This protocol describes the identification and resection of sentinel lymph nodes to make the operation as easy and minimally invasive as possible.
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Method Article
Sentinel Lymph Node Mapping and Biopsy for Endometrial Cancer at Early Stage with Laparoscopy
In This Article
Summary
Abstract
Sentinel lymph node (SLN) mapping and biopsy is a promising technique for visualizing and evaluating lymph node status in cancer. This approach has been recommended for low-risk endometrial cancer (EC) patients by authoritative international guidelines, but it has not been performed broadly in China and worldwide. This work aims to describe detailed SLN mapping and biopsy procedures to promote the clinical application. SLN mapping and postoperative pathologic ultrastaging were conducted in a patient with low-risk EC using indocyanine green (ICG) dye to track the SLNs under laparoscopy and resecting them completely for ultrastaging. In conclusion, this protocol describes details of ICG injection, and SLN mapping and biopsy in EC patients based on the experiences gained during clinical practice.
Introduction
Endometrial cancer (EC) is one of the most common diseases in gynecological oncology, and its incidence is rising1,2. Surgery is the first-line treatment for early-stage EC3,4. The evaluation of lymph node metastasis is an essential part of surgical staging in EC. The Gynecologic Oncology Group (GOG) study 33 demonstrated that lymph node metastases are associated with poor prognosis5.
As a new and essential technique for evaluating lymph node metastasis, sentinel lymph node (SLN) mapping and biopsy ha....
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Protocol
All surgery procedures related to the patient described here were approved by the Ethics Committees of Obstetrics & Gynecology Hospital of Fudan University in Shanghai, China. Informed consent was acquired from the patient.
1. Indications for SLN mapping with ICG in EC patients
- Ensure that patients are clinically diagnosed with primary EC confined to the uterus with low-risk factors (grade 1 or 2 endometrioid carcinomas, pre-surgical endometrial lesion ≤2 cm, and myometrial invasion <50%).
- Ensure that patients are not allergic to the developer (ICG).
- Ensure that patients have not experienced ret....
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Results
The patient in the present case was a 28-year-old female with irregular vaginal bleeding for 2 years, and she was diagnosed with an abnormality of the endometrium 4 months ago. Transvaginal ultrasound examination revealed a heterogeneous endometrial thickness with an adnexal mass. Abdominopelvic magnetic resonance imaging (MRI) demonstrated a 51 mm x 56 mm x 88 mm mass with a clear boundary within the uterine cavity under a high T2WI signal in a local hospital. Then, she was evaluated by hysteroscopy, and the endometrial.......
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Discussion
SLN mapping and biopsy is a more selective and tailored lymph node dissection approach that has been applied in the clinic for nearly 20 years. In the field of EC, SLN mapping and biopsy have been increasingly recommended by several guidelines due to their high diagnostic efficiency in early-stage EC, achieving overall and bilateral detection rates of 89%-95% and 52%-82%, respectively, with a sensitivity of 84%-100% and negative predictive value of 97%-100%22. The present study reports a typical E.......
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Disclosures
The authors have nothing to disclose.
Acknowledgements
This work was supported in part by grants from the National Natural Science Foundation of China (81772777), Shanghai Science and Technology Commission Medical Guidance Project (18411963700), Clinical Research Plan of SHDC (No. SHDC2020CR4079); Shanghai Pujiang Talents Project (17PJ1401400). We thank the timely help given by Fenghua Ma from radiology department for MR images and Chao Wang from pathology department for pathologic images from Obstetrics and Gynecology Hospital of Fudan University.
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Materials
| Name | Company | Catalog Number | Comments |
|---|---|---|---|
| 2-mL syringe | Becton, Dickinson and Company, USA | 301940 | |
| Coagulation forceps | Shanghai Medical Instrument (Group) Co., Ltd. Surgical Instrument Factory | D0A010 | |
| Fluorescence microscope | Olympus | IX73 | |
| Harmonic scalpel | Soering GmbH | SONOCA190 | |
| Hematoxylin-eosin staining | Beyotime Biotechnologies Corporation,CN | C0107 | |
| Immunohistochemical cytokeratin staining | MXB Biotechnologies Corporation, CN | Kit-0020 | |
| Indocyanine green (ICG) | Dandong Medical Innovation Pharmaceutical Corporation. | 3599-32-4 | |
| Pararaffin | Sangon biotech Co., Ltd. | A601889 | |
| Pinpoint Endoscopic Fluorescence Imaging system | Novadaq Technoloies Bonita, Springs, FL | NA | |
| Propofol Injection | Fresenius Kabi Deutschland GmbH D-61346 Bad Homburg v.d.H., Germany | H20030124 | |
| Silk Braided non-absorbable suture | Shanghai Ethicon | SA854G | |
| Silk thread | Beijing AKIN AIEN International Medical Technology Co.,Ltd. | VCPP71D | |
| Suction-Irrigation Tube | Shanghai SMAF | YX980D | |
| Toothless forceps | Shanghai Medical Instrument (Group) Co., Ltd. Surgical Instrument Factory | J41010 | |
| Trocar | ETHICON Co,. Ltd, USA | B10LT, B5LT |
References
- Siegel, R. L., Miller, K. D., Jemal, A. Cancer statistics, 2019. CA: A Cancer Journal for Clinicians. 69 (1), 7-34 (2019).
- Bray, F., et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortal....
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