Intraoperative near-infrared fluorescence imaging for sentinel lymph node detection in vulvar cancer: first clinical results.
OBJECTIVE
Disadvantages of the combined sentinel lymph node (SLN) procedure with radiocolloid and blue dye in vulvar cancer are the preoperative injections of radioactive tracer in the vulva, posing a painful burden on the patient. Intraoperative transcutaneous imaging of a peritumorally injected fluorescent tracer may lead to a one-step procedure, while maintaining high sensitivity. Aim of this pilot study was to investigate the applicability of intraoperative fluorescence imaging for SLN detection and transcutaneous lymphatic mapping in vulvar cancer.


METHODS
Ten patients with early stage squamous cell carcinoma of the vulva underwent the standard SLN procedure. Additionally, a mixture of 1 mL patent blue and 1 mL indocyanin green (ICG; 0.5 mg/mL) was injected immediately prior to surgery, with the patient under anesthesia. Color and fluorescence images and videos of lymph flow were acquired using a custom-made intraoperative fluorescence camera system. The distance between skin and femoral artery was determined on preoperative CT-scan as a measure for subcutaneous adipose tissue.


RESULTS
In 10 patients, SLNs were detected in 16 groins (4 unilateral; 6 midline tumors). Transcutaneous lymphatic mapping was possible in five patients (5 of 16 groins), and was limited to lean patients, with a maximal distance between femoral artery and skin of 24 mm, as determined on CT. In total, 29 SLNs were detected by radiocolloid, of which 26 were also detected by fluorescence and 21 were blue.


CONCLUSIONS
These first clinical results indicate that intraoperative transcutaneous lymphatic mapping using fluorescence is technically feasible in a subgroup of lean vulvar cancer patients.
Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
L M A
LM
Crane
G
G
Themelis
H J G
HJ
Arts
K T
KT
Buddingh
A H
AH
Brouwers
V
V
Ntziachristos
G M
GM
van Dam
A G J
AG
van der Zee
D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D007432:Intraoperative Period; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013050:Spectrometry, Fluorescence / Q000379:methods; D019265:Spectroscopy, Near-Infrared / Q000379:methods; D013668:Technetium Tc 99m Aggregated Albumin; D014846:Vulvar Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*
D004396:Coloring Agents; D012394:Rosaniline Dyes; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid; C008769:sulfan blue; D007208:Indocyanine Green