Introduction The surgical management of vulvar cancer has been evolving. Standard inguino-femoral lymphadenectomy (IFL) is associated with significant postoperative morbidity and lymphedema. Current guidelines suggest performing a sentinel lymph node biopsy with Technetium-99m (Tc99) and blue dye. With the introduction of fluorescence in surgery, the use of indocyanine green (ICG) appears to have a role in improving the detection rate of sentinel lymph nodes. We present a case of sentinel lymph node biopsy with Tc-99 and ICG.

Description 70 yo female with 3-cm vulvar squamous cell carcinoma in the posterior fourchette of the vulva. Physical exam and PET CT scan did not show abnormal groin lymph nodes or distant metastasis. Patient underwent partial radical vulvectomy with sentinel lymph node biopsy with Tc-99 and ICG. Two right sentinel lymph node and one left sentinel lymph node was identified. The post-operative course was unremarkable.

Conclusion/Implications Sentinel lymph node biopsy for vulvar cancer with Tc-99 and ICG appears feasible and may increase the detection rate of micro metastasis. ICG is an alternative to blue dye.