Background
Vulvar cancer accounts for only 4% of gynaecological malignancies, predominantly affecting the post-menopausal population. However it can affect pre-menopausal women of childbearing age, with case reports in pregnant women. Sentinel node biopsy is the standard of care for early vulval tumours, usually with a combination of radioisotope and blue dye. The use of radioisotopes is not common in pregnancy and women may be reticent due to perceived risks to the fetus. The risk with technetium is small due to the half-life and distance from the fetus, however caution is required with blue dye injection due to the risk of anaphylaxis.
Case
We present a case of 30 year old woman in her first pregnancy diagnosed with FIGO stage IB vulvar squamous cell carcinoma during early pregnancy. She subsequently underwent radical wide local excision and sentinel lymph node biopsy at 18 weeks' gestation under general anaesthetic, with injection of techetium-99m intradermal injections and scintigraphy two hours pre-operatively. Injection of blue dye was omitted due to the risk of anaphylaxis. The sentinel lymph was identified intra-operatively with the gamma probe, and removed. Surgery was uncomplicated, and she delivered her baby by spontaneous vaginal birth at term, with no maternal or fetal adverse effects.
Conclusion
Surgical management including sentinel lymph node biopsy can be utilised safely in pregnant patients with vulvar cancer using technetium, in accordance with recommendations for the general, non-pregnant population. However, due to the risk of anaphylaxis to blue dye, our standard technique was modified.