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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Aloisi A, Maruccio M, Personeni C, Palumbo M, Minicucci V, Betella I, Multinu F, Bogliolo S, Garbi A, Achilarre M, Aletti G, Zanagnolo V, Colombo N, Maggioni A. Role of pelvic exenteration in the treatment of persistent or recurrent gynecological cancers. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Maruccio M, Aloisi A, Minicucci V, Personeni C, Palumbo M, Betella I, Multinu F, Bogliolo S, Garbi A, Achilarre M, Aletti G, Zanagnolo V, Colombo N, Maggioni A. Pelvic exenteration in gynecologic oncology: Analysis of short- and long-term surgical outcomes. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Doo D, Meza-Perez S, Londono A, Boone J, Moore D, Hudson C, Betella I, Luke J, Yang E, Birrer M, Starenki D, Buchsbaum D, Norian L, Randall T, Arend R. Inhibition of the Wnt/β-catenin pathway enhances anti-tumor immunity in ovarian cancer. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Betella I, Turbitt W, Szul T, Wu B, Martinez AA, Arend R, Katre A, Norian L, Birrer M. Dkn-01: A promising strategy for targeting the Wnt pathway in ovarian cancer. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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