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#1092 SLN, daseler zones and the injection sites in vulva cancer: should we think outside the box?
  1. Sally Eltawab1,2 and
  2. Priyanka Reddy3
  1. 1Churchill Gynaecology cancer center, Oxford, Oxford, UK
  2. 2Gynaecology cancer center, ELShatby Maternity University Hospital, Alexandria, Egypt
  3. 3Oxford University Hospitals foundation trust, Oxford, UK


Introduction/Background SLN had became the standard of care for Lymph node mapping and excision in management of vulva cancer. The technique has been adopted to minimize the morbidity associated with complete inguino - femoral dissection. Different techniques have been used, to locate the SLN, and the injection is standardized to be intra-tumoral or at the scar site.

The technique sometimes fail to locate the sentinel lymph node, and the adaptation was always in modifying the technique used, e.g. radioactive material versus methylene blue or combination of both.

Few studies examined the feasibility of injection around the scar site and found to be feasible.

The hypothesis Is it time to consider injection at the clitoris ( mimicking the technique in breast cancer : peritumoral versus periareolar injection) to improve our detection rate, especially in High BMI patients.

Methodology A retrospective pilot study including 10 cases SLN detection conducted in Cancer center over a year.

The sites of sentinel lymph nodes images were reviewed and were allocated according to Daseler zones classification. The distribution was correlated to the primary tumor site, to detect the association.

Results In 1/10, no SLN was detected and complete LN dissection done.

6/10 SLN was detected in Daseler zone I ( injected : 3 at perineal lesion, 2 left lesion < 2 cm from center, and 1 on right side < 2 cm from central).

2/10 SLN detected at zone IV ( Injection: at perineum, and left upper side of vulva).

1/10 SLN detected at zone II ( injection was at the clitoris )

Conclusion 60% of SLN were detected in Daseler zone 1 ( and the injection site varied). The clitoris has good blood flow, and rich lymphatic drainage, that will improve the detection rate of SLN .

Is it time to check peritumor injection versus peri-clitorial injection ?

Disclosures No conflict of interest

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