Design: Case Study. Use of intra-operative ICG fluorescence for sentinel lymph node biopsy on vulvar cancer.

Setting: 70 yo female with 3-cm vulvar squamous cell carcinoma in the posterior fourchette of the vulva. Physical exam and PET CT scan did not show abnormal groin lymph nodes or distant metastasis. Patient underwent partial radical vulvectomy with sentinel lymph node biopsy with Tc-99 and ICG. Two right sentinel lymph node and one left sentinel lymph node was identified. Post-operative course was unremarkable.

Patients or Participants: 1 participant

Interventions: Pre-operative Lympho-scintigraphy Tc 99 with intra-operative radiolocalization and intra-operative dermal injection of indocyanine green.

Measurements and Main Results: Pathology showed invasive squamous cell carcinoma, poorly differentiated, 2x1.8 cm horizontal extend, maximum depth of invasion 0.8 cm. All circumferential margins were negative for invasive carcinoma. Invasive carcinoma was positive focally in deep margins. Lymphovascular invasion was not identified. Eight-mm metastatic carcinoma was identified in 1 out of two right inguinal sentinel lymph nodes. One left sentinel lymph node was negative for carcinoma.

Conclusion: Sentinel lymph node biopsy for vulvar cancer with Tc-99 and ICG appears safe and feasible. ICG may increase the detection rate of micro metastasis. ICG is an alternative to blue dye.