Abstract
BackgroundThis study aimed to evaluate the clinical value of indocyanine green sentinel lymph node (SLN) mapping in patients with vulvar cancer. The conventional procedure of SLN mapping in vulvar cancer includes peritumoral injection of technetium-99m nanocolloid before surgery and intraoperative injection of a blue dye. However, these techniques harbor some limitations. Near-infrared fluorescence imaging with indocyanine green has gained popularity in SLN mapping in different types of cancer.MethodsWe analyzed retrospectively vulvar cancer patients at our institution between 2013 and 2020 undergoing indocyanine green SLN mapping by applying video telescope operating microscope system technology.Results64 groins of 34 patients were analyzed. In 53 groins we used technetium-99m nanocolloid, in four patent blue, and in five both techniques, additionally to indocyanine green for SLN detection. In total, 120 SLNs were identified and removed. The SLN detection rate of indocyanine green was comparable to technetium-99m nanocolloid (p=.143) and higher than patent blue (p=.003). The best results were achieved using a combination of ICG and technetium-99m nanocolloid (detection rate of 96.9%). SLN detection rates of indocyanine green were significantly higher in patients with positive lymph nodes (p=.035) and lymphatic space invasion (p=.004) compared to technetium-99m nanocolloid.ConclusionIndocyanine green SLN mapping in vulvar cancer is feasible and safe, with reasonable detection rates. Due to its easy application and few side effects, it offers a sound alternative to the conventional SLN mapping techniques in vulvar cancer. In patients with lymph node metastasis, indocyanine green even outperformed technetium-99m nanocolloid in terms of detection rate.
Highlights
Inguinal lymph node status represents the most significant prognostic factor for survival in vulvar cancer patients [1]
We retrospectively investigated patients with histologically proven vulvar cancer who were operated at the certified cancer center of the Bern University Hospital, Switzerland between April 2013 and April 2020
In 10 groins (15.6%), we found lymph node metastases; in eight of these a sentinel lymph node (SLN) was detected
Summary
Inguinal lymph node status represents the most significant prognostic factor for survival in vulvar cancer patients [1]. The introduction of sentinel lymph node (SLN) biopsy in vulvar cancer, first described by Levenback in 1994 [5], provides a less invasive technique for staging of vulvar cancer than complete inguinofemoral lymph node dissection, with significant reduction in lymphedema, wound infection, and dehiscence without compromising groin recurrence rates or survival rates [6, 7]. This study aimed to evaluate the clinical value of indocyanine green sentinel lymph node (SLN) mapping in patients with vulvar cancer. The conventional procedure of SLN mapping in vulvar cancer includes peritumoral injection of technetium-99m nanocolloid before surgery and intraoperative injection of a blue dye. Near-infrared fluorescence imaging with indocyanine green has gained popularity in SLN mapping in different types of cancer
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