ICG-Only Sentinel Node Mapping Shows Low Groin Recurrence in Vulvar Cancer

An author reflection reports outcomes from 49 patients with early-stage, node-negative vulvar cancer who underwent sentinel lymph node mapping using indocyanine green (ICG) alone. Detection was 90.4% per groin; recurrence estimates were based on a smaller subgroup with unifocal disease and negative sentinel nodes.

ICG-only detection was 90.4% per groin.
Recurrence was 4.8% at 60 months in the reported subgroup.
Evidence comes from a small, specialized-center cohort.
Prospective comparison with conventional mapping is still needed.

Sentinel lymph node biopsy can reduce morbidity compared with systematic inguinofemoral lymphadenectomy in selected patients with early-stage vulvar cancer. This author reflection summarizes a study of exclusive ICG-guided mapping in 49 patients, representing 94 groins at risk. The main outcome was groin recurrence; the reflection also reports sentinel node detection rates.

Detection was 90.4% per groin. Among 33 patients with unifocal disease and negative sentinel nodes, representing 63 groins at risk, recurrence was 1.6% at 24 months and 4.8% at 60 months. The latter estimate included one unilateral and one bilateral recurrence.

The authors say these results are within the range reported with conventional mapping and support the feasibility of ICG-only mapping in carefully selected patients treated at an experienced tertiary center. The evidence remains limited: the cohort was small, and the authors call for larger multicenter studies, longer follow-up, and prospective comparison with radioactive tracer-based mapping. They do not suggest that ICG alone is ready to replace conventional mapping as a standard approach.

In practice

For patients with early-stage, node-negative vulvar cancer, this small study suggests that exclusive ICG-guided sentinel node mapping can be feasible in an experienced tertiary center: detection was 90.4% per groin, with 4.8% groin recurrence at 60 months in the subgroup with unifocal disease and negative sentinel nodes. These results do not establish that ICG alone is as safe as conventional mapping or justify changing practice. Larger multicenter cohorts, longer follow-up, and prospective comparisons are needed.

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Source

Annals of Surgical Oncology: ASO Author Reflections: ICG-Only Sentinel Node Mapping: A Step Toward Simplifying Vulvar Cancer Surgery ↗

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