Sentinel lymph node biopsy with cervical injection of indocyanine green in apparent early-stage endometrial cancer

predictors of unsuccessful mapping

Lucia Tortorella, Jvan Casarin, Francesco Multinu, Serena Cappuccio, Michaela E. McGree, Amy L. Weaver, Carrie L. Langstraat, Gary Keeney, Amanika Kumar, Gian Benedetto Melis, Stefano Angioni, Giovanni Scambia, Andrea Mariani, Gretchen E. Glaser

Research output: Contribution to journalArticle

Abstract

Objective: To identify predictors of unsuccessful sentinel lymph node (SLN) mapping in patients with apparent early-stage endometrial cancer (EC) undergoing surgical staging with cervical injection of indocyanine green and SLN biopsy. Methods: We retrospectively identified consecutive patients with EC with attempted SLN biopsy between June 2014 and June 2016 at our institution. Patients were grouped according to whether they had a successful procedure, defined as the bilateral identification of SLNs, or an unsuccessful procedure, defined as unilateral or no SLN mapping. Logistic regression was used to evaluate predictors of an unsuccessful procedure. Results: Among 327 patients included in the analysis, 256 (78.3%) had a successful procedure and 71 (21.7%) had an unsuccessful procedure (15.0% unilateral SLN mapping, 6.7% no mapping). The rate of successful procedure increased from 57.7% to 83.3% between the first and last quarters of the 2-year study period, which represented the learning curve for the technique. The mean (SD) operative time decreased from 164 (55) to 137 (37) minutes. By multivariable analysis, lysis of adhesions at the beginning of surgery (odds ratio, 3.07; 95% CI, 1.56–6.07) and the presence of enlarged lymph nodes (odds ratio, 4.69; 95% CI, 1.82–12.11) were independently associated with an unsuccessful procedure. Conclusions: Lysis of adhesions at the beginning of surgery and the presence of enlarged lymph nodes independently affect the bilateral detection of SLNs.

Original languageEnglish (US)
JournalGynecologic oncology
DOIs
StateAccepted/In press - Jan 1 2019

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Sentinel Lymph Node Biopsy
Indocyanine Green
Endometrial Neoplasms
Injections
Lymph Nodes
Odds Ratio
Learning Curve
Operative Time
Logistic Models

Keywords

  • Endometrial cancer
  • Indocyanine green
  • Lymph nodes
  • Sentinel lymph node mapping
  • Stage I

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Sentinel lymph node biopsy with cervical injection of indocyanine green in apparent early-stage endometrial cancer : predictors of unsuccessful mapping. / Tortorella, Lucia; Casarin, Jvan; Multinu, Francesco; Cappuccio, Serena; McGree, Michaela E.; Weaver, Amy L.; Langstraat, Carrie L.; Keeney, Gary; Kumar, Amanika; Melis, Gian Benedetto; Angioni, Stefano; Scambia, Giovanni; Mariani, Andrea; Glaser, Gretchen E.

In: Gynecologic oncology, 01.01.2019.

Research output: Contribution to journalArticle

Tortorella, L, Casarin, J, Multinu, F, Cappuccio, S, McGree, ME, Weaver, AL, Langstraat, CL, Keeney, G, Kumar, A, Melis, GB, Angioni, S, Scambia, G, Mariani, A & Glaser, GE 2019, 'Sentinel lymph node biopsy with cervical injection of indocyanine green in apparent early-stage endometrial cancer: predictors of unsuccessful mapping', Gynecologic oncology. https://doi.org/10.1016/j.ygyno.2019.08.008
Tortorella, Lucia ; Casarin, Jvan ; Multinu, Francesco ; Cappuccio, Serena ; McGree, Michaela E. ; Weaver, Amy L. ; Langstraat, Carrie L. ; Keeney, Gary ; Kumar, Amanika ; Melis, Gian Benedetto ; Angioni, Stefano ; Scambia, Giovanni ; Mariani, Andrea ; Glaser, Gretchen E. / Sentinel lymph node biopsy with cervical injection of indocyanine green in apparent early-stage endometrial cancer : predictors of unsuccessful mapping. In: Gynecologic oncology. 2019.
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abstract = "Objective: To identify predictors of unsuccessful sentinel lymph node (SLN) mapping in patients with apparent early-stage endometrial cancer (EC) undergoing surgical staging with cervical injection of indocyanine green and SLN biopsy. Methods: We retrospectively identified consecutive patients with EC with attempted SLN biopsy between June 2014 and June 2016 at our institution. Patients were grouped according to whether they had a successful procedure, defined as the bilateral identification of SLNs, or an unsuccessful procedure, defined as unilateral or no SLN mapping. Logistic regression was used to evaluate predictors of an unsuccessful procedure. Results: Among 327 patients included in the analysis, 256 (78.3{\%}) had a successful procedure and 71 (21.7{\%}) had an unsuccessful procedure (15.0{\%} unilateral SLN mapping, 6.7{\%} no mapping). The rate of successful procedure increased from 57.7{\%} to 83.3{\%} between the first and last quarters of the 2-year study period, which represented the learning curve for the technique. The mean (SD) operative time decreased from 164 (55) to 137 (37) minutes. By multivariable analysis, lysis of adhesions at the beginning of surgery (odds ratio, 3.07; 95{\%} CI, 1.56–6.07) and the presence of enlarged lymph nodes (odds ratio, 4.69; 95{\%} CI, 1.82–12.11) were independently associated with an unsuccessful procedure. Conclusions: Lysis of adhesions at the beginning of surgery and the presence of enlarged lymph nodes independently affect the bilateral detection of SLNs.",
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T1 - Sentinel lymph node biopsy with cervical injection of indocyanine green in apparent early-stage endometrial cancer

