Objectives Complete inguinal lymphadenectomy for surgical staging of early vulvar cancer (VC) is associated with significant morbidity. Utilizing sentinel lymph node (SLN) inguinal biopsy is an alternative in select women with early stage squamous cell VC. We describe our experience with SLN mapping in patients with early stage VC using indocyanine green (ICG) dye and near-infrared fluorescence (NIR).
Methods Ten patients with primary VC with tumor of <4cm, negative clinical groin examination, and pre-operative PET scan demonstrating no evidence of groin metastasis were offered inguinal SLN biopsy with their excisional procedure. Inguinal SLNs were identified via perilesional intradermal injection of 0.5–1.0ml of dilute ICG fluorescent dye (2.5 mg/ml) followed by inguinal nodal excision utilizing NIR with the Novadaq SPY elite florescence imaging system.
Results SLNs were readily identified in all patients, and 8/10 patient’s SLNs were negative for carcinoma. We biopsied 1–5 nodes with most patients having 2 nodes removed from each sides. One patient had isolated tumor cells less than 0.2mm and another had a SLN with a 6mm metastatic focus. One patient with negative SLN biopsy was later found to have a groin recurrence.
Conclusions Although further studies are needed, SNL mapping utilizing ICG dye and NIR may identify sentinel lymph nodes which can be removed, thereby avoiding the morbidity of full inguinal lymphadenectomy in selected patients with early stage VC.
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