A pilot study utilizing intraoperative lymphoscintigraphy for identification of the sentinel lymph nodes in vulvar cancer

Objective. To identify sentinel lymph nodes using intraoperative lymphoscintigraphy. Methods. Technetium-99-labded sulfur colloid was injected at the site of primary vulvar carcinoma, An intraoperative gamma counter was used to identify one or more sentinel lymph nodes. Results. Ten patients underwent bilateral inguinal and femoral lymphadenectomy. The clinical stages are as follows: T1 in 6, T2 in 2, and T3 in 2. A total of four groins (3 patients) were positive for metastases. In one patient only the sentinel node was positive for disease, In a second patient, two unilateral nodes were positive for disease and both were identified with the gamma counter as sentinel nodes, In the third patient, a single sentinel node was positive for malignancy in each groin, Multiple nonsentinel lymph nodes were positive in each groin in this patient. In no case was the sentinel node negative when other nonsentinel nodes were positive. Conclusion. Intraoperative lymphoscintigraphy quantitatively identifies one or more sentinel lymph nodes, Since sentinel lymph nodes can be localized transcutaneously, this technique may be useful for selective lymphadenectomy. Larger patient accrual is necessary to verify this technique. (C) 1997 Academic Press.