BACKGROUND: While sentinel lymph node (SLN) biopsy has been integrated into international guidelines for endometrial cancer, a standardized technique is still lacking. This study addresses whether the concurrent use of two tracers, technetium-99 (Tc) and indocyanine green (ICG), administered intracervically through distinct techniques, enhances the performance of SLN biopsies. As the blue dye is used routinely by some centers, it can be used alone; however, our analysis focused on only Tc and ICG (as is used in the majority of centers). METHODS: A prospective multicentric observational study was designed to evaluate the unilateral detection rate, bilateral detection rates, sensitivity, and consistency of SLNs when using both tracers simultaneously in patients with early-stage endometrial cancer. RESULTS: Our findings demonstrated that the simultaneous use of ICG and Tc significantly outperformed the use of either tracer alone. Unilateral detection rates were 69.2% for Tc, 84.9% for ICG, and 88.4% for both. Bilateral detection rates were 57.0% for Tc, 77.9% for ICG, and 83.6% for both. Additionally, the incidence of "empty pockets" was low with both tracers, at 2.7%. Notably, the concurrent application of both tracers identified instances where the Tc-labeled sentinel node differed from the ICG-labeled sentinel node. CONCLUSIONS: The combined use of Tc and ICG in SLN biopsy for early-stage endometrial cancer significantly enhances detection rates and reduces the occurrence of "empty pockets", potentially decreasing the need for site-specific lymphadenectomy.

Clinical Department of Gynecologic Surgery and Oncology Wroclaw Medical University 50 367 Wroclaw Poland

Department for Gynecologic and Breast Oncology University Medical Center Maribor 2000 Maribor Slovenia

Department of Anaesthesiology and Intensive Therapy Medical University of Gdansk 80 210 Gdansk Poland

Department of Gynecology and Obstetrics Charles University 1st Faculty of Medicine and University Hospital Bulovka 18000 Prague Czech Republic

Department of Gynecology Obstetrics and Neonatology Medical University of Gdansk 80 204 Gdansk Poland

Department of Obstetrics and Gynecology Gynecological Oncology and Endocrinological Gynecology University Clinical Centre in Gdansk 80 952 Gdansk Poland

Department of Obstetrics and Gynecology University Hospital Ostrava and Faculty of Medicine University of Ostrava 70800 Ostrava Czech Republic

Department of Obstetrics Gynecology and Neonatology 1st Faculty of Medicine Charles University and General University Hospital Prague 18000 Prague Czech Republic

Gynecologic Oncology Division NN Alexandrov National Cancer Centre of Belarus 223040 Minsk Belarus

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