Sentinel Lymph Node Detection in Endometrial Cancer

NCT02690259 | Completed

• 1 other identifier: RegionSkaneKKLund
• Study Type: interventional
• Target: 257
• Locations: 1 country
• Sites: 1

Brief Summary

In endometrial cancer (EC) pelvic and paraaortic lymphadenectomy is performed only in high risk groups (with approximately 20% of patients having lymph node metastases (LNM)) whereas no lymphadenectomy is recommended in low risk groups despite 5% LNM. Moreover, preoperative risk group allocation is known to be erroneous in up to 15% of patients. A technique identifying sentinel lymph nodes (SLN) in endometrial cancer have the potential to spare extensive surgery in 80% of high risk patients, identify low risk patients with nodal metastases, diminish side effects caused by full lymphadenectomy and render some expensive preoperative risk group allocation measures unnecessary. A clinically useful SLN technique requires a high technical success rate, a clear definition of SLN, an algorithm taking into account that metastatic nodes not always accumulate tracer and a reproducible surgical algorithm. A definition of SLN requires knowledge on lymphatic anatomy. Unfortunately all tracers, dyes/radiotracers often result in an abundance of colored/ signaling nodes. Therefore, a definition of a SLN requires identification of efferent/afferent lymph vessels. Several publications describe sentinel node techniques in EC with a variety of tracers (various dyes, radiotracer, alone or in combination). Sentinel nodes are usually described as "radioactive nodes" or "colored nodes" only with no further discrimination. No study relate to an anatomical description of lymphatic pathways. The aims of this study is to systematically display the major anatomical pathways with the use of ICG and to evaluate a standardized and reproducible SLN surgical algorithm based on lymphatic anatomy and identification of efferent lymph vessels.

Conditions

Endometrial Neoplasms

Keywords

Sentinel Lymph Node Biopsy

Outcome Measures

Primary Outcomes (3)

• Detection of sentinel nodes

  The study measures the sensitivity of the described Sentinel node concept regarding the detection of Sentinel lymph nodes and detection of lymph node metastases

  up to 2 months

• Detection of Sentinel nodes

  The study measures the specificity of the described Sentinel node concept regarding the detection of Sentinel lymph nodes and detection of lymph node metastases

  up to 2 months

• Detection of Setinel nodes

  The study measures the false negative rate of the described Sentinel node concept regarding the detection of Sentinel lymph nodes and detection of lymph node metastases

  up to 2 months

Secondary Outcomes (2)

• Recurrence rates

  up to 24 months after inclusion

• Lymphatic complications

  up to 24 months after inclusion

Study Arms (1)

Sentinel node procedure

EXPERIMENTAL

Enrolling all eligible endometrial cancer patient to the Sentinel node concept using indocyanine green.

Procedure: Sentinel node procedure

Interventions

Sentinel node procedure PROCEDURE

Patients with Endometrial cancer undergo Sentinel node procedure using Indocyanine green

Also known as: Indocyanine green

Sentinel node procedure

Eligibility Criteria

• Age: 18 Years+
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Planned robotic operation due to endometrial carcinoma
• Patient suitable for laparoscopic surgery
• Signed consent

You may not qualify if:

• No consent
• Inability to understand study information
• surgical or anesthesiological contraindication for laparoscopic surgery
• previous lymphatic problems
• iodine allergy iodine
• disseminated disease

Sponsors & Collaborators

• Region Skane: lead

Study Sites (1)

Department of Gynecology and Obstetrics

Lund, 22185, Sweden

Location

Related Publications (12)

• Geppert B, Persson J. Robotic infrarenal paraaortic and pelvic nodal staging for endometrial cancer: feasibility and lymphatic complications. Acta Obstet Gynecol Scand. 2015 Oct;94(10):1074-81. doi: 10.1111/aogs.12712. Epub 2015 Aug 25.

  PMID: 26218968 BACKGROUND

• Schaafsma BE, van der Vorst JR, Gaarenstroom KN, Peters AA, Verbeek FP, de Kroon CD, Trimbos JB, van Poelgeest MI, Frangioni JV, van de Velde CJ, Vahrmeijer AL. Randomized comparison of near-infrared fluorescence lymphatic tracers for sentinel lymph node mapping of cervical cancer. Gynecol Oncol. 2012 Oct;127(1):126-30. doi: 10.1016/j.ygyno.2012.07.002. Epub 2012 Jul 10.

  PMID: 22796548 BACKGROUND

• Holloway RW, Bravo RA, Rakowski JA, James JA, Jeppson CN, Ingersoll SB, Ahmad S. Detection of sentinel lymph nodes in patients with endometrial cancer undergoing robotic-assisted staging: a comparison of colorimetric and fluorescence imaging. Gynecol Oncol. 2012 Jul;126(1):25-9. doi: 10.1016/j.ygyno.2012.04.009. Epub 2012 Apr 13.

