1. Sentinel lymph node and lymphatic mapping using indocyanine green for endometrium cancer: a case report. Suat Karatas, Veysel Sal, Emel Canaz, Meltem Tekelioglu, A. Ender Yumru
Sağlık Bilimleri University, Şişli Hamidiye Etfal Training and Research Hospital, Gynecology and Obstetrics Department, Istanbul, Turkey.

2. INTRODUCTION
Sentinel lymph node (SLN) was first described in a patient with penis cancer by Cabanas as the first lymphatic place of metastasis.
Histopatologic negativity of SLN means that other non-SLN lymph nodes were negative.
Defining lymphatic metastasis of cancer especially in early stages could alter the therapeutic management and determine the prognosis.

3. SLN imaging and excision provide to detect the invasion of cancer to the lymphatic bed with sampling a couple of lymph nodes, therefore, easy and accurate diagnosis is enable.
Staging of gynecologic cancers with SLN imaging has also been used recently.

4. OBJECTIVE
The presentation of this case aimed to represent the management of staging with flourescent luminary imaging of SLN and lymphatic mapping.

5. CASE 45 year old Gravida 2, Para 2 Body mass index: 39 kg/m2
Medical history: unremarkable.
Abnormal uterine bleeding (meno-metrorrhagia)
Systemic and gynecologic examination: unremarkable.
The values of tumor markers: normal.

6. Transvaginal sonography: uneven endometrial line and 12 mm endometrial thickness.
Endometrium biopsy: endometrial adenocarcinoma at the focal site and atypical complex hyperplasia at the periphery.
PET-CT : tumoral lesion corresponding to primary endometrial tumor with increased FDG metabolism and no distent metastasis.
Surgery for staging was planned.

7. SLN IMAGING
05 ml of the total 2 ml indocyanine green 1.25 mg/ml (ICG) was injected superficially to the cervix at 3 and 9 o’clock and deeply with same amounts to the same points.
Pelvic sentinel lymph nodes were detected bilaterally and lymph node excision was performed for immunohistochemical (pancytokeratine) evaluation.

8. SURGERY
Total laparoscopic hysterectomy and bilateral salpingo-oophorectomy was performed.
Post-operative period was uneventfull.
The patient was discharged on post-operative day 2.

9. PINPOINT ENDOSCOPIC FLUORESCENCE IMAGING SYSTEM

12. Detection sensitivity are almost 100 % with this novel ICG tecnique
Detection sensitivity are almost 100 % with this novel ICG tecnique. (Blue-dye, Tecnetium-99, intraoperative gamma probe and kombined methodes are the other alternatives.)

13. Sentinel lymph nodes were able to be detected with ICG bilaterally in this patient.
We concluded that a succesfull surgery was achieved within a short time period and potential complications according to extentive lymphadenectomy were avoided with this tecnique.

14. CONCLUSION
No extentive lymph node dissection for the patients without metastasis according to SLN sampling.
Protection of extentive lymphadenectomy complications (lymphedema, etc.)

15. PINPOINT ENDOSCOPIC FLUORESCENCE IMAGING SYSTEM
The PINPOINT Endoscopic Fluorescence Imaging System combines – into a single laparoscopy platform – the latest in high definition white-light video with SPY Fluorescence imaging, resulting in bright, clear images.