Performance of Indocyanine Green Compared to 99mTc-Nanocolloids for Sentinel Lymph Node Detection in Early Vulvar Cancer

Abstract

Study objective: The aim of this study was to evaluate the performance of indocyanine green (ICG) compared to that of the gold standard 99mtechnetium (99mTc-nanocolloids) in detecting sentinel lymph nodes (SLN) in early vulvar cancer. Material and Methods: A single-center retrospective cohort study comparing SLN detection by 99mTc-nanocolloids and ICG was performed in patients presenting early vulvar cancer (T1/2), with clinically negative nodes. All SLN showing a radioactive and/or fluorescent signal were resected. The primary endpoints were the sensitivity, positive predictive value (PPV) and false negative (FN) rate of ICG in detecting SLN compared to 99mTc-nanocolloids. Results: Thirty patients were included and 99 SLN were identified in 43 groins. Compared to 99mTc-nanocolloids, ICG had a sensitivity of 80.8% (95% CI [72.6; 88.6%]), a PPV of 96.2% (95% CI [91.8; 100%]) and a FN rate of 19.1% in detecting SLN. Seventeen (17.1%) infiltrated (positive) SLN were identified out of the 99 SLN detected. Compared to 99mTc-nanocolloids, ICG showed a sensitivity of 82.3% (95% CI [73.1; 91.5%]), a PPV of 100% and a FN rate of 17.6% (3/17) in detecting infiltrated SLN. Conclusion: Despite its many advantages, ICG cannot be used as the sole tracer for the detection of SLN in early vulvar cancer and should be employed in conjunction with 99mTc-nanocolloids.

Complementary use of indocyanine green and technetium to enhance sentinel lymphadenectomy in vulvar cancer

“…4 One single-center study found a slightly lower sentinel detection rate compared with technetium-99 but indicated that growing experience with the method increased detection rate. 6 It has been recommended not to useindocyanine green as the sole tracer for sentinel detection but in conjunction with technetium-99, 7 and indocyanine green methodology needs to be consolidated. 8 This video consists of intra-operative video footage recorded with an indocyanine green exoscope for open surgery (Vitom-ICG, Karl Storz, Germany) with its different video modes applied: Combining radioactive tracer and indocyanine green methods simplifies sentinel lymphadenectomy in vulvar cancer.…”

Update on the Sentinel Node Procedure in Vulvar Cancer

“…All clinical studies (n510) until 2023 with full-text availability were included. 23,[25][26][27][28][29][30][31][32][33] The Lateralized tumors are located .1 cm from the midline; near midline tumors are located #1 cm from the midline but not crossing the midline; true midline tumors cross the midline.…”

Different tracers for sentinel node detection in gynecologic oncology

“…Benmoulay-Rigollot et al [23] retrospectively evaluated the performance of ICG compared with that of the gold standard Tc99m in detecting SLN in early vulvar cancer. Thirty patients were included and 99 SLN were identified in 43 groins.…”

“…With regard to sensitivity, the performance of ICG appears to be insufficient compared with Tc99m in detecting SLN in patients with early-stage vulvar cancer. They concluded that despite its many advantages, ICG cannot be used as the sole tracer for the detection of SLN and should be employed in conjunction with Tc99m [23].…”