Overview and Aims:

Sentinel lymph node (SLN) biopsy in endometrial cancer has emerged as an alternative to systematic lymphadenectomy, with cervical indocyanin green injection being the preferred method.

Study Design, Population and Methods:

A prospective cohort study to assess the feasibility of SLN mapping in EC using ICG and near-infrared (NIR) fluorescence is ongoing at the authors’ Gynaecological Oncology Unit, in a Portuguese level III care hospital. The authors conducted a descriptive analysis of the clinicopathologic characteristics and discuss the process of implementing a novel technique.

Results:

A minimum number of 20 patients with EC of all histologies and grades recruited until publication was established. Of all 20 patients, 12 (12/20; 60.0%) had a total laparoscopic hysterectomy plus bilateral salpingo-oophorectomy (TLH/BSO) and SLN biopsy alone, and the remaining 8 patients underwent full retroperitoneal staging (8/20; 40.0%). At least 1 SLN was detected in all patients (20/20; 100%), bilaterally in 14 (14/20; 70%) and unilaterally in 6 (6/20; 30%). In 1 case, a third SLN was identified amongst presacral nodes. No isolated para-aortic SLNs were detected. The median number of SLNs removed per patient was 2.3 (range 1-3). Out of the 20 patients, 2 (2/20; 10%) had lymph node metastases and in both cases bilateral detection of SLN did not occur. The median operative time was 240 minutes, with total SLN mapping time of approximately 40 minutes per side. Median operative time was lower among patients undergoing an SLN mapping only, compared with patients undergoing a full lymphadenectomy (219min vs 280min). No cases of ICG injection-related complications occurred. Ultrastaging of sentinel lymph nodes was performed in all cases.

Conclusions:

This is the first published series of laparoscopic sentinel lymph node biopsy using ICG and NIR fluorescence in endometrial cancer, conducted in a Portuguese hospital.

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