Sentinel lymph node biopsy with cervical injection of indocyanine green in apparent early-stage endometrial cancer: predictors of unsuccessful mapping Lucia Tortorella a,d , Jvan Casarin a , Francesco Multinu a , Serena Cappuccio a , Michaela E. McGree b , Amy L. Weaver b , Carrie L. Langstraat a , Gary L. Keeney c , Amanika Kumar a , Gian Benedetto Melis e , Stefano Angioni e , Giovanni Scambia d , Andrea Mariani a , Gretchen E. Glaser a, ⁎ a Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, United States of America b Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States of America c Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, United States of America d Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS–Università Cattolica del Sacro Cuore, Rome, Italy e Division of Gynecology and Obstetrics, University of Cagliari, Cagliari, Italy HIGHLIGHTS • The rate of failed unilateral or bilateral sentinel lymph node mapping is 21.7%. • The presence of enlarged lymph nodes and lysis of adhesions are independently associated with an unsuccessful procedure. • The expertise of the surgeon is associated with a successful procedure and consequent decreases in operative time abstract article info Article history: Received 20 May 2019 Received in revised form 31 July 2019 Accepted 4 August 2019 Available online xxxx Objective. To identify predictors of unsuccessful sentinel lymph node (SLN) mapping in patients with appar- ent early-stage endometrial cancer (EC) undergoing surgical staging with cervical injection of indocyanine green and SLN biopsy. Methods. We retrospectively identified consecutive patients with EC with attempted SLN biopsy between June 2014 and June 2016 at our institution. Patients were grouped according to whether they had a successful pro- cedure, defined as the bilateral identification of SLNs, or an unsuccessful procedure, defined as unilateral or no SLN mapping. Logistic regression was used to evaluate predictors of an unsuccessful procedure. Results. Among 327 patients included in the analysis, 256 (78.3%) had a successful procedure and 71 (21.7%) had an unsuccessful procedure (15.0% unilateral SLN mapping, 6.7% no mapping). The rate of successful proce- dure increased from 57.7% to 83.3% between the first and last quarters of the 2-year study period, which repre- sented the learning curve for the technique. The mean (SD) operative time decreased from 164 (55) to 137 (37) minutes. By multivariable analysis, lysis of adhesions at the beginning of surgery (odds ratio, 3.07; 95% CI, 1.56–6.07) and the presence of enlarged lymph nodes (odds ratio, 4.69; 95% CI, 1.82–12.11) were independently associated with an unsuccessful procedure. Conclusions. Lysis of adhesions at the beginning of surgery and the presence of enlarged lymph nodes inde- pendently affect the bilateral detection of SLNs. © 2019 Elsevier Inc. All rights reserved. Keywords: Endometrial cancer Indocyanine green Lymph nodes Sentinel lymph node mapping Stage I 1. Introduction Endometrial cancer (EC) is the most common gynecologic cancer in the United States, with 63,230 estimated new cases in 2018 [1]. Total hysterectomy with bilateral salpingo-oophorectomy and lymph node assessment (pelvic and/or paraaortic lymphadenectomy) represent the traditional surgical approach for staging of apparent early-stage EC Gynecologic Oncology xxx (xxxx) xxx Abbreviations: BMI, body mass index; EC, endometrial cancer; FIGO, International Federation of Gynecology and Obstetrics; ICG, indocyanine green; LVSI, lymphovascular space invasion; OR, odds ratio; SLN, sentinel lymph node. ⁎ Corresponding author at: Division of Gynecologic Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America. E-mail address: glaser.gretchen@mayo.edu (G.E. Glaser). YGYNO-977615; No. of pages: 5; 4C: https://doi.org/10.1016/j.ygyno.2019.08.008 0090-8258/© 2019 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Gynecologic Oncology journal homepage: www.elsevier.com/locate/ygyno Please cite this article as: L. Tortorella, J. Casarin, F. Multinu, et al., Sentinel lymph node biopsy with cervical injection of indocyanine green in apparent early-stage endo..., Gynecologic Oncology, https://doi.org/10.1016/j.ygyno.2019.08.008