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Concordance Between Intracervical and Fundal Injections for Sentinel Node Mapping in Patients With Endometrial Cancer?

A Study Using Intracervical Radiotracer and Fundal Blue Dye Injections

Farazestanian, Marjaneh, MD*; Yousefi, Zohreh, MD*; Zarifmahmoudi, Leili, PhD; Hasanzadeh Mofrad, Malihe, MD*; Kadkhodayan, Sima, MD*; Sadeghi, Ramin, MD

doi: 10.1097/RLU.0000000000002412
Original Articles

Objective A major controversy in sentinel node (SN) biopsy of endometrial cancer is the injection site of mapping material. We compared lymphatic drainage pathways of the uterine cervix and uterine body in the same patients by head-to-head comparison of intracervical radiotracer and fundal blue dye injections.

Methods All patients with pathologically proven endometrial cancer were included. Each patient received 2 intracervical injections of 99mTc-phytate. At the time of laparotomy, the uterus was exposed, and each patient was injected with 2 aliquots of patent blue V (2 mL each) in the subserosal fundal midline locations. The anatomical locations of all hot, blue, or hot/blue SNs were recorded.

Results Overall, 45 patients entered the study. At least 1 SN could be identified in 75 of 90 hemipelves (83.3% overall detection rate, 82.2% for radiotracer [intracervical] alone, and 81.1% for blue dye [fundal] alone). In 71 hemipelves, SNs were identified with both blue dye (fundal) and radiotracer (intracervical) injections. In 69 of these 71 hemipelves, at least 1 blue/hot SN could be identified (97.18% concordance rate). In 10 patients, para-aortic SNs were identified. All of these nodes were identified by fundal blue dye injection, and only 2 were hot.

Conclusions Our study shows that lymphatic drainage to the pelvic area from the uterine corpus matches the lymphatic pathways from the cervix, and both intracervical and fundal injections of SN mapping materials go to the same pelvic SNs.

From the *Women's Health Research Center and

Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Received for publication September 18, 2018; revision accepted October 23, 2018.

This study was supported by vice chancellery of research of Mashhad University of Medical Sciences with approval no. 940217.

Conflicts of interest and sources of funding: This study was supported by vice chancellery of research of Mashhad University of Medical Sciences with approval no. 940217. None declared to all authors.

Correspondence to: Ramin Sadeghi, MD, Ghaem Hospital, Ahmadabad St, Nuclear Medicine Research Center, Mashhad, Iran. E-mail:;

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