Cervical re-injection of indocyanine green to improve sentinel lymph node detection in endometrial cancer
To evaluate the role of cervical re-injection of indocyanine green (ICG) to increase the detection rate of sentinel lymph node (SLN) in patients with endometrial cancer (EC) who underwent robotic-assisted surgical staging. We retrospectively identified consecutive EC patients undergoing robotic-assi...
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| Veröffentlicht in: | Gynecologic oncology 2021-07, Vol.162 (1), p.38-42 |
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| creator | Maramai, M. Achilarre, M.T. Aloisi, A. Betella, I. Bogliolo, S. Garbi, A. Maruccio, M. Quatrale, C. Aletti, G.D. Mariani, A. Colombo, N. Maggioni, A. Multinu, F. Zanagnolo, V. |
| description | To evaluate the role of cervical re-injection of indocyanine green (ICG) to increase the detection rate of sentinel lymph node (SLN) in patients with endometrial cancer (EC) who underwent robotic-assisted surgical staging.
We retrospectively identified consecutive EC patients undergoing robotic-assisted staging with SLN biopsy at our Institution between June 2016 and April 2020. Patients were excluded if they had open abdominal surgical approach, neoadjuvant chemotherapy, and advanced stage [International Federation of Gynecology and Obstetrics (FIGO) stage III-IV] at diagnosis. According to our SLN protocol, in case of either unilateral or no SLN detection, we performed an ipsilateral or bilateral cervical re-injection of ICG.
In total, 251 patients meeting inclusion criteria were included in the analysis. At first injection, bilateral detection was achieved in 184 (73.3%), unilateral detection in 57 (22.7%), and no detection in 10 (4.0%) patients. Cervical re-injection was performed in 51 of 67 patients with failed bilateral mapping. After cervical re-injection, bilateral detection rate increased to 94.5% (222/235), while unilateral and no detection were 5.1% (12/235) and 0.4% (1/235), respectively.
Our results suggest that cervical re-injection of ICG, in case of failed bilateral mapping of SLN, brings about a significant improvement in SLN detection rates, therefore reducing the number of side-specific required lymphadenectomies.
•Cervical re-injection of ICG increases the detection rate of sentinel lymph nodes in endometrial cancer.•Compared to a single injection, re-injection allows a reduction in the number of performed side-specific lymphadenectomies.•Compared with previous studies, re-injection was not associated with an increase of ‘empty nodes’. |
| doi_str_mv | 10.1016/j.ygyno.2021.04.026 |
| format | Article |
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We retrospectively identified consecutive EC patients undergoing robotic-assisted staging with SLN biopsy at our Institution between June 2016 and April 2020. Patients were excluded if they had open abdominal surgical approach, neoadjuvant chemotherapy, and advanced stage [International Federation of Gynecology and Obstetrics (FIGO) stage III-IV] at diagnosis. According to our SLN protocol, in case of either unilateral or no SLN detection, we performed an ipsilateral or bilateral cervical re-injection of ICG.
In total, 251 patients meeting inclusion criteria were included in the analysis. At first injection, bilateral detection was achieved in 184 (73.3%), unilateral detection in 57 (22.7%), and no detection in 10 (4.0%) patients. Cervical re-injection was performed in 51 of 67 patients with failed bilateral mapping. After cervical re-injection, bilateral detection rate increased to 94.5% (222/235), while unilateral and no detection were 5.1% (12/235) and 0.4% (1/235), respectively.
Our results suggest that cervical re-injection of ICG, in case of failed bilateral mapping of SLN, brings about a significant improvement in SLN detection rates, therefore reducing the number of side-specific required lymphadenectomies.
