Intraoperative Lymphatic Mapping and Sentinel Node Identification with Blue Dye in Patients with Vulvar Cancer
Identifieur interne : 001303 ( Istex/Corpus ); précédent : 001302; suivant : 001304Intraoperative Lymphatic Mapping and Sentinel Node Identification with Blue Dye in Patients with Vulvar Cancer
Auteurs : Charles Levenback ; Robert L. Coleman ; Thomas W. Burke ; Diane Bodurka-Bevers ; Judith K. Wolf ; David M. GershensonSource :
- Gynecologic Oncology [ 0090-8258 ] ; 2001.
Abstract
Objective. To determine the effectiveness of intraoperative lymphatic with blue dye alone as a means of localizing sentinel nodes in patients with vulvar cancer. Methods. All patients undergoing primary surgical treatment for vulvar cancer were eligible for this prospective study. Isosulfan blue dye was injected intradermally at the edge of the primary tumor closest to the adjacent groin. Bilateral dye injections and groin dissections were performed if the tumor was within 2 cm of the midline. Results. Fifty-two patients were enrolled in the study between 1993 and 1999. The median age was 58 years. Eighty-seven percent of the patients had T1 or T2 lesions, and 92% had nonsuspicious lymph nodes on palpation. Sixty-seven percent of the patients had squamous cell carcinoma; the remaining patients had melanoma or adenocarcinoma. The sentinel node was identified in 46 of the 52 patients (88%), comprising 22 of the 25 patients with lateral tumors and 24 of the 27 patients with midline lesions. The sentinel node was successfully identified in 57 of the 76 (75%) dissected groins. Sentinel node identification in the groin was hampered by the effects of prior excisional biopsy vs punch biopsy (11 of 25 vs 8 of 51, P = 0.007) and by the lateral vs midline location of the tumor (22 of 25 groins vs 35 of 51 groins, P = 0.067). During the first 2 years (1993–1994), a sentinel node could not be identified in 4 of the 25 (16%) patients and 13 of the 36 (36%) groins dissected, compared with 2 of the 27 (7%) of patients treated and 6 of the 40 (15%) groins dissected from 1995 through 1999 (P = 0.034). A total of 556 nodes were removed (median, 7 per groin), of which 83 (median, 1 per groin) were sentinel. The sentinel node was not identified in 2 of the 12 groins that proved to have metastatic disease. Both events occurred in the first 2 years of the study. There were no false-negative sentinel nodes. Since 1995, we have successfully identified the sentinel node in 16 of the 16 patients (25 of 25 groins) with T1 or T2 primary lesions, squamous histology, and nonsuspicious groin nodes on physical examination. Conclusions. Experience and careful patient selection can permit sentinel node identification with blue dye injection alone in more than 95% of patients with vulvar cancer.
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DOI: 10.1006/gyno.2001.6374
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D. Anderson Cancer Center, Houston, Texas, 77030</mods:affiliation></affiliation></author><author><name sortKey="Coleman, Robert L" sort="Coleman, Robert L" uniqKey="Coleman R" first="Robert L." last="Coleman">Robert L. Coleman</name><affiliation><mods:affiliation>The University of Texas Southwestern Medical Center, Dallas, Texas, 75390</mods:affiliation></affiliation></author><author><name sortKey="Burke, Thomas W" sort="Burke, Thomas W" uniqKey="Burke T" first="Thomas W." last="Burke">Thomas W. Burke</name><affiliation><mods:affiliation>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</mods:affiliation></affiliation></author><author><name sortKey="Bodurka Bevers, Diane" sort="Bodurka Bevers, Diane" uniqKey="Bodurka Bevers D" first="Diane" last="Bodurka-Bevers">Diane Bodurka-Bevers</name><affiliation><mods:affiliation>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</mods:affiliation></affiliation></author><author><name sortKey="Wolf, Judith K" sort="Wolf, Judith K" uniqKey="Wolf J" first="Judith K." last="Wolf">Judith K. Wolf</name><affiliation><mods:affiliation>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</mods:affiliation></affiliation></author><author><name sortKey="Gershenson, David M" sort="Gershenson, David M" uniqKey="Gershenson D" first="David M." last="Gershenson">David M. Gershenson</name><affiliation><mods:affiliation>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Gynecologic Oncology</title><title level="j" type="abbrev">YGYNO</title><idno type="ISSN">0090-8258</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="2001">2001</date><biblScope unit="volume">83</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="276">276</biblScope><biblScope unit="page" to="281">281</biblScope></imprint><idno type="ISSN">0090-8258</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0090-8258</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objective. To