Skip to main content

Advertisement

SpringerLink
Log in

Retrospective validation of the laparoscopic ICG SLN mapping in patients with grade 3 endometrial cancer

  • Original Article – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the sensitivity, negative predictive value (NPV) and false-negative (FN) rate of the near infrared (NIR) indocyanine green (ICG) sentinel lymph node (SLN) mapping in patients with poorly differentiated endometrial cancer who have undergone a full pelvic and para-aortic lymphadenectomy after SLN mapping.

Methods

We performed a retrospective analysis of patients with endometrial cancer undergoing a laparoscopic NIR-ICG SLN mapping followed by a systematic pelvic and para-aortic lymphadenectomy. Inclusion criteria were a grade 3 endometrial cancer or a high-risk histology (papillary serous, clear cell carcinoma, carcinosarcoma, and neuroendocrine carcinoma) and a completion pelvic and para-aortic lymphadenectomy to the renal vessels after SLN mapping. Overall and bilateral detection rates, sensitivity, NPV, and FN rates were calculated.

Results

From December 2012 until January 2017, 42 patients fulfilled inclusion criteria. Overall and bilateral detection rates were 100 and 90.5%, respectively. Overall, 23.8% of the patients had lymph node metastases. In one patient, despite negative bilateral pelvic SLNs, a metastatic non-SLN-isolated para-aortic metastasis was detected. This NSLN was clinically suspicious and sent to frozen section analysis during the surgery. FN rate, sensitivity, and NPV were 10, 90, and 97.1%, respectively. For the SLN mapping algorithm, FN rate, sensitivity, and NPV were 0, 100, and 100%, respectively.

Conclusions

Laparoscopic NIR-ICG SLN mapping in high-risk endometrial cancer patients has acceptable sensitivity, FN rate, and NPV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • ASTEC Study Group, Kitchener H, Swart AM et al (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 373:125–136

    Article  Google Scholar 

  • Ballester M, Dubernard G, Lécuru F et al (2011) Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTI-ENDO). Lancet Oncol 12:469–476

    Article  PubMed  Google Scholar 

  • Barlin JN, Khoury-Collado F, Kim CH et al (2012) The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: beyond removal of blue nodes. Gynecol Oncol 125:531–535

    Article  PubMed  Google Scholar 

  • Benedetti Panici P, Basile S, Maneschi F et al (2008) Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 100:1707–1716

    Article  PubMed  Google Scholar 

  • Buda A, Papadia A, Zapardiel I, Vizza E, Ghezzi F, De Ponti E, Lissoni AA, Imboden S, Diestro MD, Verri D, Gasparri ML, Bussi B, Di Martino G, de la Noval BD, Mueller M, Crivellaro C (2016) From conventional radiotracer Tc-99(m) with blue dye to indocyanine green fluorescence: a comparison of methods towards optimization of sentinel lymph node mapping in early stage cervical cancer for a laparoscopic approach. Ann Surg Oncol 23:2959–2965

    Article  PubMed  Google Scholar 

  • Buda A, Papadia A, Di Martino G, Imboden S, Bussi B, Guerra L, De Ponti E, Reato C, Gasparri ML, Crivellaro C, Mueller M (2017) Real-time fluorescent sentinel lymph node mapping with indocyanine green in women with previous conization undergoing laparoscopic surgery for early invasive cervical cancer: comparison with radiotracer ± blue dye. J Minim Invasive Gynecol 25:455–460

    Article  PubMed  Google Scholar 

  • Colombo N, Creutzberg C, Amant F et al (2016) ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Ann Oncol 27:16–41

    Article  PubMed  CAS  Google Scholar 

  • Creasman WT, Morrow CP, Bundy BN et al (1987) Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer 60:2035–2041

    Article  PubMed  CAS  Google Scholar 

  • Di Martino G, Crivellaro C, De Ponti E, Bussi B, Papadia A, Zapardiel I, Vizza E, Elisei F, Diestro MD, Locatelli L, Gasparri ML, Di Lorenzo P, Mueller M, Buda A (2017) Indocyanine green versus radiotracer with or without blue dye for sentinel lymph node mapping in stage> IB1 cervical cancer (> 2 cm). J Minim Invasive Gynecol 24:954–959

    Article  PubMed  Google Scholar 

  • Ditto A, Martinelli F, Bogani G et al (2015) Sentinel node mapping using hysteroscopic injection of indocyanine green and laparoscopic near-infrared fluorescence imaging in endometrial cancer staging. J Minim Invasive Gynecol 22:132–133

