Fluorescent sentinel lymph node mapping with icg in endometrial cancer. An initial experience in Argentina

Abstract

Background: Near-infrared fluorescence-based sentinel lymph node (SLN) mapping technique with indocyanine green (ICG) has been found a useful surgical modality for sentinel node detection and disease staging in endometrial cancer (EC) worldwide. Objective: We aimed to introduce the SNL mapping technology using ICG and Near Infrared (NIR) fluorescence in Argentina. We aimed to assess the overall and bilateral detection rate of ICG based SNL mapping along with verifying its feasibility and effectiveness in surgical staging. We also aimed to discover the perceptions of surgeons regarding the use of ICG as a tracer and NIR as light-medium in SNL mapping. Method: ICG SLNs identification was evaluated retrospectively. This study was performed at the Hospital Aleman de Buenos Aires in September, 2017The detection rates were calculated along with the analysis of the number of SNL observed and operative time, and time taken by overall surgery. Subsequently, the surgeons were interviewed to ascertain their opinion of using ICG SNL mapping in endometrial cancer staging. Results: Four patients with endometrial cancer were included for analysis. The overall and bilateral detection rates have been 100% and 75%, respectively. While, under white light, no SLNs were identified. The average operative time of nodes resection was estimated 2.15 minutes. The fluorescence has been used for 2.2 minutes and overall time taken by surgery was estimated 71.5 minutes. The estimated blood loss (EBL) has been lower than 50 ml. The responses of surgeons’ from the interview have been 100% positive. The cost of the procedure based on the amount of dye used was 25 dollars per patient. Conclusion: Laparoscopic ICG SLN resulted to be feasible, practical and no expensive surgical modality for uterine cancer triage.