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Objective <p>To compare combined fundal ICG + cervical Technetium 99m versus cervical Technetium 99m in sentinel lymph node (SLN) mapping in early carcinoma endometrium.</p> Methodology <p>This prospective comparative interventional study was conducted in a tertiary care hospital from April 2021 to December 2022. 60 patients with early endometrioid carcinoma endometrium FIGO 2009 stage I–II were allocated to group A (<i>n </i>= 30) who underwent combined fundal ICG + cervical Technetium 99m injection and group B (<i>n </i>= 30) who underwent cervical Technetium 99m injection. Primary outcome was sentinel node detection rate. Secondary outcomes were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of SLN mapping and correlation of risk factors for SLN metastasis.</p> Results <p>Overall sentinel node detection rate was 100%. Bilateral sentinel node detection was better with combined fundal ICG + cervical Technetium 99m (group A) than the cervical Technetium 99m (group B)(93.33% vs 73.33%) (<i>p </i>= 0.08). Paraaortic sentinel detection was better in group A (30%) compared to group B (3.33%) (<i>p </i>= 0.012). SLN metastasis was diagnosed in 3/60 patients (5%). Significant risk factors for SLN metastasis on univariate analysis were LVSI (<i>p </i>= 0.005), lower uterine segment (LUS)&#xa0;involvement (0.002) and cervical stromal invasion (<i>p </i>= 0.01). Sensitivity, specificity, PPV and NPV in group A was 100%, 100%, 100%, 100%, respectively. Specificity and NPV of SLN mapping in group B were 100% and 100%, respectively.</p> Conclusion <p>Combined fundal ICG plus cervical Technetium 99m has better accuracy in bilateral pelvic and paraaortic SLN mapping. Risk factors for SLN metastasis on univariate analysis were LVSI, LUS involvement and cervical stromal invasion.</p>

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Combined Fundal ICG and Cervical Radiocolloid Injection Versus Cervical Injection of Radiocolloid for Sentinel Lymph Node Mapping in early Stage Endometrial Cancer: A Prospective Interventional Comparative Study

  • 期刊论文

  • 发表日期：

    2025年1月6日

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  • Nitu George,
  • Chitrathara Kesava Pillai,
  • Senthil Raja,
  • Sanam Puzhakkal,
  • Anupama Sreedhar,
  • Supriya Gupta,
  • Sukanya Suresh

摘要

Objective

To compare combined fundal ICG + cervical Technetium 99m versus cervical Technetium 99m in sentinel lymph node (SLN) mapping in early carcinoma endometrium.

Methodology

This prospective comparative interventional study was conducted in a tertiary care hospital from April 2021 to December 2022. 60 patients with early endometrioid carcinoma endometrium FIGO 2009 stage I–II were allocated to group A (n = 30) who underwent combined fundal ICG + cervical Technetium 99m injection and group B (n = 30) who underwent cervical Technetium 99m injection. Primary outcome was sentinel node detection rate. Secondary outcomes were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of SLN mapping and correlation of risk factors for SLN metastasis.

Results

Overall sentinel node detection rate was 100%. Bilateral sentinel node detection was better with combined fundal ICG + cervical Technetium 99m (group A) than the cervical Technetium 99m (group B)(93.33% vs 73.33%) (p = 0.08). Paraaortic sentinel detection was better in group A (30%) compared to group B (3.33%) (p = 0.012). SLN metastasis was diagnosed in 3/60 patients (5%). Significant risk factors for SLN metastasis on univariate analysis were LVSI (p = 0.005), lower uterine segment (LUS) involvement (0.002) and cervical stromal invasion (p = 0.01). Sensitivity, specificity, PPV and NPV in group A was 100%, 100%, 100%, 100%, respectively. Specificity and NPV of SLN mapping in group B were 100% and 100%, respectively.

Conclusion

Combined fundal ICG plus cervical Technetium 99m has better accuracy in bilateral pelvic and paraaortic SLN mapping. Risk factors for SLN metastasis on univariate analysis were LVSI, LUS involvement and cervical stromal invasion.