determine the effectiveness of intraoperative lymphatic with blue dye alone as a means of localizing sentinel nodes in patients with vulvar cancer. Methods. All patients undergoing primary surgical treatment for vulvar cancer were eligible for this prospective study. Isosulfan blue dye was injected intradermally at the edge of the primary tumor closest to the adjacent groin. Bilateral dye injections and groin dissections were performed if the tumor was within 2 cm of the midline. Results. Fifty-two patients were enrolled in the study between 1993 and 1999. The median age was 58 years. Eighty-seven percent of the patients had T1 or T2 lesions, and 92% had nonsuspicious lymph nodes on palpation. Sixty-seven percent of the patients had squamous cell carcinoma; the remaining patients had melanoma or adenocarcinoma. The sentinel node was identified in 46 of the 52 patients (88%), comprising 22 of the 25 patients with lateral tumors and 24 of the 27 patients with midline lesions. The sentinel node was successfully identified in 57 of the 76 (75%) dissected groins. Sentinel node identification in the groin was hampered by the effects of prior excisional biopsy vs punch biopsy (11 of 25 vs 8 of 51, P = 0.007) and by the lateral vs midline location of the tumor (22 of 25 groins vs 35 of 51 groins, P = 0.067). During the first 2 years (1993–1994), a sentinel node could not be identified in 4 of the 25 (16%) patients and 13 of the 36 (36%) groins dissected, compared with 2 of the 27 (7%) of patients treated and 6 of the 40 (15%) groins dissected from 1995 through 1999 (P = 0.034). A total of 556 nodes were removed (median, 7 per groin), of which 83 (median, 1 per groin) were sentinel. The sentinel node was not identified in 2 of the 12 groins that proved to have metastatic disease. Both events occurred in the first 2 years of the study. There were no false-negative sentinel nodes. Since 1995, we have successfully identified the sentinel node in 16 of the 16 patients (25 of 25 groins) with T1 or T2 primary lesions, squamous histology, and nonsuspicious groin nodes on physical examination. Conclusions. Experience and careful patient selection can permit sentinel node identification with blue dye injection alone in more than 95% of patients with vulvar cancer.</div></front></TEI><istex><corpusName>elsevier</corpusName><keywords><teeft><json:string>node</json:string><json:string>sentinel node</json:string><json:string>lymphatic</json:string><json:string>vulvar</json:string><json:string>lymphoscintigraphy</json:string><json:string>sentinel</json:string><json:string>vulvar cancer</json:string><json:string>intraoperative</json:string><json:string>midline</json:string><json:string>vulva</json:string><json:string>sentinel nodes</json:string><json:string>gynecol</json:string><json:string>intraoperative lymphatic mapping</json:string><json:string>preoperative</json:string><json:string>melanoma</json:string><json:string>lymphadenectomy</json:string><json:string>obstet</json:string><json:string>sentinel lymph nodes</json:string><json:string>obstet gynecol</json:string><json:string>midline tumors</json:string><json:string>primary tumor</json:string><json:string>sentinel node biopsy</json:string><json:string>preoperative lymphoscintigraphy</json:string><json:string>lymphatic mapping</json:string><json:string>inguinal</json:string><json:string>gynecologic</json:string><json:string>lateral</json:string><json:string>lymphatic drainage</json:string><json:string>groin dissections</json:string><json:string>lymph</json:string><json:string>groin</json:string><json:string>excisional biopsy</json:string><json:string>mapping procedure</json:string><json:string>lateral tumors</json:string><json:string>biopsy</json:string><json:string>carcinoma</json:string><json:string>gynecologic oncologists</json:string><json:string>gynecol oncol</json:string><json:string>midline lesions</json:string><json:string>lymph nodes</json:string><json:string>breast cancer</json:string><json:string>ambiguous lymphatic drainage</json:string><json:string>afferent lymphatic channel</json:string><json:string>intraoperative lymphoscintigraphy</json:string><json:string>lateral lesions</json:string><json:string>vivo studies</json:string><json:string>positive nodes</json:string><json:string>groin dissection</json:string><json:string>metastatic disease</json:string><json:string>sentinel lymph node</json:string></teeft></keywords><author><json:item><name>Charles Levenback M.D.</name><affiliations><json:string>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</json:string></affiliations></json:item><json:item><name>Robert L. Coleman M.D.</name><affiliations><json:string>The University of Texas Southwestern Medical Center, Dallas, Texas, 75390</json:string></affiliations></json:item><json:item><name>Thomas W. Burke M.D.