Naslov
Sentinel lymph node biopsy in vulvar cancer

Autori
Huić, Dražen ; Mutvar, Andrea ; Čorušić, Ante ; Zekan, Joško ; Babić, Damir ; Dodig, Damir

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
European Journal of Nuclear Medicine and Molecular Imaging ; Abstracts, Annual Congress of the EANM, Vol 33, Supplement 2 ; Sept 2006 / Carrio, I. - Braunschweig : Springer, 2006, 132-132

Skup
Annual Congress of the EANM

Mjesto i datum
Atena, Grčka, 30.09.2006. - 04.10.2006

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Nije recenziran

Ključne riječi
sentinel limfni čvor; karcinom vulve
(sentinel node; vulvar cancer)

Sažetak
Pathologic lymph node status is the most important prognostic factor in vulvar cancer. No accurate non-invasive staging techniques are available for excluding inguinofemoral lymph node metastases and therefore complete inguinofemoral lymphadenectomy is performed for staging purposes as a part of a standard treatment of vulvar cancer. Although the prognosis is good, the morbidity associated with the standard treatment is substantial. In early-stage disease (T1 and T2) only 20– 30% of the patients will have inguinofemoral lymph node metastases, while the other 70– 80% without inguinofemoral lymph node metastases will probably not benefit from this lymphadenectomy. The minimal-invasive sentinel lymph node (SN) procedure could be a promising staging technique for patients with vulvar cancer. The study evaluates feasibility of the surgical identification of inguinal sentinel nodes using lymphoscintigraphy and a gamma detecting probe and diagnostic accuracy of sentinel lymph node biopsy in staging early vulvar cancer. The study included 20 female patients (median age 70, 5 years, range 48-79 years) with early stage vulvar cancer (4 pts T1 and 16 pts T2) without evident metastases (physical examination, ultrasound, CT). Average tumoral invasion was 3, 5 mm (range >1-5, 5). 11 were unilateral, 5 had kissing lesion, 3 were in mid-line and 1 was multicentric. On the same day, few hours before the surgery Tc-99-labeled colloid human albumin was administered intradermally at 2-4 sites around the tumor (administered activity 0, 3-0, 5 mCi, particle size from 100-600 nm, total volume of 0, 3-0.4 ml). Lymphoscitigraphy was then performed untill the SN visualisation. Gamma ray detecting probe is used to locate the skin projection of sentinel node and to identify sentinel nodes during surgery. Intraoperatively, after the detection, SNs underwent separate pathologic evaluation. Complete, bilateral inguinofemoral node dissection and radical vulvectomy is subsequently performed in all patients (40 groin dissections). Scintigraphy showed focal uptake in all 20 patients ; 5-180 min. p.i. ; 27 SNs were detected (range1-5 per patient). Intraoperatively we identified 24 SNs (range 1-3 per patient ) in 18 out of 20 patients (90%). The SN was positive in 5 patients (8 SNs) ; in 3 cases the SN was the only positive node. 13 patients showed negative SNs (16 SNs): one of them had another lymph node metastasis (5% false negative). In the case of the false negative SN the tumor was in the mid-line, in the posterior part of vulva but the part of tumor (one side) was excised and it was not clearly visible so the radiopharmaceutical was administered only around one side of tumor. Lymphoscintigraphy and SN biopsy under gamma detecting probe guidance is feasible in early vulvar cancer. If these preliminary data will be confirmed, the technique would enable less aggressive treatment in patients with early vulvar cancer. The role of additional histopathological techniques for the examination of the sentinel lymph nodes, that may contribute to the more accurate staging of the disease, needs to be established.

Izvorni jezik
Engleski

Znanstvena područja
Biologija

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