    Article  PubMed  Google Scholar 

  • Ducie JA, Eriksson AGZ, Ali N et al (2017) Comparison of a sentinel lymph node mapping algorithm and comprehensive lymphadenectomy in the detection of stage IIIC endometrial carcinoma at higher risk for nodal disease. Gynecol Oncol 147:541–548

    Article  PubMed  Google Scholar 

  • Ehrisman J, Secord AA, Berchuck A et al (2016) Performance of sentinel lymph node biopsy in high-risk endometrial cancer. Gynecol Oncol Rep 17:69–71

    Article  PubMed  PubMed Central  Google Scholar 

  • Eriksson AG, Montovano M, Beavis A et al (2016) Impact of obesity on sentinel lymph node mapping in patients with newly diagnosed uterine cancer undergoing robotic surgery. Ann Surg Oncol 23:2522–2528

    Article  PubMed  Google Scholar 

  • FIGO (1989) FIGO stages 1988 revision. Gynecol Oncol 35:125–127

    Article  Google Scholar 

  • Geppert B, Lönnerfors C, Bollino M et al (2017) A study on uterine lymphatic anatomy for standardization of pelvic sentinel lymph node detection in endometrial cancer. Gynecol Oncol 45:256–261

    Article  Google Scholar 

  • Holloway RW, Ahmad S, Kendrick JE et al (2017) A prospective cohort study comparing colorimetric and fluorescent imaging for sentinel lymph node mapping in endometrial cancer. Ann Surg Oncol 24:1972–1979

    Article  PubMed  Google Scholar 

  • Imboden S, Papadia A, Nauwerk M, McKinnon B, Kollmann Z, Mohr S, Lanz S, Mueller MD (2015) A comparison of radiocolloid and indocyanine green fluorescence imaging, sentinel lymph node mapping in patients with cervical cancer undergoing laparoscopic surgery. Ann Surg Oncol 22:4198–4203

    Article  PubMed  PubMed Central  Google Scholar 

  • Krohne TU, Allam JP, Novak N, Holz FG (2016) “Iodine allergy”: a medical myth with risks for the ophthalmological patient. Ophthalmologe 113:1023–1028

    Article  PubMed  CAS  Google Scholar 

  • Kumar S, Medeiros F, Dowdy SC et al (2012) A prospective assessment of the reliability of frozen section to direct intraoperative decision making in endometrial cancer. Gynecol Oncol. 127:525–531

    Article  PubMed  Google Scholar 

  • Kumar S, Podratz KC, Bakkum-Gamez JN et al (2014) Prospective assessment of the prevalence of pelvic, paraaortic and high paraaortic lymph node metastasis in endometrial cancer. Gynecol Oncol 132:38–43

    Article  PubMed  Google Scholar 

  • Laufer J, Scasso S, Papadia A et al (2013) Association between tumor diameter and lymphovascular space invasion among women with early-stage endometrial cancer. Int J Gynaecol Obstet 123:142–145

    Article  PubMed  Google Scholar 

  • Morotti M, Menada MV, Moioli M et al (2012) Frozen section pathology at time of hysterectomy accurately predicts endometrial cancer in patients with preoperative diagnosis of atypical endometrial hyperplasia. Gynecol Oncol 125:536–540

    Article  PubMed  Google Scholar 

  • Naoura I, Canlorbe G, Bendifallah S et al (2015) Relevance of sentinel lymph node procedure for patients with high-risk endometrial cancer. Gynecol Oncol 136:60–64

    Article  PubMed  Google Scholar 

  • NCCN (2014) NCCN Clinical Practice Guidelines in Oncology. Uterine Neoplasms. Version 2.2014. http://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf

  • Papadia A, Azioni G, Brusacà B et al (2009) Frozen section underestimates the need for surgical staging in endometrial cancer patients. Int J Gynecol Cancer 19:1570–1573

    Article  PubMed  Google Scholar 

  • Papadia A, Imboden S, Siegenthaler F et al (2016a) Laparoscopic Indocyanine green sentinel lymph node mapping in endometrial cancer. Ann Surg Oncol 23:2206–2211

    Article  PubMed  PubMed Central  Google Scholar 

  • Papadia A, Imboden S, Gasparri ML et al (2016b) Endometrial and cervical cancer patients with multiple sentinel lymph nodes at laparoscopic ICG mapping: How many are enough? J Cancer Res Clin Oncol 142:1831–1836

    Article  PubMed  CAS  Google Scholar 

  • Papadia A, Gasparri ML, Siegenthaler F et al (2017a) FIGO stage IIIC endometrial cancer identification among patients with complex atypical hyperplasia, grade 1 and 2 endometrioid endometrial cancer: laparoscopic indocyanine green sentinel lymph node mapping versus frozen section of the uterus, why get around the problem? J Cancer Res Clin Oncol 143:491–497

