Laparoscopic detection of sentinel lymph nodes using blue dye in women with cervical and endometrial cancer

One of the cornerstones of gynecologic cancer surgery is the assessment and removal of the regional lymph nodes (LNs). Vital blue dye was used to shown the feasibility and accuracy of laparoscopic intraoperative lymphatic mapping of the sentinel lymph nodes (SNs) in patients with cervical and endometrial cancer (EC).

Thirty-two women were submitted to laparoscopic staging of cervical and endometrial cancer. Patent blue dye (BPD) was intraoperatively injected into the cervix in 6 cases with stage I and one case with stage II cervical cancer. In 25 cases of stage I EC, the BPD was intraoperatively injected into the cervix and uterine fundus. After the BPD procedure, the patients underwent pelvic lymphadenectomy or para-aortic lymph node dissection and either laparoscopically assisted vaginal hysterectomy (26 patients) or laparoscopic radical hysterectomy (5 patients).

Laparoscopically assisted surgical staging was successfully performed in all cases. SN detection was successful in 100% of 7 women with cervical cancer. In one patient with advanced cervical cancer the metastatic SN was found. A deposition of dye into at least one lymph node was found in 21 out of 25 cases (84%) in women with EC. Uptake of the BPD was observed in a total of 53 (14.4%) of 367 LNs. Histological analysis of two LNs of the 53 were positive for metastases, whereas the remaining 51 were negative.

With the use of laparoscopy, accurate detection using blue dye on sentinel lymph nodes in uterine cancer is feasible technique.