Sentinel lymphadenectomy in cervical cancer using near infrared fluorescence from indocyanine green combined with technetium‐99m‐nanocolloid

Objective Sentinel diagnostic in cervical cancer is performed using Technetium‐99m‐nanocolloid as a radioactive marker with or without patent blue. In the last years, indocyanine green has been evaluated for sentinel diagnostic in different tumor entities. Indocyanine green is a fluorescent molecule which emits a light signal in the near infrared band after excitation. Our study aims to evaluate indocyanine green compared to the gold standard Tc‐99m‐nanocolloid. Materials and Methods We included patients with early cervical cancer up to FIGO stage IIA with clinically node‐negative pelvic sites and the indication for nodal staging in this prospective trial. Sentinel diagnostic was carried out using Tc‐99m‐nanocolloid, indocyanine green and patent blue. We examined each pelvic site for light signals from the near infrared band, for radioactivity and for blue staining. A sentinel lymph node was defined as a Tc‐99m‐nanocolloid positive lymph node. All sentinel lymph nodes and all additional blue or fluorescent lymph nodes were excised and tested; then sent to histologic examination. Results Thirty‐three patients were included in which we found 211 Tc‐99m‐nanocolloid‐positive sentinel lymph nodes in 66 pelvic sites. Two hundred and seven of these lymph nodes were positive for indocyanine green, too, giving a sensitivity of 98.1% (95%CI 94.9–99.4%) compared to Tc‐99m‐nanocolloid. One hundred and sixty additional lymph nodes showed indocyanine green fluorescence but no Tc‐99m‐positivity, so that the sensitivity was 79.6% (95%CI 76.6–82.3%). In one patient, a pelvic site was only identified to be tumor infiltrated due to an ICG‐positive, but Tc‐99m‐negative lymph node. Conclusion Our results show that indocyanine green is a promising approach for pelvic sentinel identification in cervical cancer. ICG has a similar sensitivity as radioactive Tc‐99m‐nanocolloid and may enhance both patient safety and surgeons’ comfort. Lasers Surg. Med. 50:994–1001, 2018. © 2018 Wiley Periodicals, Inc.