Detection of sentinel nodes by lymphoscintigraphy and gamma probe guided surgery in vulvar neoplasia

Background: Pathologic lymph node status is the most important prognostic f actor in vulvar cancer; however, complete inguinofemoral node dissection is associated with significant morbidity. Intraoperative lymphoscintigraphy a ssociated with gamma detecting probe-guided surgery has proved to be reliab le in the detection of sentinel node (SN) involvement in melanoma and breas t cancer patients. The present study evaluates the feasibility of the surgi cal identification of inguinal sentinel nodes using lymphoscintigraphy and a gamma detecting probe in patients with early vulvar cancer. Methods: Technetium-99-labeled colloid human albumin was administered peril lesionally in 44 patients. Twenty patients had T-1 and 23 had T-2 invasive epidermoid vulvar cancer; one patient had a lower-third vaginal cancer, An intraoperative gamma detecting probe was used to identify SNs during surger y. Complete inguinofemoral node dissection was subsequently performed. SNs underwent separate pathologic evaluation. Results: A total of 77 groins were dissected in 44 patients. SNs were ident ified in all the studied groins. Thirteen cases had positive nodes: the SN was positive in all of them; in 10 cases the SN was the only positive node. Thirty-one patients showed negative SNs: all of them were negative for lym ph node metastasis. Conclusions: Lymphoscintigraphy and SN biopsy under gamma detecting probe g uidance proved to be an easy and reliable method for detection of SNs in ea rly vulvar cancer. If these preliminary data will be confirmed, the techniq ue would represent a real progress towards less aggressive treatment in pat ients with vulvar cancer.