patients with local advanced cervical cancer with/without NAC treatment might be unsuited for SLN mapping. SLN mapping is feasible and results in an excellent detection rate in patients with <2-cm-diameter cervical cancer. Laparoscopic surgery is the best procedure for SLN detection in patients with early-stage disease.

Keyword

Cervical Cancer; Sentinel Lymph Node; Laparoscopic Surgery; Pelvic Lymph Node; Lymph Node Metastasis

MeSH Terms

Adenocarcinoma/diagnostic imaging/pathology
Adult
Carcinoma, Squamous Cell/diagnostic imaging/*pathology/surgery
Coloring Agents
Female
Humans
*Indocyanine Green
Laparoscopy
Middle Aged
*Radiopharmaceuticals
Retrospective Studies
Sensitivity and Specificity
Sentinel Lymph Node/diagnostic imaging/*pathology
Sentinel Lymph Node Biopsy/*methods
*Technetium Compounds
*Tin Compounds
Uterine Cervical Neoplasms/diagnostic imaging/*pathology/surgery
Coloring Agents
Radiopharmaceuticals
Technetium Compounds
Tin Compounds
Indocyanine Green