Initial Experience with Dual-Tracer Sentinel Lymph Node Mapping Using RI and ICG in Robot-Assisted Surgery for...

Area of Science:

• Gynecologic Oncology
• Surgical Innovation
• Medical Imaging

Background:

• Sentinel lymph node (SLN) biopsy is a key minimally invasive technique for staging endometrial cancer.
• Optimizing SLN identification in robot-assisted surgery is crucial for accurate staging.
• Dual-tracer mapping combining radioisotope (RI) and indocyanine green (ICG) is explored for enhanced accuracy.

Purpose of the Study:

• To evaluate the feasibility and mapping characteristics of dual-tracer SLN mapping (RI + ICG).
• To assess the efficacy of this method in robot-assisted surgery for clinical stage IA endometrial cancer.
• To compare the detection rates and concordance of RI and ICG tracers.

Main Methods:

• Prospective study of 10 patients with clinical stage IA endometrioid carcinoma undergoing robot-assisted surgery.
• Cervical injection of Technetium-99m phytate followed by SPECT-CT, and intraoperative ICG administration.
• SLN identification using both RI mapping and near-infrared fluorescence imaging, followed by pelvic lymphadenectomy.

Main Results:

• 100% SLN detection rate achieved with the dual-tracer method.
• ICG fluorescence imaging identified SLNs in all patients (100%), while RI mapping detected them in 30%.
• All RI-positive SLNs were confirmed by ICG; no lymph node metastases were found. One complication (pelvic hematoma) occurred.

Conclusions:

• Dual-tracer SLN mapping with RI and ICG is feasible and effective in robot-assisted surgery for early-stage endometrial cancer.
• ICG provides sensitive lymphatic visualization, with RI offering complementary intraoperative guidance.
• Further studies with larger cohorts are needed to confirm the clinical utility of this dual-tracer approach.