The efficacy of sentinel lymph node mapping with indocyanine green in cervical cancer.
BACKGROUND
Lymph node metastasis is a significant predictive factor for disease recurrence and survival in cervical cancer patients. Given the importance of lymph node metastasis, it is imperative that patients harboring metastasis are identified and can undergo appropriate treatment. Sentinel lymph node (SLN) mapping has drawn attention as a lymph node mapping technique. We evaluated the feasibility and efficacy of (SLN) mapping using indocyanine green (ICG) in cervical cancer.


METHODS
We performed a single-center, retrospective study of 103 surgically treated cervical cancer patients who underwent SLN mapping. After using ICG to detect SLN during surgery, we removed the SLNs followed by laparoscopic or robotic-assisted radical surgery and bilateral pelvic lymphadenectomy.


RESULTS
Stage IB1 was the most common (61.17%). At least one SLN was detected in all cases. Eighty-eight patients (85.44%) had bilateral pelvic SLNs. The mean number of SLN per patient was 2.34. The side-specific sensitivity was 71.43%, the specificity was 100%, the negative predictive value (NPV) was 93.98%, and the false negative rate (FNR) was 28.57%. In cases of tumors smaller than 2 cm with negative lymph node metastasis on imaging, the study revealed a side-specific sensitivity of 100%, a specificity of 100%, a NPV of 100%, and a FNR of 0%. Large tumor size (≥ 4 cm), a previous history of a loop electrosurgical excision procedure (LEEP), depth of invasion (≥ 50%), the microscopic parametrial (PM) invasion, and vaginal extension were significantly associated with the false-negative detection of SLN. Moreover, the microscopic PM invasion was the only risk factor of the false-negative detection of SLN in multivariate analysis.


CONCLUSION
SLN mapping with ICG in cervical cancer is feasible and has high detection rate. The sensitivity of 100% was high enough to perform SLN biopsy alone in an early stage in which the tumor is less than 2 cm, with no lymphadenopathy on image examination. However, for large or invasive tumors, we would have to be cautious about performing SLN biopsy alone.


TRIAL REGISTRATION
Retrospectively registered 2017-0600.
['Kim|Ju-Hyun|JH|', 'Kim|Dae-Yeon|DY|http://orcid.org/0000-0002-8068-3475', 'Suh|Dae-Shik|DS|', 'Kim|Jong-Hyeok|JH|', 'Kim|Yong-Man|YM|', 'Kim|Young-Tak|YT|', 'Nam|Joo-Hyun|JH|']
D000230:Adenocarcinoma D000328:Adult D000368:Aged D002294:Carcinoma, Squamous Cell D004396:Coloring Agents D016889:Endometrial Neoplasms D005260:Female D005500:Follow-Up Studies D006801:Humans D007044:Hysterectomy D007208:Indocyanine Green D008197:Lymph Node Excision D008207:Lymphatic Metastasis D008875:Middle Aged D009361:Neoplasm Invasiveness D009364:Neoplasm Recurrence, Local D011379:Prognosis D012189:Retrospective Studies D000071036:Sentinel Lymph Node D021701:Sentinel Lymph Node Biopsy D015996:Survival Rate D002583:Uterine Cervical Neoplasms
Sentinel lymph node Indocyanine green Detection Sensitivity and specificity Uterine cervical neoplasms