Laparoscopic sentinel node detection with indocyanine green and near-infrareted fluorescence imaging for cervical cancer

Abstract

Objective: Radical hysterectomy with pelvic lymphadenectomy is standard therapy for cervical cancer. The standard surgical lymph node assessment is a systematic lymphadenectomy, but the procedure is associated with lymphedema and lymphocysts. A sentinel lymph node (SLN) is the first node draining the lymphatic flow from a primary tumor. If the SLN is negative for metastasis, nodes after the SLN are also considered to be negative. We report our experience using a new laparoscopic fluorescence imaging system with indocyanine green (ICG) for SLN detection with cervical cancer.
Methods: Participants included 12 patients treated from April 2014 to April 2015. Median age was 41.8 years (range, 27-56years) and median body mass index was 20.2 kg/m² (range, 15-31 years). Patients underwent SLN mapping by intracervical injection of ICG at 3 and 9 o'clock positions. Following SLN mapping, radical hysterectomy and pelvic lymphadenectomy was performed.
Result: Median SLN count was 2.8 (range, 1-7). The overall and bilateral detection rate was 100% (12/12) and 83% (10/12), respectively. Positive SLNs were identified in 2 of 12 patients (16%). SLNs were identifided in the external iliac, internal iliac, obturator and common iliac regions and sensitivity, specificity and NPV were all 100%.
Conclusions: Fluorescence imaging using ICG is a feasible and safe method for SLN detection. In the future, this technique may represent a useful treatment for patients with early cervical cancer.