Gynecologic Oncology Unit, University Hospital Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus and Autonomous University of Barcelona (UAB), Spain.
Gynecologic Oncology Unit, University Hospital of Bellvitge (IDIBELL), Barcelona, Spain.
Gynecol Oncol. 2021 Jul;162(1):32-37. doi: 10.1016/j.ygyno.2021.05.002. Epub 2021 May 13.
There is scarce evidence available about the benefit of combining technetium (Tc) and indocyanine green (ICG) for sentinel lymph node (SLN) biopsy in endometrial cancer. The aim of this study was to compare the overall and bilateral pelvic detection rates of SLNs in two retrospective cohorts: ICG exclusive vs. combined ICG+Tc.
The COMBITEC study (COMBined ICG and Technetium for SLN detection in Endometrial Cancer) consisted of a multicentre retrospective study (February 2015-June 2020) including patients diagnosed with endometrial atypical hyperplasia or early-stage endometrial carcinoma who underwent SLN biopsy by cervical injection of ICG with or without Tc in four different referral centers in Spain.
A total of 180 patients were included, 51% (n = 92) in ICG group and 49% (n = 88) in ICG+Tc group. Eighty-seven percent of the patients presented endometrioid histology, and over 99% of the procedures were performed by a minimally invasive approach. Both groups were comparable regarding their basal characteristics, except for a higher body mass index in ICG+Tc group and a bigger proportion of robotic-assisted procedures in ICG group. Overall detection rate was 92.8% without significant differences between groups (ICG: 94.6% vs ICG+Tc: 90.9%, p = .34). No significant differences were observed neither in bilateral pelvic nor aortic mapping rate. When Tc was used, surgical procedures were significantly longer. In 7.3% of mapped patients, at least one positive SLN was found (ICG: 10.3% vs ICG+Tc: 3.9%, p = .109). Empty node packet rates and number of SLNs retrieved per patient were also similar between cohorts.
Combining preoperative Tc to intraoperative ICG did not improve SLN detection in endometrial cancer, but resulted in longer procedures.
关于联合锝（Tc）和吲哚菁绿（ICG）进行子宫内膜癌前哨淋巴结（SLN）活检的益处，目前证据有限。本研究旨在比较两种回顾性队列中 SLN 的总体和双侧盆腔检测率：ICG 单独使用与 ICG+Tc 联合使用。
COMBITEC 研究（COMBined ICG 和 Technetium 用于子宫内膜癌 SLN 检测）是一项多中心回顾性研究（2015 年 2 月至 2020 年 6 月），包括在西班牙四个不同转诊中心接受经宫颈注射 ICG 联合或不联合 Tc 进行 SLN 活检的诊断为子宫内膜非典型增生或早期子宫内膜癌的患者。
共纳入 180 例患者，ICG 组 51%（n=92），ICG+Tc 组 49%（n=88）。87%的患者为子宫内膜样组织学，99%以上的手术均采用微创方法进行。两组的基本特征相似，除了 ICG+Tc 组的体重指数较高和 ICG 组的机器人辅助手术比例较高外。总体检测率为 92.8%，两组之间无显著差异（ICG：94.6%vsICG+Tc：90.9%，p=0.34）。双侧盆腔或主动脉映射率也无显著差异。当使用 Tc 时，手术时间明显延长。在 7.3%的映射患者中，至少发现一个阳性 SLN（ICG：10.3%vsICG+Tc：3.9%，p=0.109）。映射患者的空节点包率和每位患者的 SLN 数量也相似。
在子宫内膜癌中，术前 Tc 联合术中 ICG 并不能提高 SLN 检测率，但会导致手术时间延长。
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