The role of sentinel node mapping with indocyanine green and endoscopic near-infrared fluorescence imaging in endometrial and cervical cancer

Introduction: Endometrial and cervical carcinoma are common neoplasms in gynecological oncology. The prognosis and treatment depend on the stage of the cancer according to the FIGO staging system. Stage IA1 may be treated by hysterectomy or even local surgical procedures. For Stage IA2, radical hysterectomy and lymphadenectomy must be performed. Lymph node metastasis is an important prognostic factor in both cancers, however lymphadenectomy is associated with long-term complications. Thanks to the sentinel lymph node biopsy (SLNB), we can more accurately discover the staging of the primary tumor, and in case of sentinel lymph node (SLN) negative patients, can resign regional lymphadenectomy. Some researchers claim that new techniques such as indocyanine green (ICG) and endoscopic near-infrared fluorescence imaging for sentinel node mapping can be used instead of the traditional techniques. Aim: To establish the role of sentinel node mapping technique in endometrial and cervical cancer. Material and Methods: A retrospective study of medical records of five patients with cervical cancer (first group) Stage I and nine patients (second group) who underwent laparoscopic radical hysterectomy and SLNB or group of lymph nodes. These procedures were performed at Gynecology Department of the District Hospital in Garwolin. Results: All lymph nodes were clear of metastases. All patients after histopathological diagnosis were finally referred to the Cancer Centre and Institute of Oncology due to consultation or for further treatment. Conclusion: Based on the present first results and literature review, intracervical ICG injection with fluorescence imaging seems to be the best SLN mapping technique, because of its simplicity, safety, and overall lower cost. More data is required to determine if the nodes identified with this technique are able to predict metastatic disease.

Fluorescence imaging; Lymph node metastasis; Sentinel node mapping; Endometrial and cervical carcinoma.

[1] World Health Organization: “World Cancer Report 2014”. International Agency for Research on Cancer (IARC), 2014.

[2] Kent A.:“HPV Vaccination and Testing.”. Rev. Obstet. Gynecol., 2010, 3, 33.

[3] Erstad, Shannon: “Cone biopsy (conization) for abnormal cervical cell changes”. WebMD, 2007. Available at: http://www.webmd.com/cancer/cervical-cancer/cone-biopsy-conization-for-abnormalcervical-cell-changes

[4] Kitchener H.C., Trimble E.L., the Endometrial Cancer Working Group of the Gynecologic Cancer Intergroup: “Endometrial cancer state of the science meeting”. Int. J. Gynecol. Cancer, 2009, 19, 134.

[5] Rodriguez M.: “Endometrial cancer: Part 1 – Epidemiology, diagnosis and work-up”. Menopause Management, 2001, 10, 19–21.

[6] Purdie D.M., Green A.C.: “Epidemiology of endometrial cancer”. Best Pract. Res. Clin. Obstet. Gynaecol., 2001, 15, 341.

[7] German Working Group on Gynaecologic Oncology: “Recommendations for diagnosis and treatment in patients with endometrial carcinoma”. Zentralb. Gynakol., 2002, 1, 58.

[8] ASTEC study group, Kitchener H., Swart A.M., Qian Q.: “Efficacy of systematic pelvic lymphadenctomy in endometrial cancer (MRC ASTEC trial): a randomised study”. Lancet, 2009, 373, 125.

[9] Pawłowicz P., Ajdacka U.: “The role of laparoscopy in the surgical treatment of endometrial cancer”. Wideochir. Inne. Tech. Maloinwazyjne., 2015, 10, 44.

[10] Geetha P., Nair M.K.: “Laparoscopic, robotic and open method of radical hysterectomy for cervical cancer: A systematic review”. J. Minim. Access. Surg., 2012, 8, 67.

[11] Shazly S.A., Murad M.H., Dowdy S.C., Gostout B.S., Famuyide A.O.: “Robotic radical hysterectomy in early stage cervical cancer: A systematic review and meta-analysis”. Gynecol Oncol., 2015, 138, 457.

[12] Bohrer J.C., Walters M.D., Park A., Polston D., Barber M.D.: “Pelvic nerve injury following gynecologic surgery: a prospective cohort study”. Am. J. Obstet. Gynecol., 2009, 201, 531 e1.

