Reproducibility of sentinel node detection in endometrial cancer by ICG fundic & cervical injection

Abstract

Objective: The aim of this study is to study the reproducibility of the dual injection technique of IndoCyanine Green (ICG) in the cervix and fundus in endometrial cancer. Methods: Between June 2014, and December 2019, 278 patients underwent laparoscopic surgery for endometrial cancer at our institution. In all cases, under a prospective cohort study, we performed Sentinel Lymph Node (SLN) biopsy with dual cervical and fundal ICG injection. Lymphadenectomy was also performed if intermediate or high-risk criteria were present. All cases were performed independently by three surgeons, with the same protocol and system, and their results were compared. Results: Global, aortic, pelvic and bilateral pelvic detection rates (DRs) were 93.45%, 67.27%, 90.18% and 67.64%. There were no significant differences for DRs between the three surgeons. The probability of finding a positive SLN was 8.8% (SD 2.8), 21% (SD 4.1) and 12% (SD 3.3), respectively, with a significant chi-squared difference (p = 0.041), which was statistically associated with preoperative risk factors (p< 0.001) and not to a surgeon's factor in a multivariate logistic regression. Conclusions: The SLN biopsy with both cervical and fundal ICG injection offers good overall detection rates and improved mapping of the aortic area and can be reproduced with similar results among different surgeons.