MITERA: Groundbreaking surgical technique for vulvar cancer using lymphoscintigraphy and ICG mapping

A patient with vulvar cancer underwent a groundbreaking surgical technique at MITERA Hospital for inguinal lymph node metastasis assessment by Dr. Vasileios Sioulas, Chairman of the 1st Department of Gynecologic Oncology, and his associates. The technique was based on the identification of the sentinel lymph node with the combined use of lymphoscintigraphy and ICG (Indocyanine Green) mapping.

Vulvar cancer is the fourth most common malignancy of the female reproductive system. The histologic examination of the inguinal lymph nodes for the presence of metastases – which, unfortunately, cannot be definitely ruled out through imaging studies – is crucial for the successful treatment of the patients with early-stage disease. However, full inguinal lymphadenectomy is often associated with serious complications, primarily lymphedema, lymphocysts, infections and breakdown of the surgical wound.

With the novel surgical technique, the assessment of inguinal lymph node metastases in patients with vulvar cancer who meet the criteria is based on the use of lymphoscintigraphy and ICG mapping. During the surgical procedure, a 99mTc gamma probe, along with a near-infrared fluorescence camera, allow the detection of the sentinel lymph node. This is the first lymph node that receives lymph fluid from the tumor and, consequently, is at higher risk for harboring lymphatic metastases. This technique ensures the maximum accuracy in the diagnosis of lymphatic metastases and, therefore, the highest oncologic safety for patients. In addition, by minimizing the number of removed lymph nodes and the size of incisions, it significantly lowers the risk of complications associated with full inguinal lymphadenectomy.

Dr. Vasileios Sioulas, Chairman of the 1st Department of Gynecologic Oncology and the Scientific Board of MITERA Hospital, graduate from the International Fellowship in Gynecologic Oncology of the worldwide known Memorial Sloan Kettering Cancer Center (New York, USA) noted, “Following the current practice of the most prestigious US oncology centers, we successfully offer the most contemporary surgical treatment to patients with vulvar cancer who meet the relevant criteria by taking full advantage of the exceptional infrastructure at the Department of Nuclear Medicine of HYGEIA Hospital and the operating rooms of MITERA Hospital. The removal of the inguinal lymph nodes that really matter ensures effective treatment of the disease, lower perioperative complication rates and respect of our patients’ quality of life in the future.”