Background: While sentinel lymph node (SLN) biopsy has been integrated into international guidelines for endometrial cancer, a standardized technique is still lacking. This study addresses whether the concurrent use of two tracers, technetium-99 (Tc) and indocyanine green (ICG), administered intracervically through distinct techniques, enhances the performance of SLN biopsies. As the blue dye is used routinely by some centers, it can be used alone; however, our analysis focused on only Tc and ICG (as is used in the majority of centers). Methods: A prospective multicentric observational study was designed to evaluate the unilateral detection rate, bilateral detection rates, sensitivity, and consistency of SLNs when using both tracers simultaneously in patients with early-stage endometrial cancer. Results: Our findings demonstrated that the simultaneous use of ICG and Tc significantly outperformed the use of either tracer alone. Unilateral detection rates were 69.2% for Tc, 84.9% for ICG, and 88.4% for both. Bilateral detection rates were 57.0% for Tc, 77.9% for ICG, and 83.6% for both. Additionally, the incidence of “empty pockets” was low with both tracers, at 2.7%. Notably, the concurrent application of both tracers identified instances where the Tc-labeled sentinel node differed from the ICG-labeled sentinel node. Conclusions: The combined use of Tc and ICG in SLN biopsy for early-stage endometrial cancer significantly enhances detection rates and reduces the occurrence of “empty pockets”, potentially decreasing the need for site-specific lymphadenectomy.
背景：尽管前哨淋巴结活检已被纳入子宫内膜癌的国际诊疗指南，但目前仍缺乏标准化的操作技术。本研究旨在探讨通过不同宫颈注射技术联合使用锝-99和吲哚菁绿两种示踪剂是否能提升前哨淋巴结活检的检测效能。虽然部分医疗中心常规使用蓝染料作为单一示踪剂，但本研究聚焦于临床主流应用的锝-99与吲哚菁绿双示踪剂方案。方法：我们设计了一项前瞻性多中心观察研究，评估在早期子宫内膜癌患者中同时使用两种示踪剂时的单侧检出率、双侧检出率、检测灵敏度及结果一致性。结果：研究数据显示，联合使用吲哚菁绿与锝-99的检测效能显著优于单一示踪剂。单侧检出率分别为：锝-99组69.2%、吲哚菁绿组84.9%、双示踪剂组88.4%；双侧检出率分别为：锝-99组57.0%、吲哚菁绿组77.9%、双示踪剂组83.6%。此外，双示踪剂组的"空窗"发生率仅为2.7%。值得注意的是，双示踪剂联合应用发现了锝-99标记与吲哚菁绿标记前哨淋巴结存在解剖位置差异的病例。结论：在早期子宫内膜癌前哨淋巴结活检中联合应用锝-99与吲哚菁绿，能显著提高检出率并降低"空窗"发生率，可能减少特定部位淋巴结清扫术的实施需求。
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