Feasibility of a drop-in γ-probe for radioguided sentinel lymph detection in early-stage cervical cancer

Background: Minimally invasive radioguided sentinel lymph node (SLN) procedures, increasingly performed with robot-assisted laparoscopy, can benefit from using a drop-in gamma-probe instead of the conventional rigid laparoscopic gamma-probe. We evaluated the safety and feasibility of a tethered drop-in gamma-probe system for SLN detection in patients with early-stage cervical cancer. Methods: Ten patients with FIGO stage IA - IB2 or IIA1 cervical cancer scheduled for robot-assisted laparoscopic SLN procedure were included. All patients underwent preoperative 240 MBq technetium-99m nanocolloid (Tc-99m) injection and SPECT/CT imaging. Intraoperatively the tethered drop-in gamma-probe SENSEI (R) (Lightpoint Medical Ltd, Chesham, UK) was used for probe guided SLN detection, subsequently confirmed by the standard rigid laparoscopic gamma-probe. Sentinel lymph node detection rates and anatomical SLN location were assessed. Surgeon questionnaires were used to assess usability. Results: In all patients at least one SLN was successfully resected under guidance of the drop-in gamma-probe (overall detection rate: 100%). Bilateral SLN detection rate with the drop-in gamma-probe was 80%. Of the two patients with unilateral SLN detection only, one presented with an atypical SLN location at the aortic bifurcation that was detected only on SPECT/CT. The other patient had failed unilateral Tc-99m uptake. Combined use of preoperative SPECT/CT and drop-in gamma-probe resulted in a bilateral detection rate of 90%. Similar to the drop-in gamma-probe, overall and bilateral SLN detection rate of the rigid gamma-probe was 100% and 80%, respectively. No significant discrepancy existed between the count rate of the drop-in and rigid laparoscopic gamma-probe (p = 0.69). In total 21 SLN's were detected with the drop-in gamma-probes including all three tumor positive nodes. Because of wristed articulation of the robotic tissue grasper and possibility of autonomous probe control by the surgeon, maneuverability and control with the drop-in gamma-probe were highly rated in surgeon questionnaires. No adverse events related to the intervention occurred. Conclusions: Sentinel lymph node detection with a drop-in gamma-probe is safe and feasible in patients with early-stage cervical cancer. Use of the drop-in gamma-probe enhances maneuverability and surgical autonomy during robot-assisted SLN detection.

Automated summary

This study evaluated the safety and feasibility of using a tethered drop-in gamma-probe for sentinel lymph node (SLN) detection in patients with early-stage cervical cancer. The results showed that the drop-in gamma-probe had a bilateral SLN detection rate of 80% and an overall detection rate of 100%. The use of the drop-in gamma-probe enhanced the maneuverability and surgical autonomy during robot-assisted SLN detection.