</name><affiliations><json:string>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</json:string></affiliations></json:item><json:item><name>Diane Bodurka-Bevers M.D.</name><affiliations><json:string>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</json:string></affiliations></json:item><json:item><name>Judith K. Wolf M.D.</name><affiliations><json:string>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</json:string></affiliations></json:item><json:item><name>David M. Gershenson M.D.</name><affiliations><json:string>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</json:string></affiliations></json:item></author><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Objective. To determine the effectiveness of intraoperative lymphatic with blue dye alone as a means of localizing sentinel nodes in patients with vulvar cancer. Methods. All patients undergoing primary surgical treatment for vulvar cancer were eligible for this prospective study. Isosulfan blue dye was injected intradermally at the edge of the primary tumor closest to the adjacent groin. Bilateral dye injections and groin dissections were performed if the tumor was within 2 cm of the midline. Results. Fifty-two patients were enrolled in the study between 1993 and 1999. The median age was 58 years. Eighty-seven percent of the patients had T1 or T2 lesions, and 92% had nonsuspicious lymph nodes on palpation. Sixty-seven percent of the patients had squamous cell carcinoma; the remaining patients had melanoma or adenocarcinoma. The sentinel node was identified in 46 of the 52 patients (88%), comprising 22 of the 25 patients with lateral tumors and 24 of the 27 patients with midline lesions. The sentinel node was successfully identified in 57 of the 76 (75%) dissected groins. Sentinel node identification in the groin was hampered by the effects of prior excisional biopsy vs punch biopsy (11 of 25 vs 8 of 51, P = 0.007) and by the lateral vs midline location of the tumor (22 of 25 groins vs 35 of 51 groins, P = 0.067). During the first 2 years (1993–1994), a sentinel node could not be identified in 4 of the 25 (16%) patients and 13 of the 36 (36%) groins dissected, compared with 2 of the 27 (7%) of patients treated and 6 of the 40 (15%) groins dissected from 1995 through 1999 (P = 0.034). A total of 556 nodes were removed (median, 7 per groin), of which 83 (median, 1 per groin) were sentinel. The sentinel node was not identified in 2 of the 12 groins that proved to have metastatic disease. Both events occurred in the first 2 years of the study. There were no false-negative sentinel nodes. Since 1995, we have successfully identified the sentinel node in 16 of the 16 patients (25 of 25 groins) with T1 or T2 primary lesions, squamous histology, and nonsuspicious groin nodes on physical examination. Conclusions. Experience and careful patient selection can permit sentinel node identification with blue dye injection alone in more than 95% of patients with vulvar cancer.</abstract><qualityIndicators><score>7.31</score><pdfVersion>1.3</pdfVersion><pdfPageSize>549 x 739 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>2300</abstractCharCount><pdfWordCount>4310</pdfWordCount><pdfCharCount>26223</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>389</abstractWordCount></qualityIndicators><title>Intraoperative Lymphatic Mapping and Sentinel Node Identification with Blue Dye in Patients with Vulvar Cancer</title><pii><json:string>S0090-8258(01)96374-7</json:string></pii><genre><json:string>research-article</json:string></genre><host><title>Gynecologic Oncology</title><language><json:string>unknown</json:string></language><publicationDate>2001</publicationDate><issn><json:string>0090-8258</json:string></issn><pii><json:string>S0090-8258(00)X0004-2</json:string></pii><volume>83</volume><issue>2</issue><pages><first>276</first><last>281</last></pages><genre><json:string>journal</json:string></genre></host><categories><wos><json:string>science</json:string><json:string>oncology</json:string><json:string>obstetrics & gynecology</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>oncology & carcinogenesis</json:string></scienceMetrix><inist><json:string>sciences appliquees, technologies et medecines</json:string><json:string>sciences biologiques et medicales</json:string><json:string>sciences medicales</json:string></inist></categories><publicationDate>2001</publicationDate><copyrightDate>2001</copyrightDate><doi><json:string>10.1006/gyno.2001.6374</json:string></doi><id>291607900C9334C84E782025C9CC74A5D7F96E5F</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/291607900C9334C84E782025C9CC74A5D7F96E5F/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/291607900C9334C84E782025C9CC74A5D7F96E5F/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/291607900C9334C84E782025C9CC74A5D7F96E5F/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Intraoperative