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USE OF SONOVUE ‘MICROBUBBLES’ IN DETECTION OF SENTINEL LYMPH NODES IN EARLYSTAGE VULVAR CANCER: RESULTS OF A PILOT STUDY
Nithya Ratnavelu1, Christina Founta1, Ioannis Biliatis1, Peter Bartholomew2, Alan Redman3, Alice
Leaver3, Raj Naik1
1Northern Gynaecological Oncology Centre, Gateshead, UK, 2Department of Nuclear Medicine,
Queen Elizabeth Hospital, Gateshead, UK, 3Deapartment of Breast Screening, Queen Elizabeth
Hospital, Gateshead, UK
Introduction: Sentinel lymph node (SLN) detection has a proven role in the management of vulvar
cancer, avoiding the need for inguinofemoral lymphadenectomy (IFL) and it’s associated morbidity. The
standard combined approach with use of radioactive Technetium99m and patent blue dye confers risks
of radioactivity, anaphylaxis and general anaesthetic.
We present the first study investigating use of SonoVue ‘Microbubbles’ (sulphur hexafluoride) in
detecting SLN.
Method: Women presenting to the Northern Gynaecological Oncology Centre, Gateshead, with earlystage vulvar cancer were recruited to this Clinical Trial of an Investigational Medicinal Product from
January 2012 until present. They received the combined Technetium99m/blue dye technique followed
by 1ml SonoVue peritumourally intraoperatively. The Microbubbles node was marked with a guidewire
prior to excision of the SLNs, followed by IFL. Concordance was studied between nodes identified by
combined approach and those by SonoVue.
Results: Nine women received the SonoVue injection. Median age of women was 65years (38-84).
SLNs were identified by combined approach in all patients, with bilateral SLNs seen in all 3 women with
midline lesions.
SonoVue successfully detected 12 SLNs as identified by gamma probe and blue dye. In all women
SonoVue detected the most radioactive node. Median length of time to detection of first SLN was 8mins
(3-28). No adverse events were reported.
Conclusion: SonoVue ‘Microbubbles’ has proven to be an effective, feasible real-time technique for
detecting SLNs in vulvar cancer. In the future, it is conceivable that SonoVue could aid the identification
and retrieval of SLNs in an outpatient setting, thereby further reducing morbidity.