Gómez-Hidalgo Natalia R, Cabrera Silvia, Bebia Vicente, García-Pineda Virginia, Padilla-Iserte Pablo, Fabregas Francesc Fargas, Fuste Pere, Alonso Paula, Rodriguez Tomas Gómez, Fernandez-Gonzalez Sergi, Chacon Enrique, Alvarez Jose Antonio Pérez, Oliver Reyes, Gil-Moreno Antonio
Unit of Gynecologic Oncology, Service of Gynecology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Unit of Gynecology Oncology, La Santa Creu i Sant Pau Hospital, Barcelona, Spain.
Ann Surg Oncol. 2025 Jul 23. doi: 10.1245/s10434-025-17836-2.
This study aimed to evaluate the accuracy of sentinel lymph node (SLN) biopsy in endometrial cancer across Spain.
We conducted a multicenter, retrospective study including patients with stage I-II endometrial cancer (according to International Federation of Gynecology and Obstetrics [FIGO] 2009 criteria, all histologies and grades) who underwent SLN mapping from 2015 to 2022. Indocyanine green (ICG), ICG + technetium-99m (99mTC) and 99mTC with different sites of injections (cervical, uterus, or both) were used. Twenty-nine Spanish centers were enrolled.
Overall, 1221 patients were analyzed. The median number of resected SLNs was 2 (interquartile range 1-3); 526 (43%) patients received ICG, 332 (27.1%) patients received ICG + 99mTC, and 363 (29.7%) patients received 99mTC alone or with blue dye. The cervical injection was used in 1121 (92%) patients, 60 (5%) patients underwent a uterine injection, and 40 (3%) patients received both. The bilateral mapping rates were 324 (61.6%) for the ICG group, 250 (75.3%) for the ICG + 99mTC group, and 173 (47.7%) for the 99mTC group (p < 0.001). The aortic mapping rate was 18 (3.4%) for the ICG group, 38 (11.5 %) for the ICG + 99mTC group, and 25 (6.9%) for the 99mTC group, respectively (p < 0.001). Empty node packets were only diagnosed in 10 (1.6%) patients in the ICG group (p < 0.001). The sensitivity was 77% for the ICG group, 90% for the ICG + 99mTC group, and 97% for the 99mTC-alone group. The false negative rates were 6 (3.2%) for the ICG group, 2 (1.4%) for the CG + 99mTC group, and 1 (0.5%) for the 99mTC-alone group (p < 0.244).
We did not find any differences among tracers in terms of accuracy; otherwise, combining 99mTc and ICG achieved the highest overall and bilateral detection rates.
本研究旨在评估西班牙各地子宫内膜癌前哨淋巴结（SLN）活检的准确性。
我们进行了一项多中心回顾性研究，纳入了2015年至2022年期间接受SLN定位的I-II期子宫内膜癌患者（根据国际妇产科联盟[FIGO]2009标准，涵盖所有组织学类型和分级）。使用了吲哚菁绿（ICG）、ICG+锝-99m（99mTC）以及不同注射部位（宫颈、子宫或两者）的99mTC。共有29个西班牙中心参与。
总体上，对1221例患者进行了分析。切除的SLN中位数为2个（四分位间距为1-3）；526例（43%）患者接受了ICG，332例（27.1%）患者接受了ICG+99mTC，363例（29.7%）患者单独接受了99mTC或联合蓝色染料。1121例（92%）患者采用宫颈注射，60例（5%）患者进行子宫注射，40例（3%）患者两者均接受。ICG组的双侧定位率为324例（61.6%），ICG+99mTC组为250例（75.3%），99mTC组为173例（47.7%）（p<0.001）。ICG组的主动脉定位率为18例（3.4%），ICG+99mTC组为38例（11.5%），99mTC组为25例（6.9%），（p<0.001）。仅在ICG组的10例（1.6%）患者中诊断出空淋巴结包块（p<0.001）。ICG组的敏感性为77%，ICG+99mTC组为90%，单独使用99mTC组为97%。ICG组的假阴性率为6例（3.2%），ICG+99mTC组为2例（1.4%），单独使用99mTC组为1例（0.5%）（p<0.244）。
我们未发现不同示踪剂在准确性方面存在差异；否则，联合使用99mTC和ICG可实现最高的总体和双侧检测率。