Lymphatic Mapping and Sentinel Node Identification with Blue Dye in Patients with Vulvar Cancer</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>©2001 Academic Press</p></availability><date>2001</date></publicationStmt><notesStmt><note type="content">Section title: Regular Article</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Intraoperative Lymphatic Mapping and Sentinel Node Identification with Blue Dye in Patients with Vulvar Cancer</title><author xml:id="author-0000"><persName><forename type="first">Charles</forename><surname>Levenback</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Robert L.</forename><surname>Coleman</surname></persName><roleName type="degree">M.D.</roleName><affiliation>The University of Texas Southwestern Medical Center, Dallas, Texas, 75390</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Thomas W.</forename><surname>Burke</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Diane</forename><surname>Bodurka-Bevers</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Judith K.</forename><surname>Wolf</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</affiliation></author><author xml:id="author-0005"><persName><forename type="first">David M.</forename><surname>Gershenson</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</affiliation></author><idno type="istex">291607900C9334C84E782025C9CC74A5D7F96E5F</idno><idno type="DOI">10.1006/gyno.2001.6374</idno><idno type="PII">S0090-8258(01)96374-7</idno></analytic><monogr><title level="j">Gynecologic Oncology</title><title level="j" type="abbrev">YGYNO</title><idno type="pISSN">0090-8258</idno><idno type="PII">S0090-8258(00)X0004-2</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="2001"></date><biblScope unit="volume">83</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="276">276</biblScope><biblScope unit="page" to="281">281</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2001</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Objective. To determine the effectiveness of intraoperative lymphatic with blue dye alone as a means of localizing sentinel nodes in patients with vulvar cancer. Methods. All patients undergoing primary surgical treatment for vulvar cancer were eligible for this prospective study. Isosulfan blue dye was injected intradermally at the edge of the primary tumor closest to the adjacent groin. Bilateral dye injections and groin dissections were performed if the tumor was within 2 cm of the midline. Results. Fifty-two patients were enrolled in the study between 1993 and 1999. The median age was 58 years. Eighty-seven percent of the patients had T1 or T2 lesions, and 92% had nonsuspicious lymph nodes on palpation. Sixty-seven percent of the patients had squamous cell carcinoma; the remaining patients had melanoma or adenocarcinoma. The sentinel node was identified in 46 of the 52 patients (88%), comprising 22 of the 25 patients with lateral tumors and 24 of the 27 patients with midline lesions. The sentinel node was successfully identified in 57 of the 76 (75%) dissected groins. Sentinel node identification in the groin was hampered by the effects of prior excisional biopsy vs punch biopsy (11 of 25 vs 8 of 51, P = 0.007) and by the lateral vs midline location of the tumor (22 of 25 groins vs 35 of 51 groins, P = 0.067). During the first 2 years (1993–1994), a sentinel node could not be identified in 4 of the 25 (16%) patients and 13 of the 36 (36%) groins dissected, compared with 2 of the 27 (7%) of patients treated and 6 of the 40 (15%) groins dissected from 1995 through 1999 (P = 0.034). A total of 556 nodes were removed (median, 7 per groin), of which 83 (median, 1 per groin) were sentinel. The sentinel node was not identified in 2 of the 12 groins that proved to have metastatic disease. Both events occurred in the first 2 years of the study. There were no false-negative sentinel nodes. Since 1995, we have successfully identified the sentinel node in 16 of the 16 patients (25 of 25 groins) with T1 or T2 primary lesions, squamous histology, and nonsuspicious groin nodes on physical examination. Conclusions. Experience and careful patient selection can permit sentinel node identification with blue dye injection alone in more than 95% of patients with vulvar cancer.