What you need to know
Gynecologic oncologists at John Theurer Cancer Center at Hackensack University Medical Center are leaders in the use of an innovative technique called “Firefly Fluorescence Imaging,” which enables them to select which lymph nodes need to be removed and biopsied during robotic gynecologic surgery.
The approach spares many women from having many lymph nodes removed—a procedure called lymphadenectomy, which can cause uncomfortable swelling in the legs called lymphedema.
Endometrial cancer—cancer of the uterus—is the most common gynecologic cancer in the United States, estimated to affect more than 65,000 women in 2020. Seeing if cancer has spread to the nearby pelvic lymph nodes is an important part of care, a process called staging which determines the extent of cancer spread and guides what kind of treatment a patient may need.
“Cancer cells spreading from a tumor have a choice of several routes to follow to travel to other parts of the body. This fluorescence technology immediately allows us to identify and biopsy the first ‘sentinel’ lymph nodes to which endometrial cancer cells would go to if they spread.”Ami Vaidya, M.D., vice chair, Department of Obstetrics & Gynecology, co-chief, Division of Gynecologic Oncology, and director, Minimally Invasive and Robotic Gynecologic Surgery at John Theurer Cancer Center.
Sentinel lymph node biopsy has been a mainstay of breast cancer surgery for years. In those patients, a blue dye is used which collects in the sentinel nodes of the armpit and can be seen with the naked eye during surgery. But the blue dye is more challenging to see in the pelvis, due to the color of blood vessels in the area and pelvic anatomy, making it less suitable to stage gynecologic cancers. This is where the Firefly technology comes in.
Firefly Fluorescence Imaging
Here’s how it works:
- The surgeon injects a water-based fluorescent green dye into the patient’s cervix during the operation.
- The dye follows the same path that cancer cells would travel upon leaving the tumor. The dye collects in the sentinel nodes.
- The da Vinci robotic surgical platform’s Firefly Fluorescence Imaging system uses near-infrared imaging to pinpoint the sentinel nodes on the system’s screen during surgery. The screen dims and the sentinel nodes glow green, like a firefly.
- The surgeon removes one or two sentinel lymph nodes, and they are analyzed by a pathologist in the next room.
- If the sentinel nodes contain cancer cells, the surgeon removes more lymph nodes from that side of the pelvis for analysis. But if the sentinel nodes are free of cancer, no other lymph nodes need to be taken out, avoiding lymphadenectomy.
While other centers are acquiring the Firefly technology, John Theurer Cancer Center has more experience performing it than most and has done its own internal review to assess its accuracy. Women with endometrial cancer who had surgery with this technique also had traditional lymphadenectomy, and the researchers compared the accuracy of the two approaches. “By being a leader in the research of Firefly Imaging, we were able to validate it as an accurate tool for identifying the sentinel lymph nodes in women having robotic surgery for endometrial cancer,” said Dr. Vaidya.
Dr. Vaidya and her colleagues are now following patients long-term to study cancer recurrence and survival rates of women who had this procedure. They are also starting to assess its use in women who are not candidates for robotic surgery (such as those with a large uterus) to see if it can be used during open surgeries, as well as in women with other types of gynecologic cancer, such as cervical cancer.
Patients interested in making an appointment with a with a gynecologic oncologist at John Theurer Cancer Center should call 551-996-5374.