•Cervical re-injection of ICG increases the detection rate of sentinel lymph nodes in endometrial cancer.•Compared to a single injection, re-injection allows a reduction in the number of performed side-specific lymphadenectomies.•Compared with previous studies, re-injection was not associated with an increase of ‘empty nodes’.</description><identifier>ISSN: 0090-8258</identifier><identifier>EISSN: 1095-6859</identifier><identifier>DOI: 10.1016/j.ygyno.2021.04.026</identifier><identifier>PMID: 33906784</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Endometrial cancer ; Endometrial Neoplasms - diagnosis ; Endometrial Neoplasms - pathology ; Endometrial Neoplasms - surgery ; Female ; Humans ; Hysterectomy ; Indocyanine green ; Indocyanine Green - administration & dosage ; Lymph Node Excision ; Lymph Nodes - pathology ; Lymph Nodes - surgery ; Middle Aged ; Neoplasm Staging ; Re-injection ; Retrospective Studies ; Robotic Surgical Procedures ; Salpingo-oophorectomy ; Sentinel Lymph Node - pathology ; Sentinel Lymph Node - surgery ; Sentinel lymph node algorithm ; Surgical staging</subject><ispartof>Gynecologic oncology, 2021-07, Vol.162 (1), p.38-42</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-68af7639aeff8310dd782516b1ca091360386cb373b4af4c74ef6a8140b746d03</citedby><cites>FETCH-LOGICAL-c359t-68af7639aeff8310dd782516b1ca091360386cb373b4af4c74ef6a8140b746d03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ygyno.2021.04.026$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33906784$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Maramai, M.</creatorcontrib><creatorcontrib>Achilarre, M.T.</creatorcontrib><creatorcontrib>Aloisi, A.</creatorcontrib><creatorcontrib>Betella, I.</creatorcontrib><creatorcontrib>Bogliolo, S.</creatorcontrib><creatorcontrib>Garbi, A.</creatorcontrib><creatorcontrib>Maruccio, M.</creatorcontrib><creatorcontrib>Quatrale, C.</creatorcontrib><creatorcontrib>Aletti, G.D.</creatorcontrib><creatorcontrib>Mariani, A.</creatorcontrib><creatorcontrib>Colombo, N.</creatorcontrib><creatorcontrib>Maggioni, A.</creatorcontrib><creatorcontrib>Multinu, F.</creatorcontrib><creatorcontrib>Zanagnolo, V.</creatorcontrib><title>Cervical re-injection of indocyanine green to improve sentinel lymph node detection in endometrial cancer</title><title>Gynecologic oncology</title><addtitle>Gynecol Oncol</addtitle><description>To evaluate the role of cervical re-injection of indocyanine green (ICG) to increase the detection rate of sentinel lymph node (SLN) in patients with endometrial cancer (EC) who underwent robotic-assisted surgical staging.
We retrospectively identified consecutive EC patients undergoing robotic-assisted staging with SLN biopsy at our Institution between June 2016 and April 2020. Patients were excluded if they had open abdominal surgical approach, neoadjuvant chemotherapy, and advanced stage [International Federation of Gynecology and Obstetrics (FIGO) stage III-IV] at diagnosis. According to our SLN protocol, in case of either unilateral or no SLN detection, we performed an ipsilateral or bilateral cervical re-injection of ICG.
In total, 251 patients meeting inclusion criteria were included in the analysis. At first injection, bilateral detection was achieved in 184 (73.3%), unilateral detection in 57 (22.7%), and no detection in 10 (4.0%) patients. Cervical re-injection was performed in 51 of 67 patients with failed bilateral mapping. After cervical re-injection, bilateral detection rate increased to 94.5% (222/235), while unilateral and no detection were 5.1% (12/235) and 0.4% (1/235), respectively.
Our results suggest that cervical re-injection of ICG, in case of failed bilateral mapping of SLN, brings about a significant improvement in SLN detection rates, therefore reducing the number of side-specific required lymphadenectomies.