</p></abstract></profileDesc><revisionDesc><change when="2001">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/291607900C9334C84E782025C9CC74A5D7F96E5F/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: tail"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla" xml:lang="en"><item-info><jid>YGYNO</jid><aid>96374</aid><ce:pii>S0090-8258(01)96374-7</ce:pii><ce:doi>10.1006/gyno.2001.6374</ce:doi><ce:copyright type="full-transfer" year="2001">Academic Press</ce:copyright></item-info><head><ce:dochead><ce:textfn>Regular Article</ce:textfn></ce:dochead><ce:title>Intraoperative Lymphatic Mapping and Sentinel Node Identification with Blue Dye in Patients with Vulvar Cancer</ce:title><ce:author-group><ce:author><ce:given-name>Charles</ce:given-name><ce:surname>Levenback</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="A1"><ce:sup>a</ce:sup></ce:cross-ref><ce:cross-ref refid="FN1"><ce:sup>1</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Robert L.</ce:given-name><ce:surname>Coleman</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="A2"><ce:sup>b</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Thomas W.</ce:given-name><ce:surname>Burke</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="A1"><ce:sup>a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Diane</ce:given-name><ce:surname>Bodurka-Bevers</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="A1"><ce:sup>a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Judith K.</ce:given-name><ce:surname>Wolf</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="A1"><ce:sup>a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>David M.</ce:given-name><ce:surname>Gershenson</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="A1"><ce:sup>a</ce:sup></ce:cross-ref></ce:author><ce:affiliation id="A1"><ce:label>a</ce:label><ce:textfn>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</ce:textfn></ce:affiliation><ce:affiliation id="A2"><ce:label>b</ce:label><ce:textfn>The University of Texas Southwestern Medical Center, Dallas, Texas, 75390</ce:textfn></ce:affiliation><ce:footnote id="FN1"><ce:label>1</ce:label><ce:note-para>To whom correspondence should be addressed at 1515 Holcombe Boulevard, Houston, TX 77030. Fax: (713) 792-7586. E-mail: clevenba@mdanderson.org.</ce:note-para></ce:footnote></ce:author-group><ce:date-received day="16" month="4" year="2001"></ce:date-received><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para><ce:italic>Objective.</ce:italic> To determine the effectiveness of intraoperative lymphatic with blue dye alone as a means of localizing sentinel nodes in patients with vulvar cancer.</ce:simple-para><ce:simple-para><ce:italic>Methods.</ce:italic> All patients undergoing primary surgical treatment for vulvar cancer were eligible for this prospective study. Isosulfan blue dye was injected intradermally at the edge of the primary tumor closest to the adjacent groin. Bilateral dye injections and groin dissections were performed if the tumor was within 2 cm of the midline.</ce:simple-para><ce:simple-para><ce:italic>Results.</ce:italic> Fifty-two patients were enrolled in the study between 1993 and 1999. The median age was 58 years. Eighty-seven percent of the patients had T1 or T2 lesions, and 92% had nonsuspicious lymph nodes on palpation. Sixty-seven percent of the patients had squamous cell carcinoma; the remaining patients had melanoma or adenocarcinoma. The sentinel node was identified in 46 of the 52 patients (88%), comprising 22 of the 25 patients with lateral tumors and 24 of the 27 patients with midline lesions. The sentinel node was successfully identified in 57 of the 76 (75%) dissected groins. Sentinel node identification in the groin was hampered by the effects of prior excisional biopsy vs punch biopsy (11 of 25 vs 8 of 51, <ce:italic>P</ce:italic> = 0.007) and by the lateral vs midline location of the tumor (22 of 25 groins vs 35 of 51 groins, <ce:italic>P</ce:italic> = 0.067). During the first 2 years (1993–1994), a sentinel node could not be identified in 4 of the 25 (16%) patients and 13 of the 36 (36%) groins dissected, compared with 2 of the 27 (7%) of patients treated and 6 of the 40 (15%) groins dissected from 1995 through 1999 (<ce:italic>P</ce:italic> = 0.034). A total of 556 nodes were removed (median, 7 per groin), of which 83 (median, 1 per groin) were sentinel. The sentinel node was not identified in 2 of the 12 groins that proved to have metastatic disease. Both events occurred in the first 2 years of the study. There were no false-negative sentinel nodes. Since 1995, we have successfully identified the sentinel node in 16 of the 16 patients (25 of 25 groins) with T1 or T2 primary lesions, squamous histology, and nonsuspicious groin nodes on physical examination.</ce:simple-para><ce:simple-para><ce:italic>Conclusions.</ce:italic> Experience and careful patient selection can permit sentinel node identification with blue dye injection alone in more than 95% of patients with vulvar cancer.