Soergel Philipp, Hertel Hermann, Nacke Anna Kaarina, Klapdor Rüdiger, Derlin Thorsten, Hillemanns Peter
Departments of *Obstetrics and Gynaecology and †Nuclear Medicine, Hannover Medical School, Hannover, Germany.
Int J Gynecol Cancer. 2017 May;27(4):805-812. doi: 10.1097/IGC.0000000000000996.
Nowadays, sentinel diagnostic is performed using technetium 99m (Tc) nanocolloid as a radioactive marker and sometimes patent blue. In the last years, indocyanine green has been evaluated for sentinel diagnostic in different tumor entities. Indocyanine green is a fluorescent molecule that emits a light signal in the near-infrared band after excitation. Our study aimed to evaluate indocyanine green compared with the criterion-standard Tc-nanocolloid.
We included patients with primary, unifocal vulvar cancer of less than 4 cm with clinically node-negative groins in this prospective trial. Sentinel diagnostic was carried out using Tc-nanocolloid, indocyanine green, and patent blue. We examined each groin for light signals from the near-infrared band, for radioactivity, and for blue staining. A sentinel lymph node was defined as a Tc-nanocolloid-positive lymph node. All sentinel lymph nodes and all additional blue or fluorescent lymph nodes were excised and tested and then sent for histologic examination.
In all, 27 patients were included in whom we found 91 sentinel lymph nodes in 52 groins. All these lymph nodes were positive for indocyanine green, also giving a sensitivity of 100% (95% confidence interval [CI], 96.0%-100%) compared with Tc-nanocolloid. Eight additional lymph nodes showed indocyanine green fluorescence but no Tc positivity, so that the positive predictive value was 91.9% (95% confidence interval, 84.6%-96.5%). In 1 patient, a false-negative sentinel missed by all 3 modalities was found.
Our results show that indocyanine green is a promising approach for inguinal sentinel identification in vulvar cancer with a similar sensitivity as radioactive Tc-nanocolloid and worth to be evaluated in further studies.
如今，前哨诊断采用锝99m（Tc）纳米胶体作为放射性标记物，有时也使用专利蓝。在过去几年中，吲哚菁绿已被用于不同肿瘤实体的前哨诊断评估。吲哚菁绿是一种荧光分子，激发后在近红外波段发射光信号。我们的研究旨在评估吲哚菁绿与标准的Tc纳米胶体相比的情况。
在这项前瞻性试验中，我们纳入了原发性、单灶性外阴癌直径小于4cm且临床腹股沟淋巴结阴性的患者。使用Tc纳米胶体、吲哚菁绿和专利蓝进行前哨诊断。我们检查每个腹股沟是否有近红外波段的光信号、放射性和蓝色染色。前哨淋巴结定义为Tc纳米胶体阳性的淋巴结。所有前哨淋巴结以及所有额外的蓝色或荧光淋巴结均被切除并进行检测，然后送去做组织学检查。
总共纳入了27例患者，我们在52个腹股沟中发现了91个前哨淋巴结。所有这些淋巴结吲哚菁绿均呈阳性，与Tc纳米胶体相比，敏感性也为100%（95%置信区间[CI]，96.0%-100%）。另外8个淋巴结显示吲哚菁绿荧光但Tc阴性，因此阳性预测值为91.9%（95%置信区间，84.6%-96.5%）。在1例患者中，发现了一个被所有三种方法漏诊的假阴性前哨淋巴结。
我们的结果表明，吲哚菁绿是外阴癌腹股沟前哨淋巴结识别的一种有前景的方法，其敏感性与放射性Tc纳米胶体相似，值得在进一步研究中进行评估。
