Indocyanine Green Versus Radiotracer ± Blue Dye for Sentinel Lymph Node Mapping in > Stage IB1 Cervical Cancer (> 2 cm)

Abstract Study Objective To compare sentinel lymph node (SLN) mapping in women with cervical cancer stage > IB1 (tumor > 2 cm) by using indocyanine green (ICG) versus the standard radioisotope technetium 99m radiocolloid (Tc99m ) radiotracer ± blue-dye technique. Design European multicenter, retrospective observational study (Canadian Task Force Classification II-2) Setting Four academic medical centers Patients 95 women with stage IB1 (> 2 cm) who underwent SLN mapping with Tc99m ± blue dye or ICG and radical hysterectomy Intervention Detection rate and bilateral mapping rate of ICG were compared with those obtained using the standard Tc99m radiotracer ± blue dye. Lymphadenectomy was performed, and false negative rate was assessed. Measurements and Main Results Forty-seven patients underwent SLN mapping with Tc99m ± blue dye and 48 with ICG. All patients underwent radical hysterectomy with or without bilateral salpingo-oophorectomy between 2008 and 2016. The overall detection rate of SLN mapping was 91.5 and 100% for Tc99m ± blue dye and ICG, respectively. Bilateral migration was achieved for ICG (91.7%), significantly higher than the 66% obtained with Tc99m ± blue dye (p = .025). Nine of the 23 SLN-positive patients (39.1%), were exclusively diagnosed as a result of ultrastaging used to identify micrometastasis or isolated tumor cells only. Conclusions In advanced cervical cancer (stage IB1 > 2 cm) the real-time fluorescent SLN mapping with ICG achieved higher detection rate and bilateral migration rate compared with Tc99m radiotracer ± blue dye. Sentinel lymph node and ultrastaging could provide additional information for nodal staging in advanced cervical cancer. In this setting, ICG is a promising tool for mapping, as it seems less impacted by the higher stage of disease than traditional methods.