TE C H N I Q UE S A N D I N S T R U ME N T A T IO N Open Access
Role of blue dye for sentinel lymph node
detection in early endometrial cancer
, Carlo Ronsini
, Angelo Finelli
, Emanuele Perrone
, Giovanni Scambia
and Francesco Fanfani
Background: Sentinel Lymphonode analysis has become a barely new and innovative way to treat early stages
of endometrial cancer (Ballester et al., Lancet Oncol 469–476, 2011; Buda et al., Ann Surg Oncol 2975-81, 2016).
Indocyanine green cervical injection is considered gold standard for mapping nodes’ drainage. Blue dye is used as
a valid alternative in many centers, due to the lower cost of execution. The objective of this video is to prove that
methylene blue dye’s cervical injection is a valid and “low-cost” method to obtain mapping of lymphatic drainage
in patient with early endometrial cancer.
Methods: Fifty-four-year old women, with a recent diagnosis of endometrial cancer IA G2, we performed a radical
Hysterectomy type A. We diluted in equal proportions the blue dye and saline and injected 1 cl in depth and 1 cl
on the surface of the cervix, at 3 o’clock and 9 o’clock. After 20 min, it was shown with precision the lymphatic
drainage until the first lymph node station from both sides.
Results: One external iliac lymph node and one obturator were resected on the left side and one external iliac on
the right side. On histological analysis, none of the lymph nodes had any location of metastasis, neither micro-metastasis.
Myometrial infiltration was 8/19 mm.
Conclusions: Blue dye cervical injection is a “low-cost”, safe, and satisfactory procedure to point out Sentinel Lymph
Node of uterus drainage. Other tracers, such as indocyanine green, are widely used in gynecological oncology, but with a
higher cost of the product and the needing of a dedicated optical filter to be shown on human view.
Keywords: Lymph node, Blue dye, Endometrial cancer
Sentinel lymph node analysis has become a new and
innovative method to treat early stages of endometrial
cancer [1, 2]. In the aim of reducing complications
related to lymphoadenectomy, the use of different
tracers to identify first lymph node absorber of the
drainage chain is widely propagated in gynecological
oncology centers. Indocyanine green cervical injection
is considered gold standard for mapping nodes’ drain-
age, but this technique requires a dedicated optical
filter to catch signal. Blue dye is used as a valid alter-
native (77 Vs 97% bilateral detection rate) in many
centers, due to the minor cost of performing. The ob-
jective of this video is to prove that methylene blue
dye’s cervical injection is a valid and low-cost method
to obtain mapping of lymphatic drainage in patient
with early endometrial cancer.
In a 54-year-old woman, BMI 28, with a recent diagnosis
of Endometrial Cancer G2, with no previous imaging sus-
pect of deep myometrial infiltration (> 50%), we performed
a radical hysterectomy (class A of Querleu-Morrow’s clas-
sification), with bilateral salpingo-oophorectomy. Further-
more, we decided to act cervical injection of blue dye to
identify the first lymph node station. We diluted in equal
proportions the blue dye and saline and injected 1 cl in
depth and 1 cl on the surface of the cervix, at 3 o’clock and
9o’clock, in order to obtain a precise mapping of the
lymphatic course. As in this case, we prefer to practice in-
jection with a spinal anesthesia needle (27G), for the accur-
ate ratio between length and cross section, which makes
* Correspondence: Restaino.firstname.lastname@example.org
Gynecological Oncology, Hospital G. Bernabeo, Ortona, CH, Italy
Full list of author information is available at the end of the article
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made.
Restaino et al. Gynecological Surgery (2017) 14:23