Preoperative lymphoscintigraphy in the evaluation of squamous cell cancer of the vulva

Purpose: A pilot study was undertaken to determine the lymphatic drainage o f vulvar cancer using cutaneous lymphoscintigraphy. Methods: Six patients with biopsy-proved T1 squamous cell cancer of the vul va were studied using 0.4 to 0.6 mCi Tc-99m HSA. Planar imaging was perform ed after patients received intradermal injections of Tc-99m HSA in a total volume of 0.4 mi at four sites around the vulvar lesion. Results: Tumor locations included two midline lesions and three anterior th ird lesions. One tumor was located in the midthird of the labia majora. The re was no clinically suspicious inguinal adenopathy in any patient. Based o n classic anatomic descriptions of cutaneous lymphatic drainage, all but on e patient would have been predicted to have drainage to both inguinal nodal basins. Cutaneous lymphoscintigraphy was successful in all six patients. U nilateral drainage was shown in five of six patients. Only one patient had bilateral inguinal drainage, and her tumor was located in the left anterior third of the labia minora, Conclusions: Cutaneous lymphoscintigraphy with Tc-99m HSA is easily perform ed and may be potentially useful in defining lymphatic basins at risk in sq uamous cell cancer of the vulva.