Indocyanine Green Combined With Near-Infrared Imaging Compared With Radionuclide Combined With Blue Dye In Early Endometrial Cancer Sentinel Lymph Node Biopsies

Objective:The purpose of this study was to evaluate the feasibility of Indocyanine Green(ICG)combined with Near Infrared(NIR)Imaging in Endometrial cancer(EC)Sentinel lymph node biopsy,negative predictive value,specificity and sensitivity and SLN detection were compared with radionuclide(TC-99m)±methylene blue.SLN biopsy method suitable for clinical popularization was selected to provide basis for individualized and minimally invasive treatment of EC patients.Methods:Patients with EC diagnosed by curettage and pathology were collected from the Department of Gynecology of our hospital from August to February in the August 2021-february 2023.Age,histological differentiation,depth of myometrial invasion and tumor diameter were collected.All patients underwent endometrial Cancer surgery according to the National Comprehensive Cancer Network(NCCN)guidelines,and specimens were packed SLN for pathology.According to the detection mode of SLN,they were divided into two groups: group ICG combined with NIR was injected at 3 and 9 points of cervix,combined with NIR to detect SLN and resect it,then pelvic and abdominal lymphadenectomy was performed;In the TC-99 m ±methylene blue group,the acoustic feedback was provided by injecting TC-99 m at 3 and 9 points of the cervix before operation,and the visual navigation was provided by injecting themethylene blue under the serosa of the uterine body during the operation to locate the SLN and resect it,pelvic and abdominal lymphadenectomy was performed subsequently.The results of SLN detected by the two methods were compared with the results of pathology.SPSS 26.0 software was used to analyze the data.Fisher test was used to determine the age,histological differentiation,depth of myometrial invasion and tumor diameter between the two groups.We also calculated the negative predictive value,specificity,sensitivity and detection rate of the two methods to compare the feasibility of the two methods in SLN biopsy.Results:A total of 46 patients were enrolled,including 36 in the ICG plus NIR Group and 10 in the TC-99 m ±methylene blue group.There was no significant difference in age,histological differentiation,depth of myometrial invasion and tumor diameter between the two groups(P > 0.05).In ICG combined with NIR Group,SLN was detected in 2 cases,and one of them was pathologically confirmed as pelvic lymph node metastasis.Negative predictive value was97.1%,specificity was 97.1%,sensitivity was 50%,detection rate was 5.6%.Ten patients were included in the TC-99 m ±methylene blue group.No SLN was detected and no lymph node metastasis was found.Negative predictive value was 100%,specificity was 100%,sensitivity and detection rate were 0.Conclusion:1.ICG combined with NIR has high negative predictive value and specificity in early EC patients,which proves that this technique is safe and feasible and can replace systematic lymphadenectomy.2.Compared with TC-99 m ±methylene blue group,the clinical application program of ICG combined with NIR is simpler and more suitable for clinical application.