Detection of Sentinel Lymph Nodes with Near-Infrared Imaging in Cervical and Endometrial Cancer Surgery

Cervical and endometrial cancers are significant gynecologic malignancies, being the fourth and sixth most prevalent cancers in women in 2020, respectively. Gynecologic cancer staging, especially lymph node (LN) metastasis evaluation, profoundly affects patient treatment and prognosis. Although various modalities, including computed tomography, magnetic resonance imaging, and ¹⁸F-fluoro-2-deoxy-D-glucose positron emission tomography are available for LN metastasis assessment, their diagnostic accuracy is often insufficient, necessitating surgical LN evaluations. Traditional comprehensive lymph node dissection, once the standard, has now been replaced by sentinel lymph node (SLN) biopsy to minimize complications while maintaining accurate nodal staging. This review underscores the importance of near-infrared (NIR) imaging with indocyanine green (ICG) as an advanced method for SLN detection. NIR imaging, owing to its deep tissue penetration capabilities combined with ICG's unique properties, is comparable to former tracers for detecting SLNs, with minimal side effects and high diagnostic accuracy. Although challenges, such as difficulties in surgical skills and relatively high equipment costs, remain, this technique holds promise, demonstrating high detection rates and decreased morbidity, especially in early-stage cervical and endometrial cancers. This comprehensive review reinforces the growing relevance of NIR imaging with ICG in improving the diagnostic accuracy of SLN detection in gynecological cancers, thereby enhancing clinical decision-making and patient outcomes.