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Clinical Trial
. 2012 Jan;206(1):89.e1-5.
doi: 10.1016/j.ajog.2011.07.039. Epub 2011 Jul 30.

Optimization of near-infrared fluorescent sentinel lymph node mapping for vulvar cancer

Merlijn Hutteman  1 , Joost R van der Vorst, Katja N Gaarenstroom, Alexander A W Peters, J Sven D Mieog, Boudewijn E Schaafsma, Clemens W G M Löwik, John V Frangioni, Cornelis J H van de Velde, Alexander L Vahrmeijer
Affiliations
Clinical Trial

Optimization of near-infrared fluorescent sentinel lymph node mapping for vulvar cancer

Merlijn Hutteman et al. Am J Obstet Gynecol. 2012 Jan.

Abstract

Objectives: 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.

Study design: 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%).

Conclusion: 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.

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Figures

Figure 1
Figure 1. Sentinel lymph node mapping using NIR fluorescence imaging in vulvar cancer
Peritumoral injection of 1.6 mL of 500 µM ICG:HSA (injection site covered by hand) identifies lymphatic channels, which converge in a SLN (arrow) that can be seen percutaneously (top row). Identification of the SLN (arrow) and 2 afferent lymphatic channels (arrowheads) is demonstrated using NIR fluorescence imaging 17 min after injection of ICG:HSA (bottom row). Camera exposure times were 100 msec (top row) and 45 msec (bottom row). Scale bars represent 1 cm.
Figure 2
Figure 2. Optimization of ICG:HSA dose
Signal-to-background ratio (mean ± S.D.) of vulvar SLNs (ordinate) is plotted as a function of injected dose of ICG:HSA (abscissa). The SBRs of the 500, 750, and 100 µM concentration groups were not significantly different, although a trend was found favoring 750 µM over 1000 µM (P = 0.07).
See this image and copyright information in PMC

References

    1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300. - PubMed
    1. Hacker NF. Revised FIGO staging for carcinoma of the vulva. Int J Gynaecol Obstet. 2009;105:105–106. - PubMed
    1. Ansink A, Van Der Velden J. Surgical interventions for early squamous cell carcinoma of the vulva. Cochrane database of systematic reviews (Online) 2000 CD002036. - PMC - PubMed
    1. Gaarenstroom KN, Kenter GG, Trimbos JB, et al. Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions. Int J Gynecol Cancer. 2003;13:522–527. - PubMed
    1. Rouzier R, Haddad B, Dubernard G, Dubois P, Paniel BJ. Inguinofemoral dissection for carcinoma of the vulva: effect of modifications of extent and technique on morbidity and survival. J Am Coll Surg. 2003;196:442–450. - PubMed

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