Division of Gynecologic Oncology and the Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Obstet Gynecol. 2023 Mar 1;141(3):608-612. doi: 10.1097/AOG.0000000000005084. Epub 2023 Feb 2.
Vulvar Paget disease often requires extensive and, in some cases, multiple resections to treat. A fluorescein-mapping procedure followed by a staged vulvectomy may be an effective technique to tailor resection and identify clinically occult lesions.
We describe a two-step procedure; first, intravenous fluorescein sodium is injected, and the vulva is illuminated with a Wood's lamp. Representative biopsies are obtained and correlated on final pathology with the extent of disease to develop a final plan for excision. Second, using fluorescein to identify the confirmed areas of disease, the appropriate excisional procedure is performed once mapping biopsy pathology is known.
We describe our experience with eight patients with vulvar Paget disease undergoing fluorescein mapping biopsies and staged vulvectomy. Using intravenous fluorescein sodium, all patients were found to have Paget disease beyond the visible margins of their gross lesions. No patients experienced a recurrence of Paget disease within a median follow-up time of 32 months, comparable with other directed methods of surgical resection.
We report a technique for the injection of fluorescein sodium for the visualization of vulvar Paget disease capable of providing accurate surgical margins and identification of occult satellite lesions with a high degree of safety and a favorable cost profile. This staged approach to vulvectomy could offer improved accuracy of resection for vulvar Paget disease with few drawbacks.
外阴派杰病常需要广泛的切除，在某些情况下甚至需要多次切除才能治疗。荧光素定位后分期外阴切除术可能是一种有效的技术，可以精确切除并识别临床隐匿性病变。
我们描述了一个两步程序；首先，静脉注射荧光素钠，然后用伍德灯照亮外阴。获得有代表性的活检，并根据最终病理与疾病的程度进行相关性分析，以制定最终的切除计划。其次，使用荧光素识别已确认的疾病区域，一旦了解了定位活检的病理，就可以进行适当的切除。
我们描述了 8 例外阴派杰病患者进行荧光素定位活检和分期外阴切除术的经验。使用静脉注射荧光素钠，所有患者均发现其外阴派杰病超出肉眼病变的可见边界。在中位随访 32 个月内，无患者出现外阴派杰病复发，与其他定向手术切除方法的结果相当。
我们报告了一种用于可视化外阴派杰病的荧光素钠注射技术，该技术能够提供精确的手术边界，并以高度的安全性和良好的成本效益识别隐匿性卫星病变。这种分期外阴切除术方法可提高外阴派杰病切除的准确性，缺点较少。
