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Jankulovska A, Stojcevski S, Aluloski I, Tanturovski M, Manevska N, Markova AD, Stojanoski S. Predictors of Bilateral SLN Radiocolloid Detection in Endometrial Carcinoma. World J Nucl Med 2023; 22:261-266. [PMID: 38152100 PMCID: PMC10751129 DOI: 10.1055/s-0043-1777693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Introduction Sentinel lymph node (SLN) mapping is an alternative method to conventional lymphadenectomy for nodal status assessment in patients with stage I/II endometrial carcinoma (EC). This study aimed to analyze the potential predictors of unsuccessful bilateral detection of SLN after the application of radiocolloid in EC. Materials and Methods A prospective, observational, cross-sectional study was performed on 41 patients with EC in preoperative stage I, who underwent SLN mapping after cervical application of 4mCi 99m Tc-SENTI-SCINT. The demographic, clinical, and tumor-related data were obtained from the patient's medical records. Univariate analysis was used to analyze the potential factors associated with an unsuccessful bilateral SLN biopsy. Results The bilateral SLN detection rate of planar lymphoscintigraphy, single photon emission computed tomography/computed tomography, and gamma probe was 29.26, 41.46, and 26.82%, correspondingly. None of the 16 analyzed risk factors showed statistical significance for nonconclusive bilateral SLN biopsy. Conclusion Larger scale studies are needed to determine the exact risk factors for unsuccessful bilateral mapping of the lymphatic drainage after cervical application of the radiotracers. This will eventually lead to improvement in bilateral SLN detection in EC patients, so unilateral lymphadenectomy could be avoided.
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Affiliation(s)
- Anamarija Jankulovska
- Institute of Pathophysiology and Nuclear Medicine “Acad Isac S. Tadzer”, Faculty of Medicine, University of “Ss. Cyril and Methodius”, Skopje, Republic of North Macedonia
| | - Sasho Stojcevski
- University Clinic for Obstetrics and Gynecology, Skopje, Republic of North Macedonia
| | - Igor Aluloski
- University Clinic for Obstetrics and Gynecology, Skopje, Republic of North Macedonia
| | - Mile Tanturovski
- University Clinic for Obstetrics and Gynecology, Skopje, Republic of North Macedonia
| | - Nevena Manevska
- Institute of Pathophysiology and Nuclear Medicine “Acad Isac S. Tadzer”, Faculty of Medicine, University of “Ss. Cyril and Methodius”, Skopje, Republic of North Macedonia
| | - Ana Daneva Markova
- University Clinic for Obstetrics and Gynecology, Skopje, Republic of North Macedonia
| | - Sinisa Stojanoski
- Institute of Pathophysiology and Nuclear Medicine “Acad Isac S. Tadzer”, Faculty of Medicine, University of “Ss. Cyril and Methodius”, Skopje, Republic of North Macedonia
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Sánchez-Izquierdo N, Vidal-Sicart S, Campos F, Torné A, Angeles MA, Migliorelli F, Munmany M, Saco A, Diaz-Feijoo B, Glickman A, Ordi J, Perissinotti A, Del Pino M, Paredes P. Detection of the sentinel lymph node with hybrid tracer (ICG-[ 99mTc]Tc-albumin nanocolloid) in intermediate- and high-risk endometrial cancer: a feasibility study. EJNMMI Res 2021; 11:123. [PMID: 34905122 PMCID: PMC8671586 DOI: 10.1186/s13550-021-00863-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Indocyanine green (ICG) is frequently used for the detection of the sentinel lymph node (SLN) in gynecology, but it carries the loss of the presurgical SLN mapping provided by [99mTc]-based colloids. Hybrid tracers such as ICG-[99mTc]Tc-albumin nanocolloid combine the benefits of both components. The aim of this study was to evaluate the feasibility and applicability of this hybrid tracer injected by transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR) approach in the detection of SLNs in patients with intermediate- and high-risk EC. METHODS Fifty-two patients with intermediate- and high-risk EC underwent SLN biopsy after injection of a hybrid tracer using the TUMIR approach, followed by pelvic and paraaortic lymphadenectomy. SLNs were detected preoperatively by lymphoscintigraphic study and intraoperatively by gamma probe and near-infrared (NIR) optical laparoscopic camera. RESULTS Preoperative lymphatic drainage was obtained in 69% and intraoperative detection in 71.4% of patients. A total of 146 SLNs (4.17 SLNs/patient) were biopsied. Pelvic bilateral detection was observed in 57% of the women and paraaortic drainage in 34% of the patients. The radioactive component allowed the detection of SLN in 97.1% of the patients, while the fluorescent component detected 80%. In more than 17% of the patients with intraoperative detection, SLNs were detected only by the radioactive signal. Lymph node metastasis was identified in 14.3% of patients submitted to SLNB. The sensitivity and negative predictive value for metastatic involvement were 100%. CONCLUSION TUMIR injection of a hybrid tracer in patients with intermediate- and high-risk EC combines the benefits of the radiotracer and the fluorescence methods with a single tracer. The method increases the paraaortic detection rate and allows a potential increase in SLN detection. Notwithstanding, based on our findings, the radioactive component of the hybrid tracer cannot be obviated.
