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Maramai M, Achilarre MT, Aloisi A, Betella I, Bogliolo S, Garbi A, Maruccio M, Quatrale C, Aletti GD, Mariani A, Colombo N, Maggioni A, Multinu F, Zanagnolo V. Cervical re-injection of indocyanine green to improve sentinel lymph node detection in endometrial cancer. Gynecol Oncol 2021; 162:38-42. [PMID: 33906784 DOI: 10.1016/j.ygyno.2021.04.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/20/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the role of cervical re-injection of indocyanine green (ICG) to increase the detection rate of sentinel lymph node (SLN) in patients with endometrial cancer (EC) who underwent robotic-assisted surgical staging. METHODS We retrospectively identified consecutive EC patients undergoing robotic-assisted staging with SLN biopsy at our Institution between June 2016 and April 2020. Patients were excluded if they had open abdominal surgical approach, neoadjuvant chemotherapy, and advanced stage [International Federation of Gynecology and Obstetrics (FIGO) stage III-IV] at diagnosis. According to our SLN protocol, in case of either unilateral or no SLN detection, we performed an ipsilateral or bilateral cervical re-injection of ICG. RESULTS In total, 251 patients meeting inclusion criteria were included in the analysis. At first injection, bilateral detection was achieved in 184 (73.3%), unilateral detection in 57 (22.7%), and no detection in 10 (4.0%) patients. Cervical re-injection was performed in 51 of 67 patients with failed bilateral mapping. After cervical re-injection, bilateral detection rate increased to 94.5% (222/235), while unilateral and no detection were 5.1% (12/235) and 0.4% (1/235), respectively. CONCLUSIONS Our results suggest that cervical re-injection of ICG, in case of failed bilateral mapping of SLN, brings about a significant improvement in SLN detection rates, therefore reducing the number of side-specific required lymphadenectomies.
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Affiliation(s)
- M Maramai
- Department of Gynecologic Surgery, IEO European Institute of Oncology - IRCCS, Milano, Italy; Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M T Achilarre
- Department of Gynecologic Surgery, IEO European Institute of Oncology - IRCCS, Milano, Italy
| | - A Aloisi
- Department of Gynecologic Surgery, IEO European Institute of Oncology - IRCCS, Milano, Italy
| | - I Betella
- Department of Gynecologic Surgery, IEO European Institute of Oncology - IRCCS, Milano, Italy
| | - S Bogliolo
- Department of Gynecologic Surgery, IEO European Institute of Oncology - IRCCS, Milano, Italy; Department of Obstetrics and Gynecology, Tigullio Hospital, Metropolitan City of Genova, Italy
| | - A Garbi
- Department of Gynecologic Surgery, IEO European Institute of Oncology - IRCCS, Milano, Italy
| | - M Maruccio
- Department of Gynecologic Surgery, IEO European Institute of Oncology - IRCCS, Milano, Italy
| | - C Quatrale
- Department of Gynecologic Surgery, IEO European Institute of Oncology - IRCCS, Milano, Italy
| | - G D Aletti
- Department of Gynecologic Surgery, IEO European Institute of Oncology - IRCCS, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - A Mariani
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - N Colombo
- Gynecologic Oncology Program, IEO European Institute of Oncology - IRCCS, Milano, Italy; University of Milan-Bicocca, Italy
| | - A Maggioni
- Department of Gynecologic Surgery, IEO European Institute of Oncology - IRCCS, Milano, Italy
| | - F Multinu
- Department of Gynecologic Surgery, IEO European Institute of Oncology - IRCCS, Milano, Italy; Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States of America.
| | - V Zanagnolo
- Department of Gynecologic Surgery, IEO European Institute of Oncology - IRCCS, Milano, Italy
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