Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden; Department of Obstetrics and Gynecology, Centralsjukhuset Kristianstad, SE-291 33 Kristianstad, Sweden.
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden.
Gynecol Oncol. 2020 Feb;156(2):335-340. doi: 10.1016/j.ygyno.2019.11.026. Epub 2019 Nov 26.
To investigate whether combining two independent tracers increases the SLN-detection rate in cervical cancer.
Consecutive women with early stage cervical cancer planned for a robotic radical hysterectomy or a robotic radical trachelectomy with sentinel lymph node (SLN) detection were included. After cervical injections of Indocyanine green (ICG) and Tc-nanocolloid (Tc), near-infrared fluorescence imaging and a gamma probe were used to identify SLNs in the upper and lower paracervical pathways (UPP/LPP). A strict surgical algorithm was adhered to and the SLNs were defined as SLN-ICG, SLN-ICG+Tc or SLN-Tc. In FIGO-stage ≥IA2 cancers a full pelvic lymph node dissection (PLND) was performed after detection of SLNs. The primary endpoint was the SLN detection rate per tracer and combination of tracers. Secondary endpoints were sensitivity and mapping rates of the SLN algorithm per tracer and combination of tracers.
In the sixty-five analyzed women, the bilateral mapping rate was 98.5% for ICG and 60% for Tc (p < 0.01). Combining the tracers did not increase the bilateral detection rate. In three women (5%) Tc identified ICG-negative non-metastatic SLNs without impact on the bilateral detection rate. Eight women (12%) had lymph node metastases (LNMs), all had at least one metastatic SLN. Seven (35%) of the 20 metastatic SLNs were detected by ICG only and 12 (60%) were ICG and Tc positive.
SLN detection rate was significantly higher using ICG compared with Tc. ICG identified all patients with LNMs. Combining ICG and Tc did not improve the bilateral detection rate of SLNs.
研究两种独立示踪剂联合应用是否能提高宫颈癌前哨淋巴结（SLN）的检出率。
连续纳入计划行机器人根治性子宫切除术或机器人根治性宫颈切除术及 SLN 检测的早期宫颈癌患者。在宫颈注射吲哚菁绿（ICG）和 Tc-纳米胶体（Tc）后，使用近红外荧光成像和伽马探针来识别上、下子宫旁途径（UPP/LPP）中的 SLN。严格遵循手术算法，将 SLN 定义为 ICG-SLN、ICG+Tc-SLN 或 Tc-SLN。在 FIGO 分期≥IA2 的癌症中，在检出 SLN 后行全盆腔淋巴结清扫术（PLND）。主要终点是每个示踪剂和示踪剂组合的 SLN 检出率。次要终点是每个示踪剂和示踪剂组合的 SLN 算法的敏感性和绘图率。
在 65 例分析的患者中，ICG 的双侧绘图率为 98.5%，Tc 为 60%（p<0.01）。联合使用示踪剂并未增加双侧检出率。在 3 名患者（5%）中，Tc 识别出了 ICG 阴性的非转移性 SLN，而不影响双侧检出率。8 名患者（12%）有淋巴结转移（LNM），所有患者均至少有一个转移性 SLN。7 个（35%）转移性 SLN 仅被 ICG 检出，12 个（60%）为 ICG 和 Tc 阳性。
与 Tc 相比，ICG 检测 SLN 的检出率显著更高。ICG 可识别所有 LNM 患者。联合使用 ICG 和 Tc 并未提高 SLN 的双侧检出率。
