Obstet Gynecol Sci.  2022 Mar;65(2):223-225. 10.5468/ogs.21335.

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

Affiliations
  • 1Women’s Cancer Center, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
  • 2Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Korea

Abstract


Objective
To demonstrate near-infrared fluorescence image-guided inguinal sentinel lymph node (SLN) biopsy in patients with vulvar cancer.
Methods
A 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).
Results
Fluorescence 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.
Conclusion
This 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.

Keyword

Vulva cancer; Sentinel lymph node biopsy; Indocyanine green; Fluorescence

Cited by  2 articles

Indocyanine green fluorescent image-guided inguinal sentinel node biopsy for vulvar cancer: criteria and intraoperative challenges
Christos Iavazzo, Nikolaos Vrachnis, Ioannis D. Gkegkes
Obstet Gynecol Sci. 2022;65(5):483-484.    doi: 10.5468/ogs.22027.

Response to letter to editor: indocyanine green fluorescent image-guided inguinal sentinel node biopsy for vulvar cancer: criteria and intraoperative challenges
Sang Wun Kim
Obstet Gynecol Sci. 2022;65(5):485-486.    doi: 10.5468/ogs.22105.


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