title: Optimization of near-infrared fluorescent sentinel lymph node mapping for vulvar cancer.
abstract: OBJECTIVE
  Near-infrared fluorescence imaging has the potential to improve sentinel lymph node mapping in vulvar cancer, which was assessed in the current study. Furthermore, dose optimization of indocyanine green adsorbed to human serum albumin was performed.
  
  
  METHODS
  Nine vulvar cancer patients underwent the standard sentinel lymph node procedure using (99m)technetium-nancolloid and patent blue. In addition, intraoperative imaging was performed after peritumoral injection of 1.6 mL of 500, 750, or 1000 μM of indocyanine green adsorbed to human serum albumin.
  
  
  RESULTS
  Near-infrared fluorescence sentinel lymph node mapping was successful in all patients. A total of 14 sentinel lymph nodes (average, 1.6; range, 1-4) were detected: 14 radioactive (100%), 11 blue (79%), and 14 near-infrared fluorescent (100%).
  
  
  CONCLUSIONS
  This study demonstrates feasibility and accuracy of sentinel lymph node mapping using indocyanine green adsorbed to human serum albumin. Considering safety, cost, and pharmacy preferences, an indocyanine green adsorbed to human serum albumin concentration of 500 μM appears optimal for sentinel lymph node mapping in vulvar cancer.
authors.affiliation: Department of Surgery, Leiden University Medical Center, the Netherlands.
authors.forename: Merlijn
authors.initials: M
authors.lastname: Hutteman
authors.forename: Joost R
authors.initials: JR
authors.lastname: van der Vorst
authors.forename: Katja N
authors.initials: KN
authors.lastname: Gaarenstroom
authors.forename: Alexander A W
authors.initials: AA
authors.lastname: Peters
authors.forename: J Sven D
authors.initials: JS
authors.lastname: Mieog
authors.forename: Boudewijn E
authors.initials: BE
authors.lastname: Schaafsma
authors.forename: Clemens W G M
authors.initials: CW
authors.lastname: Löwik
authors.forename: John V
authors.initials: JV
authors.lastname: Frangioni
authors.forename: Cornelis J H
authors.initials: CJ
authors.lastname: van de Velde
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Vahrmeijer
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005456:Fluorescent Dyes; D006801:Humans; D007208:Indocyanine Green; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D013668:Technetium Tc 99m Aggregated Albumin; D014846:Vulvar Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*
chemical_list: D005456:Fluorescent Dyes; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid; D007208:Indocyanine Green