</ce:simple-para></ce:abstract-sec></ce:abstract></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Intraoperative Lymphatic Mapping and Sentinel Node Identification with Blue Dye in Patients with Vulvar Cancer</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Intraoperative Lymphatic Mapping and Sentinel Node Identification with Blue Dye in Patients with Vulvar Cancer</title></titleInfo><name type="personal"><namePart type="given">Charles</namePart><namePart type="family">Levenback</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</affiliation><description>To whom correspondence should be addressed at 1515 Holcombe Boulevard, Houston, TX 77030. Fax: (713) 792-7586. E-mail: clevenba@mdanderson.org.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Robert L.</namePart><namePart type="family">Coleman</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>The University of Texas Southwestern Medical Center, Dallas, Texas, 75390</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Thomas W.</namePart><namePart type="family">Burke</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Diane</namePart><namePart type="family">Bodurka-Bevers</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Judith K.</namePart><namePart type="family">Wolf</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">David M.</namePart><namePart type="family">Gershenson</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">2001</dateIssued><copyrightDate encoding="w3cdtf">2001</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Objective. To determine the effectiveness of intraoperative lymphatic with blue dye alone as a means of localizing sentinel nodes in patients with vulvar cancer. Methods. All patients undergoing primary surgical treatment for vulvar cancer were eligible for this prospective study. Isosulfan blue dye was injected intradermally at the edge of the primary tumor closest to the adjacent groin. Bilateral dye injections and groin dissections were performed if the tumor was within 2 cm of the midline. Results. Fifty-two patients were enrolled in the study between 1993 and 1999. The median age was 58 years. Eighty-seven percent of the patients had T1 or T2 lesions, and 92% had nonsuspicious lymph nodes on palpation. Sixty-seven percent of the patients had squamous cell carcinoma; the remaining patients had melanoma or adenocarcinoma. The sentinel node was identified in 46 of the 52 patients (88%), comprising 22 of the 25 patients with lateral tumors and 24 of the 27 patients with midline lesions. The sentinel node was successfully identified in 57 of the 76 (75%) dissected groins. Sentinel node identification in the groin was hampered by the effects of prior excisional biopsy vs punch biopsy (11 of 25 vs 8 of 51, P = 0.007) and by the lateral vs midline location of the tumor (22 of 25 groins vs 35 of 51 groins, P = 0.067). During the first 2 years (1993–1994), a sentinel node could not be identified in 4 of the 25 (16%) patients and 13 of the 36 (36%) groins dissected, compared with 2 of the 27 (7%) of patients treated and 6 of the 40 (15%) groins dissected from 1995 through 1999 (P = 0.034). A total of 556 nodes were removed (median, 7 per groin), of which 83 (median, 1 per groin) were sentinel. The sentinel node was not identified in 2 of the 12 groins that proved to have metastatic disease. Both events occurred in the first 2 years of the study. There were no false-negative sentinel nodes. Since 1995, we have successfully identified the sentinel node in 16 of the 16 patients (25 of 25 groins) with T1 or T2 primary lesions, squamous histology, and nonsuspicious groin nodes on physical examination. Conclusions. Experience and careful patient selection can permit sentinel node identification with blue dye injection alone in more than 95% of patients with vulvar cancer.</abstract><note type="content">Section title: Regular Article</note><relatedItem type="host"><titleInfo><title>Gynecologic Oncology</title></titleInfo><titleInfo type="abbreviated"><title>YGYNO</title></titleInfo><genre type="journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">200111</dateIssued></originInfo><identifier type="ISSN">0090-8258</identifier><identifier type="PII">S0090-8258(00)X0004-2</identifier><part><date>200111</date><detail type="volume"><number>83</number><caption>vol.</caption></detail><detail type="issue"><number>2</number><caption>no.</caption></detail><extent unit="issue pages"><start>175</start><end>448</end></extent><extent unit="pages"><start>276</start><end>281</end></extent></part></relatedItem><identifier type="istex">291607900C9334C84E782025C9CC74A5D7F96E5F</identifier><identifier type="DOI">10.1006/gyno.2001.6374</identifier><identifier type="PII">S0090-8258(01)96374-7</identifier><accessCondition type="use and reproduction" contentType="copyright">©2001 Academic Press</accessCondition><recordInfo><recordContentSource>ELSEVIER</recordContentSource><recordOrigin>Academic Press, ©2001</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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