Analysis of indocyanine green-guided sentinel lymph node mapping for cervical cancer during pregnancy

Cervical cancer is the most common gynecological malignancy during pregnancy. Management must balance maternal oncologic control with fetal safety. Sentinel lymph node mapping using indocyanine green may offer a minimally invasive alternative to pelvic lymphadenectomy, but its feasibility and safety during pregnancy remain unclear. We evaluated the feasibility, detection outcomes, and obstetric safety of indocyanine green-guided sentinel lymph node mapping in early-stage cervical cancer during pregnancy.

This multi-center retrospective case series included pregnant patients with invasive cervical cancer who underwent indocyanine green-guided sentinel lymph node mapping between May 2018 and September 2025 across seven European centers within the International Network on Cancer, Infertility and Pregnancy. Data were extracted from medical records on patient demographics, surgical procedures, obstetric outcomes, and follow-up.

Eleven pregnant patients (median maternal age 35 years, range; 21-40 years; median gestational age 16 weeks 5 days, range; 9 weeks 1 day to 23 weeks 3 days) were included. Sentinel lymph node mapping was successful in 10 patients (90.9%), with bilateral detection in 8 (72.7%). Twenty-two sentinel lymph nodes were identified, most commonly in the external iliac (45.5%) and obturator regions (22.7%). Five patients (45.5%) underwent additional pelvic lymphadenectomy. Sentinel lymph nodes were negative for metastasis in 10 patients (90.9%). One patient with bilateral positive sentinel lymph nodes opted for pregnancy termination and chemoradiation. One intrauterine fetal death at 22 weeks of gestation occurred in a patient with severe chemotherapy-induced fetal anemia. The remaining nine pregnancies reached a median gestational age of 36 weeks 2 days, with no congenital malformations; four neonates required neonatal intensive care unit admission for prematurity. Ten patients underwent hysterectomy post-partum or concomitantly with cesarean delivery. Median follow-up was 17 months (range; 4-72 months); one pelvic recurrence was reported.

Indocyanine green-guided sentinel lymph node mapping is feasible for nodal staging in selected pregnant patients with early-stage cervical cancer. Detection rates are comparable to those in non-pregnant populations and may minimize maternal morbidity while preserving pregnancy. These results support multi-center validation before broader implementation.