Optimization of near-infrared fluorescent sentinel lymph node mapping for vulvar cancer

ObjectivesNear-infrared fluorescence imaging has the potential to improve sentinel lymph node mapping in vulvar cancer, which was assessed in the current study. Furthermore, dose optimization of indocyanine green adsorbed to human serum albumin was performed.Study DesignNine vulvar cancer patients underwent the standard sentinel lymph node procedure using 99mtechnetium-nancolloid and patent blue. In addition, intraoperative imaging was performed after peritumoral injection of 1.6 mL of 500, 750, or 1000 μM of indocyanine green adsorbed to human serum albumin.ResultsNear-infrared fluorescence sentinel lymph node mapping was successful in all patients. A total of 14 sentinel lymph nodes (average, 1.6; range, 1–4) were detected: 14 radioactive (100%), 11 blue (79%), and 14 near-infrared fluorescent (100%).ConclusionThis study demonstrates feasibility and accuracy of sentinel lymph node mapping using indocyanine green adsorbed to human serum albumin. Considering safety, cost, and pharmacy preferences, an indocyanine green adsorbed to human serum albumin concentration of 500 μM appears optimal for sentinel lymph node mapping in vulvar cancer