Impact of Obesity on Sentinel Lymph Node Mapping in Patients with Newly Diagnosed Uterine Cancer Undergoing Robotic Surgery

Ane Gerda Zahl Eriksson, Margaret Montovano, Anna Beavis, Robert A. Soslow, Qin Zhou, Nadeem R. Abu-Rustum, Ginger J. Gardner, Oliver Zivanovic, Richard R. Barakat, Carol L. Brown, Douglas A. Levine, Yukio Sonoda, Mario M. Leitao, Elizabeth L. Jewell

Research output: Contribution to journalArticle

Abstract

Purpose: The aim of this study was to determine the impact of obesity on the rate of successful sentinel lymph node (SLN) mapping in patients with uterine cancer undergoing robotic surgery, and compare SLN detection rates using indocyanine green (ICG) versus blue dye. Methods: We reviewed robotic cases undergoing SLN mapping with a cervical injection from January 2011 to December 2013 using either blue dye or ICG with near-infrared (NIR) fluorescence imaging. Data were stratified by body mass index (BMI) and the dye used. Appropriate statistical tests were applied. Results: Overall, 472 cases were identified. Bilateral mapping was successful in 352 cases (75 %), and unilateral mapping was successful in 73 cases (15 %). Bilateral mapping was achieved in 266 (85 %) of 312 ICG cases compared with 86 (54 %) of 160 blue-dye cases (p < 0.001). Cases with successful bilateral mapping had a median BMI of 29.8 kg/m2 (range 16.3–65.3 kg/m2); cases with no mapping had a median BMI of 34.7 kg/m2 (range 21.4–60.4 kg/m2) (p = 0.001). With increasing BMI, there was a significant decrease in successful bilateral mapping rates for both the ICG (p < 0.001) and blue-dye groups (p = 0.041); however, the use of ICG resulted in better bilateral (p = 0.002) and overall (p = 0.011) mapping rates compared with the use of blue dye in all BMI groups. Conclusions: ICG results in a higher overall and bilateral SLN detection than blue dye in women with uterine cancer. Successful mapping decreases with increasing BMI irrespective of the dye used; however, it is significantly improved with the use of ICG and NIR fluorescence imaging compared with blue dye.

Original languageEnglish (US)
Pages (from-to)2522-2528
Number of pages7
JournalAnnals of Surgical Oncology
Volume23
Issue number8
DOIs
StatePublished - Aug 1 2016
Externally publishedYes

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Uterine Neoplasms
Robotics
Indocyanine Green
Coloring Agents
Obesity
Body Mass Index
Optical Imaging
Sentinel Lymph Node
Injections

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Impact of Obesity on Sentinel Lymph Node Mapping in Patients with Newly Diagnosed Uterine Cancer Undergoing Robotic Surgery. / Eriksson, Ane Gerda Zahl; Montovano, Margaret; Beavis, Anna; Soslow, Robert A.; Zhou, Qin; Abu-Rustum, Nadeem R.; Gardner, Ginger J.; Zivanovic, Oliver; Barakat, Richard R.; Brown, Carol L.; Levine, Douglas A.; Sonoda, Yukio; Leitao, Mario M.; Jewell, Elizabeth L.

In: Annals of Surgical Oncology, Vol. 23, No. 8, 01.08.2016, p. 2522-2528.

Research output: Contribution to journalArticle

Eriksson, AGZ, Montovano, M, Beavis, A, Soslow, RA, Zhou, Q, Abu-Rustum, NR, Gardner, GJ, Zivanovic, O, Barakat, RR, Brown, CL, Levine, DA, Sonoda, Y, Leitao, MM & Jewell, EL 2016, 'Impact of Obesity on Sentinel Lymph Node Mapping in Patients with Newly Diagnosed Uterine Cancer Undergoing Robotic Surgery', Annals of Surgical Oncology, vol. 23, no. 8, pp. 2522-2528. https://doi.org/10.1245/s10434-016-5134-2
Eriksson, Ane Gerda Zahl ; Montovano, Margaret ; Beavis, Anna ; Soslow, Robert A. ; Zhou, Qin ; Abu-Rustum, Nadeem R. ; Gardner, Ginger J. ; Zivanovic, Oliver ; Barakat, Richard R. ; Brown, Carol L. ; Levine, Douglas A. ; Sonoda, Yukio ; Leitao, Mario M. ; Jewell, Elizabeth L. / Impact of Obesity on Sentinel Lymph Node Mapping in Patients with Newly Diagnosed Uterine Cancer Undergoing Robotic Surgery. In: Annals of Surgical Oncology. 2016 ; Vol. 23, No. 8. pp. 2522-2528.
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abstract = "Purpose: The aim of this study was to determine the impact of obesity on the rate of successful sentinel lymph node (SLN) mapping in patients with uterine cancer undergoing robotic surgery, and compare SLN detection rates using indocyanine green (ICG) versus blue dye. Methods: We reviewed robotic cases undergoing SLN mapping with a cervical injection from January 2011 to December 2013 using either blue dye or ICG with near-infrared (NIR) fluorescence imaging. Data were stratified by body mass index (BMI) and the dye used. Appropriate statistical tests were applied. Results: Overall, 472 cases were identified. Bilateral mapping was successful in 352 cases (75 {\%}), and unilateral mapping was successful in 73 cases (15 {\%}). Bilateral mapping was achieved in 266 (85 {\%}) of 312 ICG cases compared with 86 (54 {\%}) of 160 blue-dye cases (p < 0.001). Cases with successful bilateral mapping had a median BMI of 29.8 kg/m2 (range 16.3–65.3 kg/m2); cases with no mapping had a median BMI of 34.7 kg/m2 (range 21.4–60.4 kg/m2) (p = 0.001). With increasing BMI, there was a significant decrease in successful bilateral mapping rates for both the ICG (p < 0.001) and blue-dye groups (p = 0.041); however, the use of ICG resulted in better bilateral (p = 0.002) and overall (p = 0.011) mapping rates compared with the use of blue dye in all BMI groups. Conclusions: ICG results in a higher overall and bilateral SLN detection than blue dye in women with uterine cancer. Successful mapping decreases with increasing BMI irrespective of the dye used; however, it is significantly improved with the use of ICG and NIR fluorescence imaging compared with blue dye.",
author = "Eriksson, {Ane Gerda Zahl} and Margaret Montovano and Anna Beavis and Soslow, {Robert A.} and Qin Zhou and Abu-Rustum, {Nadeem R.} and Gardner, {Ginger J.} and Oliver Zivanovic and Barakat, {Richard R.} and Brown, {Carol L.} and Levine, {Douglas A.} and Yukio Sonoda and Leitao, {Mario M.} and Jewell, {Elizabeth L.}",
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T1 - Impact of Obesity on Sentinel Lymph Node Mapping in Patients with Newly Diagnosed Uterine Cancer Undergoing Robotic Surgery

