Effectiveness of the Indocyanine Green Fluorescence Method for Sentinel Lymph Node Detection in Cervical Cancer Patients
Study Objective: To assess the effectiveness of the indocyanine green (ICG) fluorescence method (FM) for sentinel lymph node (SLN) detection in cervical cancer patients. Study Design: This was a prospective study. Materials and Methods: The results of examination and treatment were analyzed for 44 patients with a morphologically verified diagnosis of clinical stage IA2 or IB1-IIA1 (FIGO, 2011) cervical cancer. Endovideosurgery was performed using a high-resolution video camera, standard-length tools, a uterine manipulator, and a direct-optics video camera. After exploration of the abdominal cavity, SLNs were detected using the ICG fluorescence method and an endovideosurgery tool kit with a near-infrared reflectance (NIR) function. Thirty-seven patients underwent a laparoscopic nerve-sparing radical hysterectomy (Piver III type) with pelvic lymphadenectomy, six had a laparoscopic radical hysterectomy with extended parametrectomy and pelvic and para-aortic lymphadenectomy up to the renal vessels, and one patient had a laparoscopic radical cervicectomy with pelvic lymphadenectomy. Study Results: SLNs were detected in 43 (97.7%) cases using the ICG FM, with bilateral SLN detection in 34 (77.3%) cases. Only in one (2.3%) patient, with a pathomorphologically confirmed diagnosis of stage IIIB cervical cancer, were no SLNs detected. In total, 102 SLNs (50 SLNs on the right side, 51 SLNs on the left side, and one para-aortic SLN) (median number, 2.31) were detected in the 44 patients. Most frequently, in 70 (68.6%) of the cases, the SLNs were located near the outer and inner iliac vessels, in proximity to the common iliac artery bifurcation. Metastases in SLNs were found in six (13.6%) women: two with stage IB2 and four with stage IB1 cancer. When an SLN with metastases was found, a laparoscopic radical hysterectomy with extended parametrectomy and pelvic and para-aortic lymphadenectomy up to the renal vessels was done, as well as post-surgery chemoradiotherapy being prescribed. Conclusion: SLN detection using the ICG FM is an effective diagnostic method for cervical cancer patients. The ICG FM of SLN detection allows making a localized diagnosis; in cases of early cervical cancer, it allows intraoperative restaging of the disease and adjustment of the treatment plan.