Multimodal surgical guidance towards the sentinel node in vulvar cancer

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• 作者：H.M. Math茅ron ; N.S. van den Berg ; O.R. Brouwer ; G.H. KleinJan ; W.J. van Driel ; J.W. Trum ; E. Vegt ; G. Kenter ; F.W.B. van Leeuwen ; R.A. Vald茅s Olmos
• 关键词：Sentinel (lymph) node ; Vulvar cancer ; Fluorescence imaging ; Radioactivity ; Multimodal
• 刊名：Gynecologic Oncology
• 出版年：December, 2013
• 年：2013
• 卷：131
• 期：3
• 页码：720-725
• 全文大小：564 K

文摘

<h4 class="h4">Introductionh4>Conventional sentinel node (SN) mapping is performed by injecting a radiocolloid followed by lymphoscintigraphy (and SPECT/CT imaging). An extra intraoperative injection with blue dye can then allow for optical identification of the SN. In order to improve the current clinical standard, the hybrid tracer indocyanine green (ICG)-^99mTc-nanocolloid was introduced, a tracer that is both radioactive and fluorescent. This feasibility study aimed to evaluate the value of a multimodal-based SN biopsy in vulvar cancer.<h4 class="h4">Materials and methodsh4>

Fifteen patients with vulvar cancer (29 groins) scheduled for SN biopsy were peritumorally injected with ICG-^99mTc-nanocolloid followed by lymphoscintigraphy and SPECT/CT imaging to identify the SNs. In thirteen patients, shortly before the start of the operation, blue dye was intradermally injected around the lesion. SNs were harvested using a combination of radiotracing, fluorescence imaging, and optical blue dye detection. A portable gamma camera was used before and after SN excision to confirm excision of the preoperatively defined SNs.<h4 class="h4">Resultsh4>

Preoperative lymphoscintigraphy and SPECT/CT imaging visualized drainage to 39 SNs in 28 groins. During the operation, 98% (ex vivo 100%) of the SNs were radioactive. With fluorescence imaging 96% of the SNs (ex vivo 100%) could be visualized. Only 65% of the SNs had stained blue at the time of excision.<h4 class="h4">Conclusionh4>

ICG-^99mTc-nanocolloid can be used for preoperative SN identification and enables multimodal (radioactive and fluorescent) surgical guidance in patients with vulvar cancer. The addition of fluorescence-based optical guidance offers more effective SN visualization compared to blue dye.