ArticleJournal of surgical case reports2025
False detection and the value of combined tracer mapping in endometrial cancer: a dual case presentation.
Article in Journal of surgical case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
This case report demonstrates two contrasting clinical cases of patients with early-stage endometrial cancer undergoing sentinel lymph node (SLN) mapping. In the first case, a 68-year-old patient with a body mass index (BMI) of 38 underwent SLN mapping using indocyanine green (ICG) alone. Although fluorescence-guided dissection revealed nodes appearing "ICG-positive," histopathological evaluation confirmed the absence of lymphatic tissue in the removed specimens-indicating the presence of so-called "empty nodes." This highlights the limitations of relying solely on optical fluorescence, especially in patients with high BMI or altered lymphatic architecture. In contrast, the second case, involving a 65-year-old patient with a BMI of 40, demonstrates the effectiveness of using a combined technique with ICG and technetium-99m (Tc99m). The synergy between real-time fluorescence visualization and gamma probe detection enabled precise SLN identification and confirmed the presence of true lymphatic tissue histologically. This dual case report underscores the limitations of ICG-only SLN mapping and and illustrates the potential added value of technetium-99m in improving the accuracy of lymphatic staging, warranting further validation.
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