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Fluorescein Mapping in Vulvar Paget Disease.
Matthew K Wagar1, Ran Catherine Zhang, Paul Weisman
1Division of Gynecologic Oncology and the Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Obstetrics and Gynecology
|February 3, 2023
Summary
Fluorescein mapping before vulvar Paget disease surgery helps identify hidden lesions. This technique ensures complete tumor removal, preventing recurrence in patients undergoing staged vulvectomy.
Area of Science:
- Gynecologic Oncology
- Surgical Pathology
- Dermatology
Background:
- Vulvar Paget disease (VPD) frequently necessitates extensive surgical resection.
- Identifying the full extent of VPD, including occult lesions, is crucial for effective treatment and preventing recurrence.
Purpose of the Study:
- To evaluate the efficacy of a fluorescein-guided, staged surgical approach for treating vulvar Paget disease.
- To determine if fluorescein mapping can improve the accuracy of tumor resection and reduce recurrence rates.
Main Methods:
- A two-step procedure involving intravenous fluorescein sodium injection and Wood's lamp visualization.
- Mapping biopsies guided by fluorescein fluorescence to delineate disease extent.
- Staged vulvectomy performed based on mapping biopsy results and final pathology.
Main Results:
- Fluorescein sodium identified vulvar Paget disease beyond gross lesion margins in all eight patients.
- No recurrences were observed at a median follow-up of 32 months.
- The technique demonstrated high safety and a favorable cost profile.
Conclusions:
- Fluorescein mapping is an effective technique for visualizing vulvar Paget disease, including occult satellite lesions.
- This staged surgical approach offers improved accuracy in resection, potentially reducing recurrence.
- The method provides accurate surgical margins with a high degree of safety.
