Video article

Int J Gynecol Cancer: first published as 10.1136/ijgc-2022-003420 on 25 April 2022. Downloaded from http://ijgc.bmj.com/ on August 1, 2024 at Universidad del Rosario. Protected by
INTERNATIONAL JOURNAL OF
Sentinel lymph node mapping in early-­stage
GYNECOLOGICAL CANCER
Original research

Editorials

Joint statement

Society statement

Meeting summary

Review articles
ovarian cancer: surgical technique in 10 steps
Consensus statement

Clinical trial

Case study

Video articles

Educational video lecture

Nuria Agusti ‍ ‍,1 Pilar Paredes,2,3,4 Sergi Vidal-­Sicart ‍ ‍,2,3 Ariel Glickman,1 Aureli Torne ‍ ‍,1,3,4
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Corners of the world

Commentary

Berta Díaz-­Feijoo ‍ ‍1,3,4

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ijgc.bmj.com

1
Institute Clinic of Gynecology, Systematic pelvic and para-­aortic lymphadenectomy
Obstetrics, and Neonatology, is part of early-­stage epithelial ovarian cancer staging
Hospital Clinic of Barcelona,
Barcelona, Spain
surgery.1 Although lymph node involvement rate is
2
Department of Nuclear only 15% (6%–30%), this procedure is associated
Medicine, Hospital Clínic of with a potential severe morbidity with no evidence
Barcelona, Barcelona, Spain
3
suggesting a therapeutic value. Detection of the
Institut d'Investigacions sentinel lymph node (SLN) in patients with early-­
Biomèdiques August Pi I Sunyer
(IDIBAPS), Barcelona, Spain
stage epithelial ovarian cancer is in an experimental
4
Faculty of Medicine, University phase.2 Standardization and description of the tech-
of Barcelona, Barcelona, Spain, nique are the main objectives of this video article. It
Hospital Clinic of Barcelona, has been performed in the context of a clinical trial
Barcelona, Spain called MELISA (Mapping Sentinel Lymph Node in
Initial Stages of Ovarian Cancer-­NCT05184140).
Correspondence to We present a step-­by-­step video demonstration
Dr Nuria Agusti, Department of
(Video 1) of the technique performed at the Hospital
Gynecologic Oncology, Hospital
Clinic of Barcelona. We divided the surgical procedure

copyright.
Clinic de Barcelona, Barcelona,
Spain; ​NAGUSTI@​clinic.​cat into the 10 following steps: (1) selection of the patient; Figure 1 Schematic surgical image showing
(2) materials; (3) radiotracer injection; (4) adnex- the 99mTc-­albumin nanocolloid injection in the
ectomy; (5) frozen section; (6) ovarian lymphatic utero-­ovarian ligament before performing the
Accepted 29 March 2022
Published Online First
mapping with a portable gamma camera; (7) indo- adnexectomy
25 April 2022 cyanine green injection; (8) detection of a SLN with
a fluorescence camera and gamma probe; (9) exci-
sion of SLN and performance of staging surgery; (10) As the 99mTc- albumin nanocolloid radiotracer remains
ultrastaging of SLN. trapped in the lymph nodes for a long period it can
Unlike other gynecologic cancers, the choice of a be injected before the adnexectomy. The injection at
particular tracer and the injection time remain the this time is supposed to be the ideal setting since the
most controversial aspects since final diagnosis is lymphatic pathways have not yet been disrupted. As
usually done intra-­operatively after the frozen section. evidence suggests that a dual method allows a better

© IGCS and ESGO 2022. No

commercial re-­use. See rights
and permissions. Published by
BMJ.
To cite: Agusti N,
Paredes P, Vidal-­Sicart S,
et al. Int J Gynecol Cancer
2022;32:1082–1083. Video 1 Sentinel lymph node mapping in early-­stage ovarian cancer

1082 Agusti N, et al. Int J Gynecol Cancer 2022;32:1082–1083. doi:10.1136/ijgc-2022-003420

 Video article

Int J Gynecol Cancer: first published as 10.1136/ijgc-2022-003420 on 25 April 2022. Downloaded from http://ijgc.bmj.com/ on August 1, 2024 at Universidad del Rosario. Protected by
detection rate,3 4 the injection of indocyanine green is performed Ethics approval This study involves human participants and was approved
by the ethics committee of the Hospital Clinic of Barcelona (reference number
after confirmation of the malignancy. The small size of indocyanine
HCB/2021/0130). Participants gave informed consent to participate in the study
green molecules causes rapid lymphatic migration and makes it before taking part.
difficult to accurately identify the first node, especially after a few Provenance and peer review Not commissioned; externally peer reviewed.
minutes. In order to identify the first lymphatic node in real time, a
Data availability statement All data relevant to the study are included in the
lymphatic mapping is checked with the portable gamma camera article.
(Figure 1).
In conclusion, the description of this new surgical procedure in ORCID iDs
Nuria Agusti http://orcid.org/0000-0002-1165-0661
10 steps allows its standardization and distribution among surgical Sergi Vidal-­Sicart http://orcid.org/0000-0002-6303-3606
teams. Aureli Torne http://orcid.org/0000-0003-4700-9507
Berta Díaz-­Feijoo http://orcid.org/0000-0002-6451-1817
Collaborators Investigators collaboration: Pere Fusté, Núria Carreras, Tiermes
Marina, Andrea Ritsch, Jordi Ribera, Xavi Cases, Adela Saco, Jaume Ordi.
REFERENCES
Contributors NA: Accepts full responsibility for the work and/or the conduct
of the study, had access to the data, and controlled the decision to publish. 1 Colombo N, Sessa C, du Bois A, et al. ESMO-­ESGO consensus
conference recommendations on ovarian cancer: pathology and
Conceptualization, video editing, surgery, and writing original draft. PP:
molecular biology, early and advanced stages, borderline tumours
Conceptualization, video editing collaboration, surgery, and writing original draft. and recurrent disease†. Ann Oncol 2019;30:672–705.
SV-­S: Conceptualization, project administration, surgery, and writing review. AG: 2 Dell'Orto F, Laven P, Delle Marchette M, et al. Feasibility of sentinel
Conceptualization, surgery, and writing review. AT, BD-­F: conceptualization, project lymph node mapping of the ovary: a systematic review. Int J Gynecol
administration, surgery and video recording, supervision, and writing review. Cancer 2019;29:1209–15.
3 Lago V, Bello P, Montero B, et al. Sentinel lymph node technique in
Funding The authors have not declared a specific grant for this research from any early-­stage ovarian cancer (SENTOV): a phase II clinical trial. Int J
funding agency in the public, commercial or not-­for-­profit sectors. Gynecol Cancer 2020;30:1390–6.
Competing interests None declared. 4 Scambia G, Nero C, Uccella S, et al. Sentinel-­node biopsy in early
stage ovarian cancer: a prospective multicentre study (SELLY). Int J
Patient consent for publication Consent obtained directly from patient(s). Gynecol Cancer 2019;29:1437–9.

copyright.

Agusti N, et al. Int J Gynecol Cancer 2022;32:1082–1083. doi:10.1136/ijgc-2022-003420 1083