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Sentinel lymph node mapping with fluorescent and radioactive tracers in vulvar cancer patients

Abstract

Purpose

Application of radioactive tracers for sentinel lymph node biopsy (SLNB) in vulvar cancer has been established, however, the use of radioisotopes is expensive and requires complex logistics. This exploratory study evaluated the feasibility of near-infrared fluorescence-based SLNB in comparison to the gold standard using radioactive guidance.

Methods

At Evangelische Kliniken Essen-Mitte (Essen, Germany) between 02/2015 and 04/2019, 33 patients with squamous cell vulvar cancer and unifocal tumors (32 midline, 1 lateral) smaller than 4 cm underwent SLNB as part of their routine primary surgical therapy. Radiolabeled nanocolloid technetium 99 (99mTc) was injected preoperatively and indocyanine green (ICG) intraoperatively. Demographic and clinical data were retrieved from patients’ records, and descriptive statistics were applied. The detection rate of the ICG fluorescence technique was compared with the standard radioactive approach.

Results

In patients with midline tumors, bilateral SLNB was attempted. SLNB was feasible in 61/64 (95.3%) groins with 99mTc and in 56/64 (87.5%) with ICG. In total, 125 SLNs were excised; all SLNs were radioactive and 117 (93.6%) also fluorescent. In 8 patients with BMI > 30 kg/m2, SLNB was successful in 14/15 groins (93.3%) with 99mTc and 13/15 groins (86.7%) with ICG. Upon final histology, infiltrated nodes were present in 9/64 (14.1%) groins and 10/125 SLNs; one positive SLN was not detected with ICG.

Conclusions

SLNB using ICG is a promising technique, however, the detection rate obtained was slightly lower than with 99mTc. The detection rate increased over time indicating that experience and training may play an important role besides further methodological refinements.

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Funding

This study was not supported by any funding.

Author information

SP, AdB, PH, BA: protocol and project development, data collection and management, data analysis and interpretation, manuscript writing and editing. EB: data collection and management, data analysis and interpretation, manuscript writing and editing. SS, FH, TB: data analysis and interpretation, manuscript writing and editing. AT: data collection and management.

Correspondence to Sonia Prader.

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Conflict of interest

The authors declare that they have no conflict of interest regarding the submitted work.

Ethical approval

This retrospective analysis was approved by the Ärztekammer Nordrhein (Germany).

Informed consent

All patients provided written informed consent for sentinel lymph node detection by both modalities and data analysis.

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Prader, S., du Bois, A., Harter, P. et al. Sentinel lymph node mapping with fluorescent and radioactive tracers in vulvar cancer patients. Arch Gynecol Obstet (2020). https://doi.org/10.1007/s00404-019-05415-2

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Keywords

  • Vulvar cancer
  • Sentinel lymph node
  • Indocyanine green
  • Near-infrared fluorescence