Sentinel lymph node biopsy in early-stage endometrium cancer using methylene blue dye

Mannar Mannan Govindan; Ayyappan Srinivasan; Ajit Pai

doi:10.18203/2320-1770.ijrcog20240140

Authors

Mannar Mannan Govindan Department of Surgical Oncology, Apollo Hospitals, Chennai, Tamil Nadu, India
Ayyappan Srinivasan Department of Surgical Oncology, Apollo Hospitals, Chennai, Tamil Nadu, India
Ajit Pai Department of Surgical Oncology, Apollo Hospitals, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20240140

Keywords:

Lymphadenectomy, Early-stage endometrium cancer, Endometrial cancer, Methylene blue, SLNB

Abstract

Background: The nodal evaluation of early-stage carcinoma endometrium has evolved rapidly, with various methods and dyes explored for sentinel lymph node biopsy (SLNB). Our study specifically aims to investigate the utilization of 1% methylene blue in SLNB for carcinoma endometrium at our center.

Methods: In our prospective study of 105 patients with early-stage CA endometrium in our center between June 2021 and August 2022, we used 1% methyl blue dye for SLNB identification. We followed each patient for a minimum of 6 months. We documented demographic characteristics, SLNB features, and postoperative outcomes.

Results: Out of 105 patients,94 patients (93%) of the study population belong to clinical FIGO stage IA disease.82 patients (81%) had biopsy specimens that showed endometrioid variant grade 1, followed by grade 2 in 13 patients (12.9%). 82 patients (81.2%) had unilateral SLNB visualisation 48 patients( 47.5%) had bilateral visualization of nodes. 19 patients (18.8%) of the study population had negative visualization of nodes on both sides. The average number of sentinel nodes retrieved was 2 nodes in 48 patients (45.5%), with a false negative rate of 4%.

Conclusion: In our study, using a 1% methylene blue dye for an SLNB in Ca endometrium showed less than 50% success in visualizing both sides. Therefore, we do not recommend using it as a standard method. However, in resource-limited settings where indocyanine green (ICG) and radiocolloid are not available, considering methylene blue as an alternative is a viable option provided the SLNB algorithm is followed.

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References

Achouri A, Huchon C, Bats AS, Bensaid C, Nos C, Lécuru F. Complications of lymphadenectomy for gynecologic cancer. Eur J Surg Oncol. 2013;39(1):81-6.

Schlappe BA, Weaver AL, McGree ME, Ducie J, Eriksson AGZ, Dowdy SC et al. Multicenter study comparing oncologic outcomes after lymph node assessment via a sentinel lymph node algorithm versus comprehensive pelvic and paraaortic lymphadenectomy in patients with serous and clear cell endometrial carcinoma. Gynecol Oncol. 2020;156(1):62-9.

Carlson JW, Kauderer J, Hutson A, Carter J, Armer J, Lockwood S et al. GOG 244-The lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients. Gynecol Oncol. 2020;156(2):467-74.

Kang S, Yoo HJ, Hwang JH, Lim M-C, Seo S-S, Park S-Y. Sentinel lymph node biopsy in endometrial cancer: Meta-analysis of 26 studies. Gynecologic Oncol. 2011;123(3):522-7.

Panici PB, Basile S, Maneschi F, Lissoni AA, Signorelli M, Scambia G et al. Systematic Pelvic Lymphadenectomy vs No Lymphadenectomy in Early-Stage Endometrial Carcinoma: Randomized Clinical Trial. J Natl Cancer Inst. 2008;100(23):1707-16.

NCCN- National Comprehensive Cancer Network guidelines for ca endometrium. 2021.

Burke T, Levenback ChH, Tornos C, Morris M, Wharton JT, Gershenson DM et al. Intra-abdominal lym- phatic mapping to direct selective pelvic and paraaortic lymphadenec- tomy in women with high risk endometrial cancer: results of a pilot study. Gynecol Oncol. 1996;62(2):169-73.

Frost JA, Webster KE, Bryant A, Morrison J. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev. 2017;10(10):CD007585.

Rossi EC, Kowalski LD, Scalici J, Cantrell L, Schuler K, Hanna RK et al. A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): A multicentre, prospective, cohort study. Lancet Oncol. 2017;18(3):384-92.

Barlin JN, Khoury-Collado F, Kim C, Leitao MM, Chi DS, Sonoda Y et al. The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: Beyond removal of blue nodes. Gynecol Oncol. 2012;125(3):531-5.

Rajanbabu A, Agarwal R. A prospective evaluation of the sentinel node mapping algorithm in endometrial cancer and correlation of its performance against endometrial cancer risk subtypes. Eur J Obstet Gynecol Reprod Biol. 2018;224:77-80.

Nidhi N, Rupinder KS, Vandana J, Amita N, Sudhir KR. Clinical Outcomes of Robotic Versus Open Radical Hysterectomy in Endometrial Cancer Staging: An Experience at a Tertiary Referral Care Center. J Gynecologic Surgery. 2019;35(5):279-84.

Hagen B, Valla M, Aune G, Merethe R, Anne BA, Elisabeth A et al. Indocyanine green fluorescence imaging of lymph nodes during robotic-assisted laparoscopic operation for endometrial cancer. A prospective validation study using a sentinel lymph node surgical algorithm. Gynecol Oncol. 2016;143(3):479-83.

ASTEC study group, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373(9677):1764.

De Boer SM, Powell ME, Mileshkin L, Dionyssios K, Paul B, Christine HM et al. Adjuvant chemoradiotherapy versus radiotherapy alone in women with high-risk endometrial cancer (PORTEC- 3): patterns of recurrence and post-hoc survival analysis of a randomised phase 3 trial [published correction appears in. Lancet Oncol. 2019;468(9):1273-85.

Keys HM, Roberts JA, Brunetto VL, Richard JZ, Nick MS, Jeffrey DB et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study [published correction appears in Gynecol Oncol. 2004;94(1):241-2.

Darin MC, Gómez-Hidalgo NR, Westin SN, et al. Role of Indocyanine Green in Sentinel Node Mapping in Gynecologic Cancer: Is Fluorescence Imaging the New Standard? J Minim Invasive Gynecol. 2016;23(2):186-93.

Khoury-Collado F, St Clair C, Abu-Rustum NR. Sentinel Lymph Node Mapping in Endometrial Cancer: An Update. Oncologist. 2016;21(4):461-6.

Li W, Jiang J, Fu Y, Yuanming S, Chuyao Z, Shuzhong Y et al. Implications of Isolated Para-Aortic Lymph Node Metastasis in Endometrial Cancer: A Large-Scale, Multicenter, and Retrospective Study. Front Med (Lausanne). 2021;8:754890.

Eriksson AG, Beavis A, Soslow RA, Qin Z, Nadeem RAR, Ginger JG et al. A Comparison of the Detection of Sentinel Lymph Nodes Using Indocyanine Green and Near-Infrared Fluorescence Imaging Versus Blue Dye During Robotic Surgery in Uterine Cancer. Int J Gynecol Cancer. 2017;27(4):743-7.

How J, Gotlieb WH, Press JZ, et al. Comparing indocyanine green, technetium, and blue dye for sentinel lymph node mapping in endometrial cancer. Gynecol Oncol. 2015;137(3):436-42.

Montgomery LL, Thorne AC, Van Zee KJ, Jane F, Alexandra SH, Mary G et al. Isosulfan blue dye reactions during sentinel lymph node mapping for breast cancer. Anesth Analg. 2002;95(2):382-8.