  PMID: 22507531 BACKGROUND

• van der Vorst JR, Hutteman M, Gaarenstroom KN, Peters AA, Mieog JS, Schaafsma BE, Kuppen PJ, Frangioni JV, van de Velde CJ, Vahrmeijer AL. Optimization of near-infrared fluorescent sentinel lymph node mapping in cervical cancer patients. Int J Gynecol Cancer. 2011 Nov;21(8):1472-8. doi: 10.1097/IGC.0b013e31822b451d.

  PMID: 22027751 BACKGROUND

• Rossi EC, Ivanova A, Boggess JF. Robotically assisted fluorescence-guided lymph node mapping with ICG for gynecologic malignancies: a feasibility study. Gynecol Oncol. 2012 Jan;124(1):78-82. doi: 10.1016/j.ygyno.2011.09.025. Epub 2011 Oct 11.

  PMID: 21996262 BACKGROUND

• Rossi EC, Jackson A, Ivanova A, Boggess JF. Detection of sentinel nodes for endometrial cancer with robotic assisted fluorescence imaging: cervical versus hysteroscopic injection. Int J Gynecol Cancer. 2013 Nov;23(9):1704-11. doi: 10.1097/IGC.0b013e3182a616f6.

  PMID: 24177256 BACKGROUND

• Jewell EL, Huang JJ, Abu-Rustum NR, Gardner GJ, Brown CL, Sonoda Y, Barakat RR, Levine DA, Leitao MM Jr. Detection of sentinel lymph nodes in minimally invasive surgery using indocyanine green and near-infrared fluorescence imaging for uterine and cervical malignancies. Gynecol Oncol. 2014 May;133(2):274-7. doi: 10.1016/j.ygyno.2014.02.028. Epub 2014 Feb 28.

  PMID: 24582865 BACKGROUND

• How J, Gotlieb WH, Press JZ, Abitbol J, Pelmus M, Ferenczy A, Probst S, Gotlieb R, Brin S, Lau S. Comparing indocyanine green, technetium, and blue dye for sentinel lymph node mapping in endometrial cancer. Gynecol Oncol. 2015 Jun;137(3):436-42. doi: 10.1016/j.ygyno.2015.04.004. Epub 2015 Apr 12.

  PMID: 25870917 BACKGROUND

• Plante M, Touhami O, Trinh XB, Renaud MC, Sebastianelli A, Grondin K, Gregoire J. Sentinel node mapping with indocyanine green and endoscopic near-infrared fluorescence imaging in endometrial cancer. A pilot study and review of the literature. Gynecol Oncol. 2015 Jun;137(3):443-7. doi: 10.1016/j.ygyno.2015.03.004. Epub 2015 Mar 11.

  PMID: 25771495 BACKGROUND

• Sinno AK, Fader AN, Roche KL, Giuntoli RL 2nd, Tanner EJ. A comparison of colorimetric versus fluorometric sentinel lymph node mapping during robotic surgery for endometrial cancer. Gynecol Oncol. 2014 Aug;134(2):281-6. doi: 10.1016/j.ygyno.2014.05.022. Epub 2014 Jun 2.

  PMID: 24882555 BACKGROUND

• Luhrs O, Ekdahl L, Geppert B, Lonnerfors C, Persson J. Resection of the upper paracervical lymphovascular tissue should be an integral part of a pelvic sentinel lymph node algorithm in early stage cervical cancer. Gynecol Oncol. 2021 Nov;163(2):289-293. doi: 10.1016/j.ygyno.2021.08.031. Epub 2021 Sep 9.

  PMID: 34509298 DERIVED

• Luhrs O, Ekdahl L, Lonnerfors C, Geppert B, Persson J. Combining Indocyanine Green and Tc99-nanocolloid does not increase the detection rate of sentinel lymph nodes in early stage cervical cancer compared to Indocyanine Green alone. Gynecol Oncol. 2020 Feb;156(2):335-340. doi: 10.1016/j.ygyno.2019.11.026. Epub 2019 Nov 26.

  PMID: 31780237 DERIVED

MeSH Terms

Conditions

Endometrial Neoplasms

Interventions

Indocyanine Green

Condition Hierarchy (Ancestors)

Uterine Neoplasms; Genital Neoplasms, Female; Urogenital Neoplasms; Neoplasms by Site; Neoplasms; Uterine Diseases; Genital Diseases, Female; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Genital Diseases

Intervention Hierarchy (Ancestors)

Indoles; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Heterocyclic Compounds

Study Officials

• Jan Persson, Ass Prof

  Lund University

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: DIAGNOSTIC
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Detection of SLN followed by a complete lymphadenectomy. In this way every patients will serve as her own control

Study Record Dates

• First Submitted: November 5, 2015
• First Posted: February 24, 2016
• Study Start: June 1, 2014
• Primary Completion: May 30, 2018
• Study Completion: May 30, 2018
• Last Updated: March 22, 2019

Record last verified: 2019-03

Locations

SE (1)