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Preoperative sentinel lymph node localization in vulvar cancer: preliminary experience with inguinal intradermal contrast-enhanced ultrasound

  • Ultrasound
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the feasibility and diagnostic performance of intradermal contrast-enhanced ultrasound (CEUS) sentinel lymph node (SLN) procedure in vulvar cancer.

Methods

Twelve consecutive patients with vulvar cancer underwent preoperatively inguinal CEUS SLN examination and guide wire marking of the enhanced lymph nodes. Altogether, 20 groins were examined with CEUS contrast agent injections including 8 bilateral groins due to midline tumours. One groin was excluded due to previous inguinal surgery. The results of the CEUS examinations were compared to conventional SLN biopsy using radiocolloid scintigraphy and/or methylene blue dye and final postoperative histopathology.

Results

The inguinal sentinel CEUS procedure had a technical success rate of 94.7% (18/19 injections) for identifying a potential inguinal SLN. Conventional SLN biopsy using lymphoscintigraphy and/or methylene blue dye was successfully performed in 16 groins. Compared to conventional SLN biopsy, the overall sensitivity was 81.2% (13/16 injections). Additionally, CEUS detected enhancing SLNs in two cases when traditional SLN procedure failed to do so. All metastatic SLNs (n = 5) were correctly identified by CEUS procedure.

Conclusions

Intradermal CEUS SLN localization can be applied in the inguinal lymphatic region in patients with vulvar cancer. Further studies are needed to verify the clinical value of this method.

Key points

• CEUS is a feasible method for inguinal SLN detection in vulvar cancer

• All metastatic inguinal SLNs were identified by CEUS procedure

• Further studies are needed to verify the clinical value of this method

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Abbreviations

CEUS:

Contrast-enhanced ultrasound

LN:

Lymph node

SLN:

Sentinel lymph node

SLNB:

Sentinel lymph node biopsy

LND:

Lymph node dissection

US:

Ultrasound

ESGO:

European Society of Gynaecological Oncology

SCC:

Squamocellular carcinoma

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Author information

Authors and Affiliations

  1. Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland

    O. Lahtinen, R. Vanninen & S. Rautiainen

  2. Institute of Clinical Medicine, Unit of Radiology, University of Eastern Finland, Kuopio, Finland

    O. Lahtinen, R. Vanninen & S. Rautiainen

  3. Department of Gynaecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland

    M. Eloranta, M. Anttila & H. Kärkkäinen

  4. Cancer Center of Eastern Finland, Kuopio, Finland

    M. Eloranta, M. Anttila, H. Kärkkäinen & R. Sironen

  5. Institute of Clinical Medicine, School of Medicine, Gynaecology, University of Eastern Finland, Kuopio, Finland

    M. Anttila

  6. Institute of Clinical Medicine/Clinical Pathology, University of Eastern Finland, Kuopio, Finland

    R. Sironen

  7. Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland

    R. Sironen

Authors
  1. O. Lahtinen
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  2. M. Eloranta
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  4. H. Kärkkäinen
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  6. R. Vanninen
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  7. S. Rautiainen
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Corresponding author

Correspondence to O. Lahtinen.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Suvi Rautiainen.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

This study has received funding by Kuopio University Hospital (VTR grant) and the Instrumentarium Science Foundation.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• prospective

• experimental

• performed at one institution

Electronic supplementary material

Video 1.

Video clip of the intradermal CEUS sentinel procedure. CEUS demonstrates the afferent lymphatic vessel and partially enhancing SLN with a metastatic deposit as a non-enhancing hypoechoid area (MPG 1640 kb)

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Lahtinen, O., Eloranta, M., Anttila, M. et al. Preoperative sentinel lymph node localization in vulvar cancer: preliminary experience with inguinal intradermal contrast-enhanced ultrasound. Eur Radiol 28, 2089–2095 (2018). https://doi.org/10.1007/s00330-017-5155-7

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  • DOI: https://doi.org/10.1007/s00330-017-5155-7

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