Exploratory Study of the Clinical Value of Near-Infrared Sentinel Lymph Node Mapping With Indocyanine Green in Vulvar Cancer Patients

Siegenthaler, Franziska; Imboden, Sara; Knabben, Laura; Mohr, Stefan; Papadia, Andrea; Mueller, Michael D.

doi:10.3389/fonc.2021.652458

Cited by 8 publications

(6 citation statements)

References 38 publications

(39 reference statements)

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“…To be able to more accurately detect the amount of SLN and its anatomical location, a preoperative 3D single-photon emission tomography imaging is performed [ 115 ]. However, this technique consists of some limitations: (i) preoperative injection of radiopharmaceuticals is a painful procedure; (ii) blue dye can cause allergic reactions and stain at the injection site; and, (iii) when the lymphatic tissue is covered by skin or fat the visualization of blue dye is limited, resulting in a lower detection rate [ 116 ].…”

Section: Treatmentmentioning

confidence: 99%

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Management of Early-Stage Vulvar Cancer

Pedrão

Guimarães

Possati-Resende

et al. 2022

Cancers

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Vulvar cancer is a rare gynecological malignancy since it represents 4% of all cancers of the female genital tract. The most common histological type is squamous cell carcinoma (90%). This type can be classified into two clinicopathological subtypes according to the etiology. The first subtype is associated with persistent human papillomavirus infection and is usually diagnosed in younger women. The second subtype is associated with lichen sclerosus condition, and in most cases is diagnosed in postmenopausal women. Currently, an increase in first subtype cases has been observed, which raised the concern about associated mortality and treatment morbidity among young women. Vulvar cancer treatment depends on histopathology grade and staging, but surgery with or without radiotherapy as adjuvant treatment is considered the gold standard. In recent decades, sentinel lymph node biopsy has been incorporated as part of the treatment. Therefore, we sought to review and discuss the advances documented in the literature about vulvar cancer focusing on the treatment of early-stage disease. Relevant articles, such as the GROINS-V studies and the GOG protocols, are presented in this review. Additionally, we discuss key points such as the evolution of treatment from invasive surgery with high morbidity, to more conservative approaches without compromising oncologic safety; the role of sentinel lymph node mapping in the initial staging, since it reduces the complications caused by inguinofemoral lymphadenectomy; the recurrences rates, since local recurrence is common and curable, however, groin-associated, or distant recurrences have a poor prognosis; and, finally, the long-term follow-up that is essential for all patients.

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Section: Treatmentmentioning

confidence: 99%

“…In patients with lymph node metastasis or lymphatic vascular space invasion, ICG was significantly higher than TC-99 ( p = 0.035 and 0.004, respectively). Finally, the authors concluded that SLN mapping using ICG with near-infrared fluorescence imaging in patients with vulvar cancer is feasible, accurate, and safe [ 116 ].…”

Section: Treatmentmentioning

confidence: 99%

Management of Early-Stage Vulvar Cancer

Pedrão

Guimarães

Possati-Resende

et al. 2022

Cancers

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“…In addition, fluorescence-emission-guided tissue observation can detect small and numerous lymph nodes. This approach offers the advantage of swiftly observing these nodes during the surgical procedure [9,10].…”

Section: Introductionmentioning

confidence: 99%

Single Quasi–Symmetrical LED with High Intensity and Wide Beam Width Using Diamond–Shaped Mirror Refraction Method for Surgical Fluorescence Microscope Applications

Ju,

Yoon,

Lee

et al. 2023

Diagnostics

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To remove tumors with the same blood vessel color, observation is performed using a surgical microscope through fluorescent staining. Therefore, surgical microscopes use light emitting diode (LED) emission and excitation wavelengths to induce fluorescence emission wavelengths. LEDs used in hand–held type microscopes have a beam irradiation range of 10° and a weak power of less than 0.5 mW. Therefore, fluorescence emission is difficult. This study proposes to increase the beam width and power of LED by utilizing the quasi–symmetrical beam irradiation method. Commercial LED irradiates a beam 1/r2 distance away from the target (working distance). To obtain the fluorescence emission probability, set up four mirrors. The distance between the mirrors and the LED is 5.9 cm, and the distance between the mirrors and the target is 2.95 cm. The commercial LED reached power on target of 8.0 pW within the wavelength band of 405 nm. The power reaching the target is 0.60 mW in the wavelength band of 405 nm for the LED with the beam mirror attachment method using the quasi–symmetrical beam irradiation method. This result is expected to be sufficient for fluorescence emission. The light power of the mirror was increased by approximately four times.

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“…Based on this evidence, this technique has been extended to vulvar cancers. Recently, several studies have shown the feasibility, accuracy, and safety of SLN mapping using ICG with near-infrared fluorescence imaging in vulvar cancer [ 7 , 8 ].…”

mentioning

confidence: 99%

“…The advantages of SLN mapping using ICG with near-infrared fluorescence imaging include easier application, absence of radioactivity, and fewer side effects [ 8 ]. In addition, the procedure is less invasive, with little pain and scarring.…”

mentioning

confidence: 99%

Indocyanine green fluorescent image-guided inguinal sentinel lymph node biopsy in vulvar cancer

Kwak¹,

Lee²,

Lee³

et al. 2022

Obstet Gynecol Sci

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ObjectiveTo demonstrate near-infrared fluorescence image-guided inguinal sentinel lymph node (SLN) biopsy in patients with vulvar cancer.MethodsA 40-year-old woman with a 3-cm-sized palpable left vulvar mass was diagnosed with vulvar cancer on biopsy with protrusion into the vaginal cavity. Pelvic contrast-enhanced magnetic resonance imaging and F-18 fluorodeoxyglucose positron-emission tomography-computed tomography showed a small ulcerative enhancing lesion confined to the left vulva without distant metastasis. The patient was scheduled for radical vulvectomy with a left inguinal SLN biopsy. Indocyanine green was injected directly into the vulvar mass to map lymphatic drainage. A 4-cm-sized linear incision was made on the left inguinal crease, and the lymphatic channels of the left inguinal area were dissected under fluorescent image guidance using a 1588 Advanced Imaging Modalities Platform laparoscopic camera (Stryker, Kalamazoo, MI, USA).ResultsFluorescence image-guided left inguinal SLN biopsy and radical vulvectomy were performed. The pathologic diagnosis confirmed vulvar adenoid cystic carcinoma with metastasis to the left inguinal lymph node (International Federation of Gynecology and Obstetrics stage IIIA). The patient was discharged without complications and received adjuvant radiotherapy.ConclusionThis video demonstrates a successful ICG fluorescence image-guided left inguinal SLN biopsy in a vulvar cancer patient using a laparoscopic camera. Mapping of inguinal SLNs in patients with vulvar cancer may help in retaining surgical radicality while minimizing operative complications.

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Exploratory Study of the Clinical Value of Near-Infrared Sentinel Lymph Node Mapping With Indocyanine Green in Vulvar Cancer Patients

Cited by 8 publications

References 38 publications

Management of Early-Stage Vulvar Cancer

Management of Early-Stage Vulvar Cancer

Single Quasi–Symmetrical LED with High Intensity and Wide Beam Width Using Diamond–Shaped Mirror Refraction Method for Surgical Fluorescence Microscope Applications

Indocyanine green fluorescent image-guided inguinal sentinel lymph node biopsy in vulvar cancer

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