The concept of sentinel node mapping in endometrial cancer has really been something that we’ve talked quite a bit about and it’s a way to try to advance the surgical staging of endometrial cancer. Endometrial cancer is the most common gynaecologic cancer, it’s a cancer on the rise in the United States and in the United Kingdom. In the US 63,000 women will have endometrial cancer every year. So the main, initial treatment is usually surgery to remove the uterus, staging to try to identify are there cancer cells outside of the uterus and the pelvic lymph nodes are an important part. So this concept is pretty simple – when the patient goes to sleep you inject a dye, now we’re using indocyanine green which is a green dye, injected directly into the cervix and then you do a laparoscopic, robotic or open surgery. Then you use a near infrared camera that uses a laser to intensify the image that you get from ICG. You get these beautiful fluorescent images that show you where the lymphatics are condensing in the paracervix, going to the iliac obturator region to find your sentinel nodes.
We’ve done several studies, prospective and retrospective. There has been a recent prospective randomised trial comparing blue dye versus the indocyanine green dye that showed superiority of the ICG in detecting sentinel nodes and in bilateral detection of sentinel nodes which is very important. So ICG, indocyanine green, with a near infrared system has really become the standard of care in the United States and more and more in Europe and throughout the world. There’s a lot of interest in the UK to use this system, a lot of colleagues are interested in adopting this system.
The advantage is that every patient will have surgery and at least will leave the operating room with, at the minimum, bilateral pelvic nodes so you have good surgical staging. Then you can decide, based on final pathology, what to do – whether you abbreviate the adjuvant therapy, whether you need radiation or chemo etc. It’s an interesting concept, there’s still a lot to learn about what to do with patients who have positive lymph nodes. But from the technical standpoint the injection technique, finding the nodes, the technical aspects have really been sorted out quite a bit. It’s now easily scalable to take someone who doesn’t do the procedure, teach them how to do the procedure and be able to bring it to their system.
It’s very important to have champions in departments who want to do this, who really invest into this. It’s very important to follow the sentinel node algorithm which is like a checklist to make sure that nothing gets missed so you can keep your false negative rate low.