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Affiliation(s)
- Nuria Sánchez-Izquierdo
- Department of Nuclear Medicine, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Sergi Vidal-Sicart
- Department of Nuclear Medicine, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Francisco Campos
- Department of Nuclear Medicine, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Aureli Torné
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Martina Aida Angeles
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic of Barcelona, Barcelona, Spain.,Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Federico Migliorelli
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal des Vallées de l'Ariège, Saint-Jean-de-Verges, France
| | - Meritxell Munmany
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Adela Saco
- Department of Pathology, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Berta Diaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Ariel Glickman
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Jaume Ordi
- Department of Pathology, Hospital Clínic of Barcelona, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain.,ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, 08036, Barcelona, Spain
| | - Andrés Perissinotti
- Department of Nuclear Medicine, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Marta Del Pino
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Pilar Paredes
- Department of Nuclear Medicine, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain. .,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain. .,Faculty of Medicine, University of Barcelona, Barcelona, Spain.
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Abstract
Endometrial cancer (EC) is known as a common gynecological malignancy. The incidence rate is on the increase annually. Lymph node status plays a crucial role in evaluating the prognosis and selecting adjuvant therapy. Currently, the patients with high-risk (not comply with any of the following: (1) well-differentiated or moderately differentiated, pathological grade G1 or G2; (2) myometrial invasion< 1/2; (3) tumor diameter < 2 cm are commonly recommended for a systematic lymphadenectomy (LAD). However, conventional LAD shows high complication incidence and uncertain survival benefits. Sentinel lymph node (SLN) refers to the first lymph node that is passed by the lymphatic metastasis of the primary malignant tumor through the regional lymphatic drainage pathway and can indicate the involvement of lymph nodes across the drainage area. Mounting evidence has demonstrated a high detection rate (DR), sensitivity, and negative predictive value (NPV) in patients with early-stage lower risk EC using sentinel lymph node mapping (SLNM) with pathologic ultra-staging. Meanwhile, SLNM did not compromise the patient’s progression-free survival (PFS) and overall survival (OS) with low operative complications. However, the application of SLNM in early-stage high-risk EC patients remains controversial. As revealed by the recent studies, SLNM may also be feasible, effective, and safe in high-risk patients. This review aims at making a systematic description of the progress made in the application of SLNM in the treatment of EC and the relevant controversies, including the application of SLNM in high-risk patients.
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Affiliation(s)
- Lirong Zhai
- Department of Gynecology and Obstetrics, Peking University People's Hospital, Beijing, China
| | - Xiwen Zhang
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, China
| | - Manhua Cui
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, China
| | - Jianliu Wang
- Department of Gynecology and Obstetrics, Peking University People's Hospital, Beijing, China
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Angeles MA, Migliorelli F, Vidal-Sicart S, Saco A, Ordi J, Ros C, Fusté P, Munmany M, Escura S, Carreras N, Sánchez-Izquierdo N, Pahisa J, Torné A, Paredes P, Del Pino M. Paraaortic sentinel lymph node detection in intermediate and high-risk endometrial cancer by transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR). J Gynecol Oncol 2021; 32:e52. [PMID: 33908710 PMCID: PMC8192237 DOI: 10.3802/jgo.2021.32.e52] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/21/2021] [Accepted: 02/20/2021] [Indexed: 12/11/2022] Open
Abstract
Objective We aimed to evaluate the accuracy of sentinel lymph node (SLN) mapping with transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR) to detect lymph node (LN) metastases, in patients with intermediate and high-risk endometrial cancer (EC), focusing on its performance to detect paraaortic involvement. Methods Prospective study including women with preoperative intermediate or high-risk EC, according to ESMO-ESGO-ESTRO consensus, who underwent SLN mapping using the TUMIR approach. SLNs were preoperatively localized by planar and single photon emission computed tomography/computed tomography images, and intraoperatively by gamma-probe. Immediately after SLN excision, all women underwent systematic pelvic and paraaortic lymphadenectomy by laparoscopy. Results The study included 102 patients. The intraoperative SLN detection rate was 79.4% (81/102). Pelvic and paraaortic drainage was observed in 92.6% (75/81) and 45.7% (37/81) women, respectively, being exclusively paraaortic in 7.4% (6/81). After systematic lymphadenectomy, LN metastases were identified in 19.6% (20/102) patients, with 45.0% (9/20) showing paraaortic involvement, which was exclusive in 15.0% (3/20). The overall sensitivity and negative predictive value (NPV) of SLNs by the TUMIR approach to detect lymphatic involvement were 87.5% and 97.0%, respectively; and 83.3% and 96.9%, for paraaortic metastases. After applying the MSKCC SLN mapping algorithm, the sensitivity and NPV were 93.8% and 98.5%, respectively. Conclusion The TUMIR method provides valuable information of endometrial drainage in patients at higher risk of paraaortic LN involvement. The TUMIR approach showed a detection rate of paraaortic SLNs greater than 45% and a high sensitivity and NPV for paraaortic metastases in women with intermediate and high-risk EC.
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Affiliation(s)
- Martina Aida Angeles
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic of Barcelona, Spain.,Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Federico Migliorelli
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal des Vallées de l'Ariège, St. Jean de Verges, France
| | - Sergi Vidal-Sicart
- Department of Nuclear Medicine, Hospital Clínic of Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Adela Saco
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain.,Department of Anatomo-pathology, Hospital Clínic of Barcelona, Spain
| | - Jaume Ordi
- Faculty of Medicine, University of Barcelona, Barcelona, Spain.,Department of Anatomo-pathology, Hospital Clínic of Barcelona, Spain.,Institut de Salut Global de Barcelona (ISGlobal), Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Cristina Ros
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic of Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Pere Fusté
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic of Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Meritxell Munmany
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic of Barcelona, Spain
| | - Sílvia Escura
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic of Barcelona, Spain
| | - Núria Carreras
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic of Barcelona, Spain
| | | | - Jaume Pahisa
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic of Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Aureli Torné
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic of Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Pilar Paredes
- Department of Nuclear Medicine, Hospital Clínic of Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain.
| | - Marta Del Pino
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic of Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
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