•Cervical re-injection of ICG increases the detection rate of sentinel lymph nodes in endometrial cancer.•Compared to a single injection, re-injection allows a reduction in the number of performed side-specific lymphadenectomies.•Compared with previous studies, re-injection was not associated with an increase of ‘empty nodes’.</description><subject>Endometrial cancer</subject><subject>Endometrial Neoplasms - diagnosis</subject><subject>Endometrial Neoplasms - pathology</subject><subject>Endometrial Neoplasms - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Hysterectomy</subject><subject>Indocyanine green</subject><subject>Indocyanine Green - administration & dosage</subject><subject>Lymph Node Excision</subject><subject>Lymph Nodes - pathology</subject><subject>Lymph Nodes - surgery</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Re-injection</subject><subject>Retrospective Studies</subject><subject>Robotic Surgical Procedures</subject><subject>Salpingo-oophorectomy</subject><subject>Sentinel Lymph Node - pathology</subject><subject>Sentinel Lymph Node - surgery</subject><subject>Sentinel lymph node algorithm</subject><subject>Surgical staging</subject><issn>0090-8258</issn><issn>1095-6859</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtPwzAQhC0EgvL4BUjIRy4J6zh1kgMHVPGSkLjA2XLsDbhK7GKnlfLvcWnhyGkPOzO78xFyySBnwMTNMp8-JufzAgqWQ5lDIQ7IjEEzz0Q9bw7JDKCBrC7m9Qk5jXEJABxYcUxOOG9AVHU5I3aBYWO16mnAzLol6tF6R31HrTNeT8pZh_QjIDo6emqHVfAbpBHdmBY97adh9UmdN0gNjnu3dRSTe8Ax2JSsldMYzslRp_qIF_t5Rt4f7t8WT9nL6-Pz4u4l03zejOl11VWCNwq7ruYMjKlSAyZaphU0jAvgtdAtr3hbqq7UVYmdUDUroa1KYYCfketdbvr0a41xlIONGvteOfTrKFNYw5kQ9VbKd1IdfIwBO7kKdlBhkgzklrFcyh_GcstYQikT4-S62h9YtwOaP88v1CS43Qkw1dxYDDJqi4mBsSERksbbfw98A8sOj80</recordid><startdate>202107</startdate><enddate>202107</enddate><creator>Maramai, M.</creator><creator>Achilarre, M.T.</creator><creator>Aloisi, A.</creator><creator>Betella, I.</creator><creator>Bogliolo, S.</creator><creator>Garbi, A.</creator><creator>Maruccio, M.</creator><creator>Quatrale, C.</creator><creator>Aletti, G.D.</creator><creator>Mariani, A.</creator><creator>Colombo, N.</creator><creator>Maggioni, A.</creator><creator>Multinu, F.</creator><creator>Zanagnolo, V.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202107</creationdate><title>Cervical re-injection of indocyanine green to improve sentinel lymph node detection in endometrial cancer</title><author>Maramai, M. ; Achilarre, M.T. ; Aloisi, A. ; Betella, I. ; Bogliolo, S. ; Garbi, A. ; Maruccio, M. ; Quatrale, C. ; Aletti, G.D. ; Mariani, A. ; Colombo, N. ; Maggioni, A. ; Multinu, F. ; Zanagnolo, V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-68af7639aeff8310dd782516b1ca091360386cb373b4af4c74ef6a8140b746d03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Endometrial cancer</topic><topic>Endometrial Neoplasms - diagnosis</topic><topic>Endometrial Neoplasms - pathology</topic><topic>Endometrial Neoplasms - surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Hysterectomy</topic><topic>Indocyanine green</topic><topic>Indocyanine Green - administration & dosage</topic><topic>Lymph Node Excision</topic><topic>Lymph Nodes - pathology</topic><topic>Lymph Nodes - surgery</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>Re-injection</topic><topic>Retrospective Studies</topic><topic>Robotic Surgical Procedures</topic><topic>Salpingo-oophorectomy</topic><topic>Sentinel Lymph Node - pathology</topic><topic>Sentinel Lymph Node - surgery</topic><topic>Sentinel lymph node algorithm</topic><topic>Surgical staging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Maramai, M.</creatorcontrib><creatorcontrib>Achilarre, M.T.</creatorcontrib><creatorcontrib>Aloisi, A.</creatorcontrib><creatorcontrib>Betella, I.</creatorcontrib><creatorcontrib>Bogliolo, S.</creatorcontrib><creatorcontrib>Garbi, A.