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Abstract
Introduction/Background Lymph nodal status assessment is important for prognosis in vulvar cancer. The standard-of-care is the sentinel lymph node biopsy with radioactive tracer. However, there are controversies in its use, and the studies are limited. Indocyanine green fluorescence-ICG could be a promising option with the advantage of not needing nuclear medicine.
Methodology Prospective evaluation of sentinel lymph node in early-stage vulvar cancer by preoperative technetium and intraoperative ICG. The primary endpoint was to determine accuracy in the detection rate for ICG compared with technetium. Secondary objectives included tracer modality relationship with obesity, tumor size and location. This study evaluates ICG sentinel lymph node detection compared with the criterion-standard with technetium (dual modality method).
Results In total, 75 patients participated at 8 Spanish centers. The overall sentinel lymph node detection rate was 85.3% for technetium and 82.7% for ICG. For lateral tumors (38 cases), the detection rate was 84.2% vs. 89.5%, while for midline tumors (37 cases) it was 86.5% vs. 75.7% for middle tumors, using technetium and ICG, respectively. The median sentinel node harvest was 1.7 (range 1–4), with 24% metastatic involvement. The sensitivity and positive predictive value for ICG based on the standard technique with technetium was 91.08% (95% CI, 83.76–95.84) and 94.8% (95% CI, 84.84–96.48), respectively. No significant differences were found comparing the two tracers in patients with midline lesions, obesity (body mass index ≥30) and tumor size ≥2–4 cm.
Conclusion ICG is not superior to Tecnecium for for detection of SN in vulvar cancer. Although without significance, tc shows better rate of detection. Anyway, ICG can be a good tool in Hospitals without facilita of nuclear.
Disclosures No disclosure