European Radiology

, Volume 28, Issue 5, pp 2089–2095 | Cite as

Preoperative sentinel lymph node localization in vulvar cancer: preliminary experience with inguinal intradermal contrast-enhanced ultrasound

  • O. Lahtinen
  • M. Eloranta
  • M. Anttila
  • H. Kärkkäinen
  • R. Sironen
  • R. Vanninen
  • S. Rautiainen



To evaluate the feasibility and diagnostic performance of intradermal contrast-enhanced ultrasound (CEUS) sentinel lymph node (SLN) procedure in vulvar cancer.


Twelve consecutive patients with vulvar cancer underwent preoperatively inguinal CEUS SLN examination and guide wire marking of the enhanced lymph nodes. Altogether, 20 groins were examined with CEUS contrast agent injections including 8 bilateral groins due to midline tumours. One groin was excluded due to previous inguinal surgery. The results of the CEUS examinations were compared to conventional SLN biopsy using radiocolloid scintigraphy and/or methylene blue dye and final postoperative histopathology.


The inguinal sentinel CEUS procedure had a technical success rate of 94.7% (18/19 injections) for identifying a potential inguinal SLN. Conventional SLN biopsy using lymphoscintigraphy and/or methylene blue dye was successfully performed in 16 groins. Compared to conventional SLN biopsy, the overall sensitivity was 81.2% (13/16 injections). Additionally, CEUS detected enhancing SLNs in two cases when traditional SLN procedure failed to do so. All metastatic SLNs (n = 5) were correctly identified by CEUS procedure.


Intradermal CEUS SLN localization can be applied in the inguinal lymphatic region in patients with vulvar cancer. Further studies are needed to verify the clinical value of this method.

Key points

• CEUS is a feasible method for inguinal SLN detection in vulvar cancer

• All metastatic inguinal SLNs were identified by CEUS procedure

• Further studies are needed to verify the clinical value of this method


Vulvar cancer Sentinel lymph node Contrast-enhanced ultrasound Inguinal lymph node Guide-wire marking 



Contrast-enhanced ultrasound


Lymph node


Sentinel lymph node


Sentinel lymph node biopsy


Lymph node dissection




European Society of Gynaecological Oncology


Squamocellular carcinoma


Compliance with ethical standards


The scientific guarantor of this publication is Suvi Rautiainen.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.


This study has received funding by Kuopio University Hospital (VTR grant) and the Instrumentarium Science Foundation.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.




performed at one institution

Supplementary material

330_2017_5155_MOESM1_ESM.mpg (1.6 mb)
Video 1. Video clip of the intradermal CEUS sentinel procedure. CEUS demonstrates the afferent lymphatic vessel and partially enhancing SLN with a metastatic deposit as a non-enhancing hypoechoid area (MPG 1640 kb)


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • O. Lahtinen
    • 1
    • 2
  • M. Eloranta
    • 3
    • 4
  • M. Anttila
    • 3
    • 4
    • 5
  • H. Kärkkäinen
    • 3
    • 4
  • R. Sironen
    • 4
    • 6
    • 7
  • R. Vanninen
    • 1
    • 2
  • S. Rautiainen
    • 1
    • 2
  1. 1.Diagnostic Imaging Centre, Department of Clinical RadiologyKuopio University HospitalKuopioFinland
  2. 2.Institute of Clinical Medicine, Unit of RadiologyUniversity of Eastern FinlandKuopioFinland
  3. 3.Department of Gynaecology and ObstetricsKuopio University HospitalKuopioFinland
  4. 4.Cancer Center of Eastern FinlandKuopioFinland
  5. 5.Institute of Clinical Medicine, School of Medicine, GynaecologyUniversity of Eastern FinlandKuopioFinland
  6. 6.Institute of Clinical Medicine/Clinical PathologyUniversity of Eastern FinlandKuopioFinland
  7. 7.Department of Clinical PathologyKuopio University HospitalKuopioFinland

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