DOI: 10.1007/s00259-017-3706-4Pages: 1853-1861

Role of ICG-99mTc-nanocolloid for sentinel lymph node detection in cervical cancer: a pilot study

1. Hospital Clínic, Nuclear Medicine Department

2. Hospital Clínic, Nuclear Medicine Department, Radiopharmacy Unit

3. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)

4. Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clinic

5. Hospital Clínic, Department of Pathology

6. Centre de Recerca en Salut Internacional de Barcelona (CRESIB)

Correspondence to:
Pilar Paredes
Tel: 0034 932 271 708
Email: pparedes@clinic.ub.es

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Abstract

Purpose

Sentinel lymph node biopsy (SLNB) can be used for nodal staging in early cervical cancer. For this purpose, the tracers most commonly used are radiotracers based on technetium. For the last decade, indocyanine green (ICG) has been used as a tracer for SLNB in other malignancies with excellent results and, more recently, a combination of ICG and a radiotracer has been shown to have the advantages of both tracers. The aim of this study was to evaluate the role of ICG-99mTc-nanocolloid in SLN detection in patients with cervical cancer.

Methods

This prospective study included 16 patients with cervical cancer. The hybrid tracer was injected the day (19–21 h) before surgery for planar and SPECT/CT lymphoscintigraphy. Blue dye was administered periorificially in 14 patients. SLNs were removed according to their distribution on lymphoscintigraphy and when radioactive, fluorescent and/or stained with blue dye. Nodal specimens were pathologically analysed for metastases including by immunochemistry.

Results

Lymphoscintigraphy and SPECT/CT showed drainage in all patients. A total of 69 SLNs were removed, of which 66 were detected by their radioactivity signal and 67 by their fluorescence signal. Blue dye identified only 35 SLNs in 12 of the 14 patients (85.7%). All patients showed bilateral pelvic drainage. Micrometastases were diagnosed in two patients, and were the only lymphatic nodes involved.

Conclusions

SLNB with ICG-99mTc-nanocolloid is feasible and safe in patients with early cervical cancer. This hybrid tracer provided bilateral SLN detection in all patients and a higher detection rate than blue dye, so it could become an alternative to the combined technique.

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  • Accepted: Apr 11, 2017
  • Online: May 10, 2017

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