    Article  PubMed  Google Scholar 

  • Papadia A, Gasparri ML, Buda A et al (2017b) Are allergic reactions to indocyaninegreen really that uncommon? A single institution experience. Obstet Gynecol Rep 1:1–2

    Article  Google Scholar 

  • Papadia A, Zapardiel I, Bussi B et al (2017c) Sentinel lymph node mapping in patients with stage I endometrial carcinoma: a focus on bilateral mapping identification by comparing radiotracer Tc99m with blue dye versus indocyanine green fluorescent dye. J Cancer Res Clin Oncol 143:475–480

    Article  PubMed  CAS  Google Scholar 

  • Papadia A, Gasparri ML, Buda A et al (2017d) Sentinel lymph node mapping in endometrial cancer: comparison of fluorescence dye with traditional radiocolloid and blue. J Cancer Res Clin Oncol 143:2039–2048

    Article  PubMed  CAS  Google Scholar 

  • Papadia A, Zapardiel I, Bussi B, Ghezzi F, Ceccaroni M, De Ponti E, Elisei F, Imboden S, de la Noval BD, Gasparri ML, Di Martino G, De Santiago J, Mueller M, Vecchione F, Dell’Orto F, Buda A (2017e) Sentinel lymph node mapping in patients with stage I endometrial carcinoma: a focus on bilateral mapping identification by comparing radiotracer Tc99(m) with blue dye versus indocyanine green fluorescent dye. J Cancer Res Clin Oncol 143:475–480

    Article  PubMed  CAS  Google Scholar 

  • Rossi EC, Kowalski LD, Scalici J et al (2017) A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. Lancet Oncol 18:384–392

    Article  PubMed  Google Scholar 

  • Ruscito I, Gasparri ML, Braicu EI et al (2016) Sentinel node mapping in cervical and endometrial cancer: indocyanine green versus other conventional dyes—a meta-analysis. Ann Surg Oncol 23:3749–3756

    Article  PubMed  Google Scholar 

  • Sala P, Morotti M, Menada MV et al (2014) Intraoperative frozen section risk assessment accurately tailors the surgical staging in patients affected by early-stage endometrial cancer: the application of 2 different risk algorithms. Int J Gynecol Cancer 24:1021–1026

    Article  PubMed  Google Scholar 

  • Sinno AK, Fader AN, Roche KL et al (2014) A comparison of colorimetric versus fluorometric sentinel lymph node mapping during robotic surgery for endometrial cancer. Gynecol Oncol 134:281–286

    Article  PubMed  Google Scholar 

  • Sinno AK, Peijnenburg E, Fader AN et al (2016) Reducing overtreatment: A comparison of lymph node assessment strategies for endometrial cancer. Gynecol Oncol 143:281–286

    Article  PubMed  Google Scholar 

  • Soliman PT, Westin SN, Dioun S et al (2017) A prospective validation study of sentinel lymph node mapping for high-risk endometrial cancer. Gynecol Oncol 146:234–239

    Article  PubMed  PubMed Central  Google Scholar 

  • Tanner EJ, Sinno AK, Stone RL et al (2015) Factors associated with successful bilateral sentinel lymph node mapping in endometrial cancer. Gynecol Oncol 138:542–547

    Article  PubMed  Google Scholar 

  • Touhami O, Grégoire J, Renaud MC et al (2017) Performance of sentinel lymph node (SLN) mapping in high-risk endometrial cancer. Gynecol Oncol 147:549–553

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Effingerstrasse 102, 3010, Bern, Switzerland

    Andrea Papadia, Maria Luisa Gasparri, Anda P. Radan, Chantal A. L. Stämpfli & Michael D. Mueller

  2. Dipartimento Assistenziale Integrato Ostetricia e Ginecologia, Perinatologia e Puericultura, “Sapienza” University of Rome, Rome, Italy

    Maria Luisa Gasparri

  3. Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, Rome, Italy

    Maria Luisa Gasparri

  4. Institute of Pathology, University of Bern, Murtenstrasse 31, 3008, Bern, Switzerland

    Tilman T. Rau

Authors
  1. Andrea Papadia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Luisa Gasparri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anda P. Radan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chantal A. L. Stämpfli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tilman T. Rau
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael D. Mueller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrea Papadia.

Ethics declarations

Conflict of interest

None of the authors have any conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Papadia, A., Gasparri, M.L., Radan, A.P. et al. Retrospective validation of the laparoscopic ICG SLN mapping in patients with grade 3 endometrial cancer. J Cancer Res Clin Oncol 144, 1385–1393 (2018). https://doi.org/10.1007/s00432-018-2648-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-018-2648-y

Keywords

Search

Navigation