Prospective head-to-head comparative study using Indocyanine green (ICG) versus patent blue dye for sentinel lymph node biopsy in patients with early-stage cervical cancer

Background This study evaluated comparatively the capacity of ICG and patentblue in detect the sentinel lymphnodes. We aimed to assess the differences in anatomical distribution, bilateral detection and the role of Frozen Section.

Methods Prospective study of 103 laparoscopically operated patients with CC (< FIGO 1b1). Both tracers were injected in the same fashion. Distribution and location of all SLNs were documented. All SLNs were processed according to standard protocol and underwent to FS, histopathology and ultrastaging.

Results In average 3.3 ± 1.67 SLNs were detected per patient. Combined bilateral detection was 99%. Bilateral detection rate for ICG alone was 93.2% and it was significantly higher than for patentblue (77.7%) (p=0.004). The addition of blue-dye increased the bilateral identification in 6%, this difference was statistically significant (p=0.032). In 97.4% of the cases, the SLNs were located below the common iliac vessels and none was para-aortic. In 72% of the women, green and blue nodes were simultaneously identified and, in 92% of the cases, SLNs had the identical topography. We observed nine positive nodes in 7 patients (7%), all of then detected by ICG and only 6 by patent blue (66%). The frozen section failed to detect 1/3 macrometastases and 3/4 micrometastases, resulting in sensitivity of 43%.

Conclusion The anatomical distribution and topographic localization of the SNL obtained were not different. ICG provides higher bilateral detection and has superior sensitivity to diagnose nodal metastasis. The addition of blue-dye increased the bilateral detection. Frozen section has a poor diagnostic value, especially for micrometastases.

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Artikel online veröffentlicht:
11. Oktober 2022