{"paper_id":"6090b21f-36df-436d-a02c-87b6f809c4a8","body_text":"Abstract\nPurpose\nLymph node metastasis is a significant predictive factor for disease recurrence and survival in cervical cancer patients and relevant for therapeutic strategies. We evaluated the clinical value of indocyanine green (ICG) by measuring the sensitivity and negative predictive value of sentinel lymph node mapping compared with the gold standard of complete lymphadenectomy in detecting lymph node metastases for cervical cancer.\nMethods\nWe utilized the near-infrared imaging agent ICG to detect tumor-infested lymph nodes in the pelvis analogue to a classical sentinel lymph node procedure by analyzing data from 20 patients who had undergone surgery for cervical cancer at our institution. A laparoscopic lymph node mapping procedure by means of ICG, followed by a complete pelvic lymphadenectomy with or without paraaortic lymphadenectomy was done in all patients.\nResults\nHistological examination identified seven patients with tumor-positive pelvic nodes, whereas mapping with ICG identified only five of these patients. Detection rate of positive nodes by ICG mapping and false negative rate was 71.4% and 28.6%, respectively; bilateral detection rate was 83.3%. One of the two false negative patients additionally suffered from deep infiltrating endometriosis.\nConclusions\nOur results indicate that ICG can identify the relevant pelvic nodes independent of tumor size, provided bilateral detection is achieved and additional, related diseases are excluded.\nTrial Registration\nThis trial is registered within the German Clinical Trial Register (DRKS-ID: DRKS00014692).\nSimilar content being viewed by others\nReferences\nhttps://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/. Accessed June 2019\nRobert Koch Institut. Krebs in Deutschland 2013/14, 11. Ausgabe. Gesundheitsberichterstattung des Bundes 2017. https://www.krebsdaten.de/Krebs/DE/Content/Publikationen/Krebs_in_Deutschland/kid_2017/krebs_in_deutschland_2017.pdf;jsessionid=7026C5FB7EAC6766D3B5BA35C01B5B05.1_cid298?__blob=publicationFile. Accessed June 2019\nCibula D, Abu-Rustum NR, Dusek L et al (2012) Prognostic significance of low volume sentinel lymph node disease in early-stage cervical cancer. Gynecol Oncol 124:496–501\nHauspy J, Beiner M, Harley I, Ehrlich L, Rasty G, Covens A (2007) Sentinel lymph node in vulvar cancer. Cancer 110:1015–1023\nde Hullu JA, Doting E, Piers DA et al (1998) Sentinel lymph node identification with technetium-99m-labeled nanocolloid in squamous cell cancer of the vulva. J Nucl Med 39:1381–1385\nLeitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Diagnostik, Therapie und Nachsorge des Mammakarzinoms, Langversion, 4.1, 2018, AWMF-Registernummer: 032/045OL, https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Mammakarzinom_4_0/Version_4.1/LL_Mammakarzinom_Langversion_4.1.pdf .Accessed Dec 2018\nTax C, Rovers MM, de Graaf C, Zusterzeel PL, Bekkers RL (2015) The sentinel node procedure in early stage cervical cancer, taking the next step: a diagnostic review. Gynecol Oncol 139:559–567\nFrumovitz M (2017) Sentinel lymph node biopsy for cervical cancer patients—what’s it gonna take? Gynecol Oncol 144:3–4\nRamirez PT, Salvo G (2017) Molecular innovations in sentinel lymph node evaluation: moving beyond radiotracers and colored dyes. J Minim Invasive Gynecol 24:1–2\nSalvo G, Ramirez PT, Levenback CF et al (2017) Sensitivity and negative pre-dictive value for sentinel lymph node biopsy in women with early-stage cervical cancer. Gynecol Oncol 145:96–101\nCormier B, Diaz JP, Shih K et al (2011) Establishing a sentinel lymph node mapping algorithm for the treatment of early cervical cancer. Gynecol Oncol 122:275–280\nDitto A, Martinelli F, Bogani G, Papadia A, Lorusso D, Raspagliesi F (2015) Sentinel node mapping using hysteroscopic injection of indocyanine green and laparoscopic near-infrared fluorescence imaging in endometrial cancer staging. J Minim Invasive Gynecol 22:132–133\nLecuru F, Mathevet P, Querleu D et al (2011) Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study. J Clin Oncol 29:1686–1691\nLeitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsch Krebshilfe, AWMF): S3-Leitlinie Diagnostik, Therapie und Nachsorge der Patientin mit Zervixkarzinom. Langversion, 1.0, 2014, AWMF-Registernummer: 032/033OL, https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Zervixkarzinom/LL_Zervixkarzinom_Langversion_1.0.pdf. Accessed Dec 2018\nLennox GK, Covens A (2017) Can sentinel lymph node biopsy replace pelvic lymphadenectomy for early cervical cancer? Gynecol Oncol 144:16–20\nM. Schmidt, R. Bares, W. Brenner, A. Buck, F. Grünwald, J. Kopp, B. J. Krause, O. Schober, J. Sciuk, F. Sudbrock, H. Wengenmair. Deutsche Gesellschaft für Nuklearmedizin (DGN). Handlungsempfehlung (S1-Leitlinie): Verfahrensanweisung für die technische Durchführung der nuklearmedizinischen Wächter-Lymphknoten-Diagnostik. Stand: 10/2014 –AWMF-Registernummer 031–033.