T2 - predictors of unsuccessful mapping

AU - Tortorella, Lucia

AU - Casarin, Jvan

AU - Multinu, Francesco

AU - Cappuccio, Serena

AU - McGree, Michaela E.

AU - Weaver, Amy L.

AU - Langstraat, Carrie L.

AU - Keeney, Gary

AU - Kumar, Amanika

AU - Melis, Gian Benedetto

AU - Angioni, Stefano

AU - Scambia, Giovanni

AU - Mariani, Andrea

AU - Glaser, Gretchen E.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To identify predictors of unsuccessful sentinel lymph node (SLN) mapping in patients with apparent early-stage endometrial cancer (EC) undergoing surgical staging with cervical injection of indocyanine green and SLN biopsy. Methods: We retrospectively identified consecutive patients with EC with attempted SLN biopsy between June 2014 and June 2016 at our institution. Patients were grouped according to whether they had a successful procedure, defined as the bilateral identification of SLNs, or an unsuccessful procedure, defined as unilateral or no SLN mapping. Logistic regression was used to evaluate predictors of an unsuccessful procedure. Results: Among 327 patients included in the analysis, 256 (78.3%) had a successful procedure and 71 (21.7%) had an unsuccessful procedure (15.0% unilateral SLN mapping, 6.7% no mapping). The rate of successful procedure increased from 57.7% to 83.3% between the first and last quarters of the 2-year study period, which represented the learning curve for the technique. The mean (SD) operative time decreased from 164 (55) to 137 (37) minutes. By multivariable analysis, lysis of adhesions at the beginning of surgery (odds ratio, 3.07; 95% CI, 1.56–6.07) and the presence of enlarged lymph nodes (odds ratio, 4.69; 95% CI, 1.82–12.11) were independently associated with an unsuccessful procedure. Conclusions: Lysis of adhesions at the beginning of surgery and the presence of enlarged lymph nodes independently affect the bilateral detection of SLNs.

AB - Objective: To identify predictors of unsuccessful sentinel lymph node (SLN) mapping in patients with apparent early-stage endometrial cancer (EC) undergoing surgical staging with cervical injection of indocyanine green and SLN biopsy. Methods: We retrospectively identified consecutive patients with EC with attempted SLN biopsy between June 2014 and June 2016 at our institution. Patients were grouped according to whether they had a successful procedure, defined as the bilateral identification of SLNs, or an unsuccessful procedure, defined as unilateral or no SLN mapping. Logistic regression was used to evaluate predictors of an unsuccessful procedure. Results: Among 327 patients included in the analysis, 256 (78.3%) had a successful procedure and 71 (21.7%) had an unsuccessful procedure (15.0% unilateral SLN mapping, 6.7% no mapping). The rate of successful procedure increased from 57.7% to 83.3% between the first and last quarters of the 2-year study period, which represented the learning curve for the technique. The mean (SD) operative time decreased from 164 (55) to 137 (37) minutes. By multivariable analysis, lysis of adhesions at the beginning of surgery (odds ratio, 3.07; 95% CI, 1.56–6.07) and the presence of enlarged lymph nodes (odds ratio, 4.69; 95% CI, 1.82–12.11) were independently associated with an unsuccessful procedure. Conclusions: Lysis of adhesions at the beginning of surgery and the presence of enlarged lymph nodes independently affect the bilateral detection of SLNs.

KW - Endometrial cancer

KW - Indocyanine green

KW - Lymph nodes

KW - Sentinel lymph node mapping

KW - Stage I

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JF - Gynecologic Oncology

SN - 0090-8258

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