Sentinel Lymph Node Staging with Indocyanine Green for Patients with Cervical Cancer: The Safety and Feasibility of Open Approach Using SPY-PHI Technique

SIMPLE SUMMARY: While several studies have been conducted on the safety and efficacy of sentinel lymph node technique during minimally invasive radical hysterectomy and indicated that using indocyanine green alone is a better tracer agent, there is now high unmet medical need and growing demand for more data about sentinel lymph node detection and the most suitable tracer in open surgery for cervical cancer, especially after the publishing of the of Laparoscopic Approach to Cervical Cancer (LACC) Trial data. The aim of this study is to assess the feasibility and safety of sentinel lymph nodes with indocyanine green in cervical cancer patients undergoing radical hysterectomy in open surgery and to compare the detection rates of this tracer in the open versus laparoscopic approaches. ABSTRACT: (1) Background: Sentinel lymph node staging (SLN) with indocyanine green (ICG) in cervical cancer is the standard of care in most national and international guidelines. However, the vast majority of relevant studies about the safety and feasibility of this method are conducted on minimally invasive surgery; (2) Methods: This study is a retrospective analysis of a retrospective collected database of 76 consecutive patients with cervical cancers, who were operated laparoscopically (50%), or laparotomy (50%). Sentinel nodes were defined as the ICG-positive pelvic nodes in the first and second echelons. False negative cases were defined as positive non-sentinel lymph nodes despite successful sentinel mapping or failed mapping bilaterally by per-patient assessment or unilaterally by pelvic sidewall assessment; (3) Results: Regardless of the approach (open or laparoscopic), the SLN technique achieved a total sensitivity, specificity, and negative predictive value (NPV) of 94.7%, 98.6%, and 94.7%, respectively in the entire sample. The bilateral detection rate was as high as 93.4% with identical results in both approaches. The sensitivity and NPV for SNL in open surgery was found to be similar to minimal access surgery; (4) Conclusions: ICG and SPY-PHI technique is a reliable tool to detect sentinel lymph nodes in cervical cancer during laparotomy.