\nBarranger E, Coutant C, Cortez A, Uzan S, Darai E (2010) Sentinel node biopsy is reliable in early-stage cervical cancer but not in locally advanced disease. Ann Oncol 16:1237–1242\nRauch P, Merlin J-L, Leufflen L et al (2016) Limited effectiveness of patent blue dye in addition to isotope scanning for identification of sentinel lymph nodes: cross-sectional real-life study in 1024 breast cancer patients. Int J Surg 33:177–181\nKim JH, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT, Nam JH (2018) The efficacy of sentinel lymph node mapping with indocyanine green in cervical cancer. World J Surg Oncol 16(1):52\nFrangioni JV (2003) In vivo near-infrared fluorescence imaging. Curr Opin Chem Biol 7(5):626–634\nMarshall MV, Rasmussen JC, Tan IC et al (2010) Near-infrared fluorescence imaging in humans with indocyanine green: a review and update. Open Surg Oncol J 2:12–25\nIetto G, Amico F, Soldini G, Chiappa C, Franchin M, Iovino D, Romanzi A, Saredi G, Cassinotti E, Boni L, Tozzi M, Carcano G (2016) Real-time intraoperative fluorescent lymphography: a new trechnique for lymphatic sparing surgery. Transplant Proc 48(9):3073–3078\nBeavis AL, Salazar-Marioni S, Sinno AK et al (2016) Sentinel lymph node detection rates using indocyanine green in women with early-stage cervical cancer. Gynecol Oncol 143:302–306\nTanaka T, Terai Y, Ashihara K et al (2017) The detection of sentinel lymph nodes in laparoscopic surgery for uterine cervical cancer using 99m- technetium-tin colloid, indocyanine green, and blue dye. J Gynecol Oncol 28:e13\nElisei F, Crivellaro C, Giuliani D et al (2016) Sentinel-node mapping in endometrial cancer patients: comparing SPECT/CT, gamma-probe and dye. Ann Nucl Med 31:93–99\nBuda A, Papadia A, Zapardiel I et al (2016) From conventional radiotracer Tc–99 with blue dye to indocyanine green fluorescence: a comparison of methods towards optimization of sentinel lymph node mapping in early stage cervical cancer for a laparoscopic approach. Ann Surg Oncol 23:2959–2965\nPapathemelis T, Jablonski E, Scharl A, Hauzenberger T, Gerken M, Klinkhammer-Schalke M, Hipp M, Scharl S (2018) Sentinel lymph node biopsy in breast cancer patients by means of indocyanine green using the Karl Storz VITOM® fluorescence camera. Biomed Res Int 26(2018):6251468\nBuda A, Papadia A, Di Martino G, Imboden S, Bussi B, Guerra L, De Ponti E, Reato C, Gasparri ML, Crivellaro C, Mueller M (2018) Real-time fluorescent sentinel lymph node mapping with indocyanine green in women with previous conization undergoing laparoscopic surgery for early invasive cervical cancer: comparison with radiotracer ± blue dye. J Minim Invasive Gynecol 25(3):455–460\nhttps://www.krebsgesellschaft.de/gcs/german-cancer-society/certification.html. Accessed June 2019\nhttps://www.ccc.uk-erlangen.de/. Accessed June 2019\nJerman LF, Hey-Cunningham AJ (2015) The role of the lymphatic system in endometriosis: a comprehensive review of the literature. Biol Reprod 92(3):64–71\nBuda A, Elisei F, Palazzi S et al (2016) Quality of care for cervical and endometrial cancer patients: the impact of different techniques of sentinel lymph node mapping on patient satisfaction. Ann Surg Oncol 23:2975–2981\nAbu Khoury-Collado F, Glaser GE, Zivanovic O et al (2009) Improving sentinel lymph node detection rates in endometrial cancer: how many cases are needed? Gynecol Oncol 115:453–455\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nConflict of interest\nThe authors declare that there are no conflicts of interest regarding the publication of this article.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nElectronic supplementary material\nBelow is the link to the electronic supplementary material.\nRights and permissions\nAbout this article\nCite this article\nPapathemelis, T., Scharl, A., Anapolski, M. et al. Value of indocyanine green pelvic lymph node mapping in the surgical approach of cervical cancer. Arch Gynecol Obstet 301, 787–792 (2020). https://doi.org/10.1007/s00404-020-05457-x\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00404-020-05457-x","source_license":"public-domain-us","license_restricted":false}