AU - Eriksson, Ane Gerda Zahl

AU - Montovano, Margaret

AU - Beavis, Anna

AU - Soslow, Robert A.

AU - Zhou, Qin

AU - Abu-Rustum, Nadeem R.

AU - Gardner, Ginger J.

AU - Zivanovic, Oliver

AU - Barakat, Richard R.

AU - Brown, Carol L.

AU - Levine, Douglas A.

AU - Sonoda, Yukio

AU - Leitao, Mario M.

AU - Jewell, Elizabeth L.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Purpose: The aim of this study was to determine the impact of obesity on the rate of successful sentinel lymph node (SLN) mapping in patients with uterine cancer undergoing robotic surgery, and compare SLN detection rates using indocyanine green (ICG) versus blue dye. Methods: We reviewed robotic cases undergoing SLN mapping with a cervical injection from January 2011 to December 2013 using either blue dye or ICG with near-infrared (NIR) fluorescence imaging. Data were stratified by body mass index (BMI) and the dye used. Appropriate statistical tests were applied. Results: Overall, 472 cases were identified. Bilateral mapping was successful in 352 cases (75 %), and unilateral mapping was successful in 73 cases (15 %). Bilateral mapping was achieved in 266 (85 %) of 312 ICG cases compared with 86 (54 %) of 160 blue-dye cases (p < 0.001). Cases with successful bilateral mapping had a median BMI of 29.8 kg/m2 (range 16.3–65.3 kg/m2); cases with no mapping had a median BMI of 34.7 kg/m2 (range 21.4–60.4 kg/m2) (p = 0.001). With increasing BMI, there was a significant decrease in successful bilateral mapping rates for both the ICG (p < 0.001) and blue-dye groups (p = 0.041); however, the use of ICG resulted in better bilateral (p = 0.002) and overall (p = 0.011) mapping rates compared with the use of blue dye in all BMI groups. Conclusions: ICG results in a higher overall and bilateral SLN detection than blue dye in women with uterine cancer. Successful mapping decreases with increasing BMI irrespective of the dye used; however, it is significantly improved with the use of ICG and NIR fluorescence imaging compared with blue dye.

AB - Purpose: The aim of this study was to determine the impact of obesity on the rate of successful sentinel lymph node (SLN) mapping in patients with uterine cancer undergoing robotic surgery, and compare SLN detection rates using indocyanine green (ICG) versus blue dye. Methods: We reviewed robotic cases undergoing SLN mapping with a cervical injection from January 2011 to December 2013 using either blue dye or ICG with near-infrared (NIR) fluorescence imaging. Data were stratified by body mass index (BMI) and the dye used. Appropriate statistical tests were applied. Results: Overall, 472 cases were identified. Bilateral mapping was successful in 352 cases (75 %), and unilateral mapping was successful in 73 cases (15 %). Bilateral mapping was achieved in 266 (85 %) of 312 ICG cases compared with 86 (54 %) of 160 blue-dye cases (p < 0.001). Cases with successful bilateral mapping had a median BMI of 29.8 kg/m2 (range 16.3–65.3 kg/m2); cases with no mapping had a median BMI of 34.7 kg/m2 (range 21.4–60.4 kg/m2) (p = 0.001). With increasing BMI, there was a significant decrease in successful bilateral mapping rates for both the ICG (p < 0.001) and blue-dye groups (p = 0.041); however, the use of ICG resulted in better bilateral (p = 0.002) and overall (p = 0.011) mapping rates compared with the use of blue dye in all BMI groups. Conclusions: ICG results in a higher overall and bilateral SLN detection than blue dye in women with uterine cancer. Successful mapping decreases with increasing BMI irrespective of the dye used; however, it is significantly improved with the use of ICG and NIR fluorescence imaging compared with blue dye.

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