Detection of sentinel lymph nodes in minimally invasive surgery using indocyanine green and near-infrared fluorescence imaging for uterine and cervical malignancies

Abstract Objectives Our primary objective was to assess the detection rate of sentinel lymph nodes (SLNs) using indocyanine green (ICG) and near-infrared (NIR) fluorescence imaging for uterine and cervical malignancies. Methods NIR fluorescence imaging for the robotic platform was obtained at our in...

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Bibliographic Details
Published in:Gynecologic oncology 2014-05, Vol.133 (2), p.274-277
Main Authors: Jewell, Elizabeth L, Huang, Juan Juan, Abu-Rustum, Nadeem R, Gardner, Ginger J, Brown, Carol L, Sonoda, Yukio, Barakat, Richard R, Levine, Douglas A, Leitao, Mario M
Format: Article
Language:English
Subjects:
Adenocarcinoma - pathology
Adult
Aged
Aged, 80 and over
Carcinosarcoma - pathology
Cervical cancer
Cervix Uteri - pathology
Coloring Agents
Female
Hematology, Oncology and Palliative Medicine
Humans
Indocyanine Green
Leiomyosarcoma - pathology
Lymph Nodes - pathology
Lymphatic Metastasis
Middle Aged
Minimally Invasive Surgical Procedures - methods
Near-infrared fluorescence imaging
Obstetrics and Gynecology
Optical Imaging - methods
Sentinel lymph node
Sentinel Lymph Node Biopsy - methods
Sentinel lymph node mapping
Spectroscopy, Near-Infrared - methods
Uterine cancer
Uterine Cervical Neoplasms - pathology
Uterine Neoplasms - pathology
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Summary:Abstract Objectives Our primary objective was to assess the detection rate of sentinel lymph nodes (SLNs) using indocyanine green (ICG) and near-infrared (NIR) fluorescence imaging for uterine and cervical malignancies. Methods NIR fluorescence imaging for the robotic platform was obtained at our institution in 12/2011. We identified all cases planned for SLN mapping using fluorescence imaging from 12/2011–4/2013. Intracervical ICG was the fluorophobe in all cases. Four cc (1.25 mg/mL) of ICG was injected into the cervix alone divided into the 3- and 9-o'clock positions, with 1 cc deep into the stroma and 1 cc submucosally before initiating laparoscopic entry. Blue dye was concurrently injected in some cases. Results Two hundred twenty-seven cases were performed. Median age was 60 years (range, 28–90 years). Median BMI was 30.2 kg/m2 (range, 18–60 kg/m2 ). The median SLN count was 3 (range, 1–23 ). An SLN was identified in 216 cases (95%), with bilateral pelvic mapping in 179 (79%). An aortic SLN was identified in 21 (10%) of the 216 mapped cases. When ICG alone was used to map cases, 188/197 patients mapped, for a 95% detection rate compared to 93% (28/30) in cases in which both dyes were used ( P = NS). Bilateral mapping was seen in 156/197 (79%) ICG-only cases and 23/30 (77%) ICG and blue dye cases ( P = NS). Conclusions NIR fluorescence imaging with intracervical ICG injection using the robotic platform has a high bilateral SLN detection rate and appears favorable to using blue dye alone and/or other modalities. Combined use of ICG and blue dye appears unnecessary.
ISSN:0090-8258
1095-6859
DOI:10.1016/j.ygyno.2014.02.028