A recent systematic review suggests that indocyanine green (ICG) may be an effective, less invasive option for detecting vulvar cancer, comparable to traditional tracers such as technetium-99m (Tc-99m) and blue dye (BD), according to a study published in the American Journal of Obstetrics & Gynecology.
Vulvar cancer accounts for about 5% of gynecologic malignancies worldwide, making it the fourth most common female reproductive tract cancer. Early detection improves prognosis and increases five-year survival, but conventional complete lymphadenectomy can impair quality of life.
The review analyzed 61 studies—including 59 observational studies and two randomized controlled trials—covering 4,637 women who underwent sentinel lymph node biopsy (SLNB) for vulvar cancer. Researchers compared the detection rates (DRs) of Tc-99m, BD, ICG, and superparamagnetic iron oxide (SPIO).
Key Findings
Combined per-patient DR across all methods: 92%
ICG as a standalone tracer: 86% per-patient DR
Tc-99m: 98% per-patient DR
BD: 82% per-patient DR
Tc-99m + BD: 94% per-patient DR
Tc-99m + ICG: 98% per-patient DR
SPIO: 100% per-patient DR (per-grain DR not available due to small sample size)
Overall, the per-grain detection rate was 84% across methods. Investigators noted that ICG shows potential as an effective, minimally invasive alternative for sentinel lymph node mapping in vulvar cancer.
Clinical Implications
Experts emphasize that vulvar health awareness and early diagnosis remain critical, especially in postmenopausal women. Melissa Mauskar, MD, associate professor at UT Southwestern, highlighted challenges in diagnosis due to overlapping conditions such as genitourinary syndrome of menopause, chronic yeast infections, and irritant dermatitis. She encouraged providers to normalize conversations about vulvar and sexual health to support timely detection and care.
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