Seventh Biennial Meeting of the International Gynecologic Cancer Society: Abstracts
INTRAOPERATIVE LYMPHOSCINTIGRAPHY FOR SENTINEL LYMPH NODE IDENTIFICATION IN SQUAMOUS CELL CANCER OF THE VULVA
Reinthaller, A.; Sliutz, G.; Schatten, Ch.; Hefler, L.; Sinzinger, H.1; Kainz, Oh.
Author Information
Department of Gynecology, University of Vienna Medical School, Vienna, Austria
Abstract F18
OBJECTIVE: The standard treatment of patients with squamous cell carcinoma of the vulva is local tumor resection with adequate margins and inguinofemoral lymphadenectomy. Inguinal lymph node dissection as a diagnostic procedure has a certain morbidity like wound break down, leg edema, prolonged lymphorrhea and lymph cysts. The aim of the study was to evaluate the feasibility of identification of sentinel lymph nodes (SLNs). In addition we investigated whether the histopathology of SLNs is representative for histopathology of the other lymph nodes.
METHODS: Technetium-labeled colloid was injected at the site of the primary vulvar cancer. The SLNS were identified by gamma-camera and the time to first identification was noted. The patients were then transferred to the operating theatre. Intraoperative identification of SLNs was done by a hand held gamma counter. SLNS were dissected and controlled with the gamma counter after removal. Subsequently we performed a bilateral inguinofemoral lymphadenectomy followed by local wide excision of the primary tumor.
RESULTS: Seven patients with stage I or II vulvar cancer were treated as described above. In all cases one or two SLNs were identified. First identification of SLNs was possible in 5 to 30 minutes after colloid injection. A total of three groins (2 patients) were positive for metastases. In one patient two SLNs in the right groin and one SLN in the left groin were positive for malignancy. All nodes were identified as SLNs by the gamma counter. The none-SLNs were all negative. The second patient showed one positive SLN and multiple positive none-SLNs in the left groin. No SLN and no metastases were identified in the right groin. To date no false-negative SLNs have been found.
CONCLUSION: Intraoperative lymphoscintigraphy identifies one or more SNLs with great accuracy. The SLNs can be localized transcutaneously. The method therefore offers the possibility of selective lymphadenectomy. To date in our series and in two other reports (1, 2) no false-negative SLNs have been found. Larger patient accrual is necessary to determine the possible clinical value of this technique.
1. de-Hullu JA, Dotting E, Piers DA, Hollema H, Aaldera JG, Koops HS, Boonstra H, van der Zee AG. Sentinel lymphnode identification with technetium-99m-labeled nano-colloid in squamous cell cancer of the vulva.) Nud Med 1998; 39:138 [Context Link]
2. Decesare SL, Fiorica JV, Roberts WS, Reintgen D, Arango H, Hoffman MS, Puleo C, Cavanagh D. A pilot study utilizing intraoperative lymphoscintigraphy for identification of the sentinel lymphnodes in vulvar cancer. Gynecol Oncol 1997;66:425 [Context Link]
