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Gedgaudaite M, Sukovas A, Paskauskas S, Bartusevicius A, Atstupenaite V, Svedas E, Celiesiute J, Cizauskas A, Vaitkiene D, Gaurilcikas A. The Feasibility of Sentinel Lymph-Node, Mapped with Indocyanine Green, Biopsy in Endometrial Cancer Patients: A Prospective Study. Medicina (B Aires) 2022; 58:medicina58060712. [PMID: 35743975 PMCID: PMC9227427 DOI: 10.3390/medicina58060712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background and objectives. Systematic pelvic lymphadenectomy (LND) is an essential part of lymph-node status evaluation in endometrial cancer (EC) patients to tailor the adjuvant treatment. However, it is associated with the post-operative lymphatic complications and does not improve the outcomes of the disease. Indocyanine green (ICG) mapped sentinel lymph-node biopsy (SLB) has recently been introduced into the clinical practice as an alternative for the surgical lymph-node evaluation in EC patients with the potential to decrease LND related complications. The aim of our study was to evaluate the feasibility of ICG mapped SLB in low, intermediate, and high-risk EC patients in a center with no previous experience on endoscopic SLB procedure. Materials and Methods: The prospective study was performed. 170 patients with histologically confirmed EC were included. Sentinel lymph-nodes (SLs) were mapped with ICG dye and removed ahead of the total laparoscopic hysterectomy. Low-risk patients received only SLB, while SLB and LND were performed for intermediate and high-risk patients. Results: The overall detection rate of SLs was 88.8%. Bilateral mapping was achieved in 68.2% of the patients. The overall detection rate for low-risk patients was 93.7%, 85.0% for the intermediate-risk group, and 100% for high-risk patients (p = 0.232). The most common anatomical sites of SLs were the external iliac (45.8% on the right and 46.6% on the left) and obturator regions (20.9% and 25.6%, respectively). Positive lymph-nodes were found in 8 (4.7%) patients. The sensitivity of SLB was 75.0% and negative predictive value (NPV)—97.2%. Conclusions: Even in the center with no previous experience, sentinel lymph-node biopsy using ICG mapping is feasible. However, the favorable outcomes might be associated with the learning process of newly established method.
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Affiliation(s)
- Migle Gedgaudaite
- Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (A.S.); (S.P.); (A.B.); (E.S.); (J.C.); (D.V.); (A.G.)
- Correspondence: ; Tel.: +370-672-22104
| | - Arturas Sukovas
- Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (A.S.); (S.P.); (A.B.); (E.S.); (J.C.); (D.V.); (A.G.)
| | - Saulius Paskauskas
- Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (A.S.); (S.P.); (A.B.); (E.S.); (J.C.); (D.V.); (A.G.)
| | - Arnoldas Bartusevicius
- Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (A.S.); (S.P.); (A.B.); (E.S.); (J.C.); (D.V.); (A.G.)
| | - Vaida Atstupenaite
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania;
| | - Eimantas Svedas
- Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (A.S.); (S.P.); (A.B.); (E.S.); (J.C.); (D.V.); (A.G.)
| | - Joana Celiesiute
- Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (A.S.); (S.P.); (A.B.); (E.S.); (J.C.); (D.V.); (A.G.)
| | - Arvydas Cizauskas
- Department of Pathological Anatomy, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania;
| | - Daiva Vaitkiene
- Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (A.S.); (S.P.); (A.B.); (E.S.); (J.C.); (D.V.); (A.G.)
| | - Adrius Gaurilcikas
- Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (A.S.); (S.P.); (A.B.); (E.S.); (J.C.); (D.V.); (A.G.)
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