Rundle Stuart, Korompelis Porfyrios, Ralte Angela, Bewick Diane, Ratnavelu Nithya
Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Sherif Hill, Gateshead, Tyne and Wear, NE9 6SX, UK.
Eur J Surg Oncol. 2023 Feb;49(2):481-485. doi: 10.1016/j.ejso.2022.09.015. Epub 2022 Sep 28.
The sentinel lymph node (SLN) procedure for vulva cancer is a safe alternative to a radical inguino-femoral lymphadenectomy (IFLN) for small unifocal tumours. SLN evaluation through biopsy and ultra-staging has helped gynaecological oncology surgeons improve operative morbidity with no cost to oncologic safety. Established techniques for groin SLN detection and excision in vulvar cancer use Tc-nanocolloid radiotracer and blue dye (BD) for identification of the SLN. Indocyanine green (ICG)-near infrared (ICG-NIR) techniques for SLN mapping have proven utility in other gynaecological cancer sites and is gaining interest as a technique for SLN mapping in vulvar cancer METHODS: Fifty consecutive patients with unifocal vulvar squamous cell cancers of <40 mm lateral diameter and with depth of invasion > 1 mm underwent SLN mapping and excision using a combination of Tc-nanocolloid, BD and ICG. SLN detection results were recorded on a per-patient and per-groin basis. The success rates SLN for detection by individual tracer substance or combinations of tracer were determined by presence of one or more tracer, detectable in the SLN specimen.
92% of patients had a successful SLN procedure. The per-groin detection rate was 84%. All successfully mapped SLN were identified with the combination of ICG-NIR and Tc-nanocolloid compared to 69% with BD Tc-nanocolloid. Success rates for the SLN procedure were not dependent on prior excision of the primary lesion or operator experience.
Incorporation of ICG-NIR into standard SLN mapping protocols may allow for the abandonment of routine use of BD and its poor side effect profile.
对于小的单灶性外阴癌肿瘤，前哨淋巴结（SLN）手术是根治性腹股沟股淋巴结清扫术（IFLN）的一种安全替代方法。通过活检和超分期进行SLN评估有助于妇科肿瘤外科医生降低手术发病率，同时不影响肿瘤学安全性。外阴癌腹股沟SLN检测和切除的既定技术使用锝纳米胶体放射性示踪剂和蓝色染料（BD）来识别SLN。吲哚菁绿（ICG）-近红外（ICG-NIR）技术用于SLN定位已在其他妇科癌症部位得到证实，并且作为外阴癌SLN定位技术正受到关注。方法：连续50例单灶性外阴鳞状细胞癌患者，肿瘤直径<40mm且浸润深度>1mm，采用锝纳米胶体、BD和ICG联合进行SLN定位和切除。按患者和腹股沟记录SLN检测结果。通过在SLN标本中检测到一种或多种示踪剂来确定单个示踪剂物质或示踪剂组合检测SLN的成功率。
92%的患者SLN手术成功。腹股沟检测率为84%。与BD+锝纳米胶体的69%相比，所有成功定位的SLN均通过ICG-NIR和锝纳米胶体联合识别。SLN手术的成功率不依赖于原发灶的先前切除或术者经验。
将ICG-NIR纳入标准SLN定位方案可能允许放弃BD的常规使用及其不良副作用。
