Role of ultrastaging in sentinel lymph node biopsy with ICG mapping in endometrial cancer



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Abstract

BACKGROUND: Endometrial cancer is oncological disease of the female reproductive system in developed countries, typically detected at early stages. Currently, one of the most popular methods for sentinel lymph node mapping and biopsy in stage I endometrial cancer is the use of indocyanine green (ICG) followed by ultrastaging technology.

AIM: To determine the feasibility and protocol of sentinel lymph node ultrastaging following ICG mapping in different risk groups for lymphogenic metastases in stage I endometrial cancer.

MATERIALS AND METHODS: A cohort study was conducted, including 286 patients with verified uterine body cancer at stages cT1a-T1bN0M0, who underwent treatment at the Department of Oncogynecology No. 70 of the Moscow S.P. Botkin Multidisciplinary Research and Clinical Center of the Moscow Department of Health and at the Kaluga Regional Clinical Oncology Center from 2023 to 2024. Patients underwent sentinel lymph node biopsy (SLNB) with ICG mapping using indocyanine green and subsequent ultrastaging.

RESULTS: The bilateral detection rate of sentinel lymph nodes was 70.9%. The detection rate of N1 in the low-risk group was 3.6%, in the intermediate-risk group — 12.8%, and in the high-risk group — 21.3%. A trend toward an increase in the proportion of macrometastases was observed as the risk increased from low to high. The proportion of metastatic changes detected through immunohistochemical (IHC) examination was 28.3%.

CONCLUSION: SLNB is advisable in all risk groups for lymphogenic metastasis, except for patients with high risk, who, according to the new FIGO 2023 classification of endometrial cancer, will be classified as stage II of the disease. This cohort of patients is recommended to undergo full lymphadenectomy.

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About the authors

Vladimir A. Alimov

Moscow S.P. Botkin Multidisciplinary Research and Clinical Center, Moscow, Russia; Russian Medical Academy of Continuous Professional Education, Moscow, Russia

Email: alimovvladimirr@gmail.com
ORCID iD: 0000-0002-6423-3917
SPIN-code: 6262-0720

MD, Cand. Sci. (Medicine), researcher, head of gynecological oncology department 

Russian Federation, Moscow, Russia; Moscow, Russia

Sergei A. Skugarev

Kaluga Regional Clinical Oncology Center, Kaluga, Russia

Email: skugarevsa@gmail.com
ORCID iD: 0000-0002-0521-8207
SPIN-code: 5682-7051

surgeon, oncologist, gynaecologist, head of the department of oncogynaecology and breast tumours, Kaluga Regional Clinical Oncological Dispensary, Kaluga Region

Russian Federation, Kaluga, Russia

Elena G. Novikova

Hertsen Moscow Oncology Research Institute — branch of the National Medical Research Radiological Centre, Moscow, Russia

Email: egnov@bk.ru
ORCID iD: 0000-0003-2768-5698
SPIN-code: 2143-9975

MD, Dr. Sci. (Medicine), Professor, Honoured Scientist of the Russian Federation, Honoured Physician of Russia, Laureate of the State Prize of the Russian Federation

Russian Federation, Moscow, Russia

Sergei S. Lebedev

Moscow S.P. Botkin Multidisciplinary Research and Clinical Center, Moscow, Russia; Russian Medical Academy of Continuous Professional Education, Moscow, Russia

Email: lebedevssd@yandex.ru
ORCID iD: 0000-0001-5366-1281
SPIN-code: 2736-0683

MD, Cand. Sci. (Medicine), surgeon, oncologist, leading researcher

Russian Federation, Moscow, Russia; Moscow, Russia

Zurab A. Bagatelia

Moscow S.P. Botkin Multidisciplinary Research and Clinical Center, Moscow, Russia; Russian Medical Academy of Continuous Professional Education, Moscow, Russia

Email: bagateliaza@botkinmoscow.ru
ORCID iD: 0000-0001-5699-3695
SPIN-code: 5391-5670

MD, Dr. Sci. (Medicine), Professor, surgeon, oncologist, leading researcher

Russian Federation, Moscow, Russia; Moscow, Russia

Anastasia A. Laevskaya

Moscow S.P. Botkin Multidisciplinary Research and Clinical Center, Moscow, Russia

Email: ayaksveal@yandex.ru
ORCID iD: 0000-0002-5593-6549
Russian Federation, Moscow, Russia

Anna M. Arutyunyan

Moscow S.P. Botkin Multidisciplinary Research and Clinical Center, Moscow, Russia

Email: dr.arutyunyana@gmail.com

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow, Russia

Dmitriy S. Lantsov

Kaluga Regional Clinical Oncology Center, Kaluga, Russia

Email: alimovvladimirr@gmail.com
ORCID iD: 0009-0001-7314-4844

MD, Cand. Sci. (Medicine)

Russian Federation, Kaluga, Russia

Irina O. Tinkova

Moscow S.P. Botkin Multidisciplinary Research and Clinical Center, Moscow, Russia

Email: alimovvladimirr@gmail.com
ORCID iD: 0000-0002-6960-1184

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow, Russia

Alexey V. Shabunin

Moscow S.P. Botkin Multidisciplinary Research and Clinical Center, Moscow, Russia; Russian Medical Academy of Continuous Professional Education, Moscow, Russia

Author for correspondence.
Email: info@botkinmoscow.ru
ORCID iD: 0000-0002-4230-8033
SPIN-code: 8917-7732

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow, Russia; Moscow, Russia

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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