Introduction/Background Sentinel lymph node biopsy (SLNB) is an alternative to inguinofemoral lymphadenectomy for selected patients with stage I or II vulvar carcinoma without palpable inguinal lymph nodes. It is a precise and safe technique that does not increase groin recurrence or worsen survival rates. In addition, it significantly reduces the morbidity and side effects of lymphadenectomy such as wound dehiscence or infection, lymphedema or lymphocysts. To date, the use a radioactive tracer like technetium 99 (99mTc) is mandatory, and it can be combined with a colorant tracer being blue dye the most used one. However, the near-infrared (NIR) fluorescence tracer indocyanine green (ICG) is an alternative technique with some advantages derived from its characteristics such as a higher tissue penetration and better intraoperative identification compared to blue dye.
Methodology In this video we explain step by step the surgical technique of SLNB using ICG in a patient with an unifocal 1cm left-sided squamous cell carcinoma.
To carry out the procedure, the day before surgery 2mCi of Tc99 nanocolloid is injected peritumoral in four quadrants (0.1ml in each quadrant) followed by Single Photon Emission Computed Tomography (SPECT) scan. Intraoperatively, 4ml of ICG is injected 2cm paraclitoroidal bilaterally (2ml on each side). Intraoperative pathological assessment was performed.
Results Bilateral SLN was detected and both were intraoperatively reported as negative. Additionally, radical excision of the vulvar lesion was performed. The patient was discharged the day after surgery without postoperative complications. No metastases were found in the ultrastaging exam of the SLN.
Conclusion ICG is a safe technique for SLN detection in early-stage vulvar cancer combined with 99mTC tracer. Due to its high tissue penetration, a deeper and earlier visualization of signal is possible, making its detection easier compared to blue dye.
Disclosures The authors have no conflicts of interest.
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