[13] Abu-Rustum N.R., Alektiar K., Iasonos A., Lev G., Sonoda Y., Aghajanian C., et al.: “The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: a 12-year experience at Memorial Sloan-Kettering Cancer Center”. Gynecol. Oncol., 2006, 103, 714.

[14] Kashima K., Yahata T., Fujita K., Tanaka K.: “Analysis of the complications after radical hysterectomy for stage IB, IIA and IIB uterine cervical cancer patients”. J. Obstet. Gynaecol. Res., 2006, 36, 555.

[15] Sakuragi N.: “Up-to-date management of lymph node metastasis and the role of tailored lymphadenectomy in cervical cancer”. Int. J. Clin. Oncol., 2007, 12, 165.

[16] Levenback C.: “Update on sentinel lymph node biopsy in gynecologic cancers”. Gynecol. Oncol., 2008, 111, S42.

[17] Abu-Rustum N.R.: “The increasing credibility of sentinel lymph nodemapping in endometrial cancer”. Ann. Surg. Oncol., 2013, 20, 353.

[18] Hopkins M.P., Morley G.W.: “Stage IB squamous cell cancer of the cervix: clinicopathologic features related to survival”. Am. J. Obstet. Gynecol., 1991, 164, 1520.

[19] American College of Obstetricians and Gynecologists: “ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer”. Obstet. Gynecol., 2005, 106, 413.

[20] Obermair A., Ginbey P., McCartney A.J.: “Feasibility and safety of total laparoscopic radical hysterectomy”. J. Am. Assoc. Gynecol. Laparosc., 2003, 10, 345.

[21] Cardosi R.J., Cox C.S., Hoffman M.S.: “Postoperative neuropathies after major pelvic surgery”. Obstet. Gynecol., 2002, 100, 240.

[22] Lutman C.V., Havrilesky L.J., Cragun J.M., Secord A.A., Calingaert B., Berchuck A., et al.: “Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology”. Gynecol. Oncol., 2006, 102, 92.

[23] Tada H., Teramukai S., Fukushima M., Sasaki H.: “Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma”. BMC Cancer, 2009, 9, 47.

[24] Kilgore L.C., Partridge E.E., Alvarez R.D., Austin J.M., Shingleton H.M., Noojin F. 3rd, et al.: “Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling”. Gynecol.Oncol., 1995, 56, 29.

[25] Chan J.K., Cheung M.K., Huh W.K., Osann K., Husain A., Teng N.N., et al.: “Therapeutic role of lymph node resection in endometrioid corpus cancer: a study of 12,333 patients”. Cancer, 2006, 107, 1823.

[26] Creasman W.T., Morrow C.P., Bundy B.N., Homesley H.D., Graham J.E., Heller P.B.: “Surgical pathologic spread patterns of endometrial cancer. A Gynecological Oncology Group Study”. Cancer, 1987, 60, 2035.

[27] Holloway R.W., Molero Bravo R.A., Rakowski J.A., James J.A., Jeppson C.N., Ingersoll S.B., Ahmad S.: “Detection of sentinel lymph nodes in patients with endometrial cancer undergoing roboticassisted staging: a comparison of colorimetric and fluorescence imaging”. Gynecol. Oncol., 2012, 126, 25.

[28] Jewell E.L., Huang J.J., Abu-RustumN.R., Gardner G.J., Brown C.L., Sonoda Y., et al.: “Detection of sentinel lymph nodes in minimally invasive surgery using indocyanine green and near-infrared fluorescence imaging for uterine and cervical malignancies”. Gynecol. Oncol., 2014, 133, 274.

[29] Sinno A.K., Fader A.N., Roche K.L., Giuntoli R.L., Tanner E.J.: “A comparison of colorimetric versus fluorometric sentinel lymph node mapping during robotic surgery for endometrial cancer”. Gynecol. Oncol., 2014, 134, 281.

[30] Rossi E.C., Jackson A., Ivanova A., Boggess J.F.: “Detection of sentinel nodes for endometrial cancerwith robotic assisted fluorescence imaging: cervical versus hysteroscopic injection”. Int. J. Gynecol. Cancer, 2013, 23, 1704.

[31] Rossi E.C., Ivanova A., Boggess J.F.: “Robotically assisted fluorescence- guided lymph node mapping with ICG for gynecologic malignancies: a feasibility study”. Gynecol. Oncol., 2012, 124, 78.