Sentinel node biopsy in endometrial cancer with dual cervical and fundal indocyanine green injection

Abstract

Purpose The aim of this study was describe a novel sentinel lymph node (SLN) tracer injection procedure featuring dual cervical and fundal indocyanine green (ICG) injection for endometrial cancer and results of SLN biopsy. Methods Between June 26, 2014 and October 31, 2016, 111 patients underwent laparoscopic surgery for endometrial cancer at our institution. In all cases, we performed SLN biopsy with dual cervical and fundal ICG injection. All SLNs were processed with an ultrastaging technique. A total of 69 patients also underwent total pelvic and paraaortic lymphadenectomy. Results The detection rates were as follows: 92.79% (103/111) overall for SLNs; 89.19% (99/111) overall for pelvic SLNs; 61.26% (68/111) for bilateral SLNs; 59.46% (66/111) for paraaortic SLNs, and 4% (4/111) for isolated paraaortic SLNs. We found macroscopic lymph node metastasis in 11 patients (9.9%) and microdisease in lymph nodes in another 10 patients, raising the overall rate of lymph node involvement to 18.92%. There was 1 false-negative (negative SLN biopsy but positive aortic lymphadenectomy) and another positive case in 1 undetected SLN. The sensitivity of detection was 94.44%, specificity 100%, negative predictive value 97.83%, and negative likelihood ratio 0.06 for intermediate and high-risk endometrial cancer groups. Conclusions The SLN biopsy with both cervical and fundal ICG injection offers good overall detection rates and improved mapping of the aortic area. The SLN ultrastaging increases the number of nodes considered positive.