</creatorcontrib><creatorcontrib>Maruccio, M.</creatorcontrib><creatorcontrib>Quatrale, C.</creatorcontrib><creatorcontrib>Aletti, G.D.</creatorcontrib><creatorcontrib>Mariani, A.</creatorcontrib><creatorcontrib>Colombo, N.</creatorcontrib><creatorcontrib>Maggioni, A.</creatorcontrib><creatorcontrib>Multinu, F.</creatorcontrib><creatorcontrib>Zanagnolo, V.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gynecologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Maramai, M.</au><au>Achilarre, M.T.</au><au>Aloisi, A.</au><au>Betella, I.</au><au>Bogliolo, S.</au><au>Garbi, A.</au><au>Maruccio, M.</au><au>Quatrale, C.</au><au>Aletti, G.D.</au><au>Mariani, A.</au><au>Colombo, N.</au><au>Maggioni, A.</au><au>Multinu, F.</au><au>Zanagnolo, V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cervical re-injection of indocyanine green to improve sentinel lymph node detection in endometrial cancer</atitle><jtitle>Gynecologic oncology</jtitle><addtitle>Gynecol Oncol</addtitle><date>2021-07</date><risdate>2021</risdate><volume>162</volume><issue>1</issue><spage>38</spage><epage>42</epage><pages>38-42</pages><issn>0090-8258</issn><eissn>1095-6859</eissn><abstract>To evaluate the role of cervical re-injection of indocyanine green (ICG) to increase the detection rate of sentinel lymph node (SLN) in patients with endometrial cancer (EC) who underwent robotic-assisted surgical staging.
We retrospectively identified consecutive EC patients undergoing robotic-assisted staging with SLN biopsy at our Institution between June 2016 and April 2020. Patients were excluded if they had open abdominal surgical approach, neoadjuvant chemotherapy, and advanced stage [International Federation of Gynecology and Obstetrics (FIGO) stage III-IV] at diagnosis. According to our SLN protocol, in case of either unilateral or no SLN detection, we performed an ipsilateral or bilateral cervical re-injection of ICG.
In total, 251 patients meeting inclusion criteria were included in the analysis. At first injection, bilateral detection was achieved in 184 (73.3%), unilateral detection in 57 (22.7%), and no detection in 10 (4.0%) patients. Cervical re-injection was performed in 51 of 67 patients with failed bilateral mapping. After cervical re-injection, bilateral detection rate increased to 94.5% (222/235), while unilateral and no detection were 5.1% (12/235) and 0.4% (1/235), respectively.
Our results suggest that cervical re-injection of ICG, in case of failed bilateral mapping of SLN, brings about a significant improvement in SLN detection rates, therefore reducing the number of side-specific required lymphadenectomies.
•Cervical re-injection of ICG increases the detection rate of sentinel lymph nodes in endometrial cancer.•Compared to a single injection, re-injection allows a reduction in the number of performed side-specific lymphadenectomies.•Compared with previous studies, re-injection was not associated with an increase of ‘empty nodes’.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33906784</pmid><doi>10.1016/j.ygyno.2021.04.026</doi><tpages>5</tpages></addata></record> |
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| subjects | Endometrial cancer Endometrial Neoplasms - diagnosis Endometrial Neoplasms - pathology Endometrial Neoplasms - surgery Female Humans Hysterectomy Indocyanine green Indocyanine Green - administration & dosage Lymph Node Excision Lymph Nodes - pathology Lymph Nodes - surgery Middle Aged Neoplasm Staging Re-injection Retrospective Studies Robotic Surgical Procedures Salpingo-oophorectomy Sentinel Lymph Node - pathology Sentinel Lymph Node - surgery Sentinel lymph node algorithm Surgical staging |
| title | Cervical re-injection of indocyanine green to improve sentinel lymph node detection in endometrial cancer |
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