FROM TOP:
1. EARLY LYMPHATIC PATHWAY TO THE
SENTINEL NODE
2. LATE LYMPHATIC PATHWAY TO THE
SENTINEL NODE
3. LYMPH NODE TARGETED WITH DYE CH1
Indigo-Cyanide Green (ICG) dye is injected into the cervix
after the patient has been placed under anaesthetic. A small
dose (only 1mg) of the ICG is injected into the uterine
cervix. After this, the surgeon will proceed with normal
laparoscopic entry into the abdomino-pelvic cavity and use
Advanced Modality Imaging to visualise the ICG tracer in the
lymphatic channels and nodes. Successful mapping is defined
by observing a lymphatic channel from the cervix (injection
site) to at least one lymph node in each side of the pelvis.
All detected sentinel lymph nodes are numerically labelled
according to the order in which they were located and then
excised. Specimens are given to the pathologist, who follows
specific protocols in order to assess all the lymph nodes
removed.
Gynaecological Oncologists are experienced in the use of
sentinel lymph node techniques as it applies to vulval cancer
with the majority of our practitioners having utilised this
technique successfully over many years.
A major study recently published has highlighted that
the use of sentinel lymph node assessment in endometrial
cancer provided an additional benefit to patients suitable
for lymphadenectomy, resulting in a reduction in the risk of
pelvic sidewall recurrences compared to a complete pelvic
lymphadenectomy (1). A further large multi-centre study
published last year demonstrated the safety of sentinel lymph
node biopsy using the tracer ICG in endometrial cancer in
comparison to standard pelvic lymphadenectomy (2). The
same pattern of both safety and additional benefit to the
patient is now being realised in early stage ovarian (3) and
cervical cancer (4).
This new technology will decrease unnecessary recurrence
of disease in patients with no compromise of oncologic
outcomes. It is reliable, reproducible and accurate - with only
3 percent of patients with lymph node disease unrecognised
by this technique (false negative rate). Patients receiving a
negative sentinel lymph node biopsy can be reassured that
this result is accurate in more than 99 percent of cases (2).
It is crucial to determine whether or not cancer has reached
the local lymph nodes of patients due to the new evidence
that patients with node-positive disease (lymph nodes that are
positive for cancer cells) have improved survival rates with
post-operative chemotherapy (5).
26 | Pindara Magazine ISSUE 13 | 2018