Papadia Andrea, Gasparri Maria Luisa, Buda Alessandro, Mueller Michael D
Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Effingerstrasse 102, 3010, Bern, Switzerland.
Department of Gynecology Obstetrics and Urology, Sapienza University of Rome, Rome, Italy.
J Cancer Res Clin Oncol. 2017 Oct;143(10):2039-2048. doi: 10.1007/s00432-017-2501-8. Epub 2017 Aug 21.
Sentinel lymph node (SLN) mapping in endometrial cancer (EMCA) is rapidly gaining acceptance in the clinical community. As compared to a full lymphadenectomy in every patient, to a selective lymphadenectomy after frozen section of uterus in selected patients with intrauterine risk factors or to a strategy in which a lymphadenectomy is always omitted, SLN mapping seems to be a reasonable and oncologically safe middle ground. Various protocols can be used when applying an SLN mapping. In this manuscript we review the characteristics, toxicity and clinical impact of technetium-99m radiocolloid (Tc-99m), of the blue dyes (methylene blue, isosulfan blue and patent blue) and of indocyanine green (ICG). ICG has an excellent toxicity profile, has higher overall and bilateral detection rates as compared to blue dyes and higher bilateral detection rates as compared to a combination of Tc-99m and blue dye. The detrimental effect of BMI on the detection rates is attenuated when ICG is used as a tracer. The ease of use of the ICG SLN mapping is perceived by the patients as a better quality of care delivered. Whenever possible, ICG should be favored over the other tracers for SLN mapping in EMCA patients.
前哨淋巴结（SLN）定位在子宫内膜癌（EMCA）中正在迅速获得临床界的认可。与对每位患者进行全面淋巴结清扫术、对有子宫内危险因素的选定患者在子宫冰冻切片后进行选择性淋巴结清扫术或始终省略淋巴结清扫术的策略相比，SLN定位似乎是一个合理且肿瘤学上安全的中间立场。应用SLN定位时可使用各种方案。在本手稿中，我们回顾了99m锝放射性胶体（Tc-99m）、蓝色染料（亚甲蓝、异硫蓝和专利蓝）以及吲哚菁绿（ICG）的特性、毒性和临床影响。ICG具有出色的毒性特征，与蓝色染料相比，总体和双侧检测率更高，与Tc-99m和蓝色染料联合使用相比，双侧检测率更高。当使用ICG作为示踪剂时，BMI对检测率的不利影响会减弱。患者认为ICG SLN定位使用方便，所提供的护理质量更高。只要有可能，在EMCA患者的SLN定位中，ICG应优于其他示踪剂。
