A Pilot Study Utilizing Intraoperative Lymphoscintigraphy for Identification of the Sentinel Lymph Nodes in Vulvar Cancer

DeCesare, Steven; Fiorica, James V.; Roberts, William S.; Reintgen, Douglas S.; Arango, Hector; Hoffman, Mitchel S.; Puleo, Chris; Cavanagh, Denis

doi:10.1006/gyno.1997.4798

Cited by 152 publications

(41 citation statements)

References 14 publications

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“…25 However, its role remains investigational in breast cancer. 26 The potential utility of sentinel lymphadenectomy has now been described in several solid neoplasms, including squamous cell cancer of the vulva, [27][28][29] Merkel cell carcinoma, 30 thyroid cancer, 31 and most recently gastrointestinal malignancies. 20 All of these approaches use intraoperative lymphatic techniques to map the lymphatics and identify the SN at the time of surgery.…”

Section: Discussionmentioning

confidence: 99%

Ex Vivo Sentinel Node Mapping in Carcinoma of the Colon and Rectum

Wong

Steineman²,

Calderia³

et al. 2001

Annals of Surgery

125

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ObjectiveIncreasing evidence supports that the sentinel node (SN) is at greatest risk for harboring metastatic disease. This study describes a novel technique to identify the SN in colorectal carcinoma. MethodsWithin 30 minutes of resection, colorectal specimens were injected submucosally with isosulfan blue in four quadrants. Blue lymphatic channels were identified in the mesentery and followed to the blue-stained SN(s), which were then harvested. The specimen was fixed in formalin and subsequently analyzed in the usual fashion. Blue-stained nodes that were negative by hematoxylin and eosin staining were further analyzed by immunohistochemical staining. ResultsDuring a 6-month period, 26 patients with adenocarcinoma of the colon and/or rectum undergoing routine resection were studied. There were 18 men and 8 women ranging in age from 29 to 86 years (median 66). Blue-stained SNs were identified in 24 of 26 specimens. The mean number of SNs identified per patient was 2.8 Ϯ 1.6. Seventy-three SNs were identified from a total of 479 lymph nodes harvested. The mean number of nodes identified per patient was 18.4 Ϯ 7. A total of 67 lymph nodes in 12 patients were identified by hematoxylin and eosin staining to have evidence of metastatic disease. Fourteen (20%) of these nodes in six patients were stained blue. However, with immunohistochemical staining, only one blue node did not have evidence of metastatic tumor in a lymphatic basin with tumor present. Four patients (29%) whose lymphatic basins were negative by hematoxylin and eosin staining were upstaged by immunohistochemical staining of the SN. ConclusionsEx vivo mapping of the colon and rectum is technically feasible and may provide a useful approach to the ultrastaging of colorectal carcinoma.

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Section: Discussionmentioning

confidence: 99%

Ex Vivo Sentinel Node Mapping in Carcinoma of the Colon and Rectum

Wong

Steineman²,

Calderia³

et al. 2001

Annals of Surgery

125

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“…Systematic review suggests that computerised tomography (CT), ultrasound, magnetic resonance imaging (MRI), positron emission tomography (PET) and fine-needle biopsy show inconsistent results and are not accurate enough for the routine assessment of groin node status. 61 Sentinel node identification is currently the most promising diagnostic tool for the assessment of lymph node status in vulval carcinoma, [62][63][64][65][66] but its safety is still to be proven. 58 Clearly in pregnancy…”

Section: Discussionmentioning

confidence: 99%

Squamous Cell Vulval Carcinoma and Pregnancy — A Review

Palmer¹,

Vatish²,

Tidy³

2010

European Oncology &Amp; Haematology

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Carcinoma of the vulva accounts for 4% of all female genital tract malignancies. 1 The incidence in the UK is two per 100,000 female population. 2 Vulval cancer is rare in young women with rates of more than one per 100,000 among women aged 25-44 years in the UK. 2 In the US, 15% of vulval cancers are reported to occur in women <50 years of age. 3,4 Prior studies have reported an incidence of 3.3% in women <35 years old, 5 2.3% in women <40 years old and 6.1%in women <45 years old. 6In recent years, an increased incidence of vulval cancer in younger women has been observed. Reports of either vulval carcinoma presenting during pregnancy, 25,[27][28][29] or of pregnancy following treatment for vulval cancer, are rare [29][30][31] because the majority of women with the condition are perimenopausal with completed families, post-menopausal or rendered infertile or of reduced fertility following treatment with radiotherapy and chemotherapy. 31 With the increasing incidence of HPV, VIN and HIV, and a concomitant increase in the incidence of vulval carcinoma in younger women, we are progressively more likely to encounter patients with either vulval carcinoma in pregnancy or pregnancy following treatment for vulval cancer. Given the paucity of available information to assist in managing these patients, and the increased likelihood of seeing this condition, a review of the management strategies in squamous cell vulval cancer associated with pregnancy is timely. MethodWe performed a computerised search (MEDLINE ® /embase ® ) to Squamous Cell Vulval Carcinoma and Pregnancy -A Review AbstractMaternal vulval carcinoma and pregnancy following vulval cancer are rare. However, vulval carcinoma in younger women is increasing, thus we are progressively more likely to encounter patients with either vulval carcinoma in pregnancy, or pregnancy following treatment for vulval cancer. Given the paucity of available information we performed a literature review considering the strategies employed in the management of these women. A computerised search (MEDLINE ® /embase ® ) was performed to identify all registered articles pertaining to squamous cell vulval carcinoma diagnosed or treated in pregnancy, and all cases of pregnancy following treatment for vulval cancer. In addition, cross-references of all selected articles were checked. Twenty-four reports were identified in the literature. In total, 21 cases of vulval carcinoma in pregnancy and 13 cases of pregnancy following vulval cancer were considered. Reports in the literature of vulval cancer associated with pregnancy span a time period of over 65 years making the production of definitive guidelines problematic as significant changes in the management of vulval cancer and changes in obstetrical and neonatal care need to be accounted for. Longer-term maternal and neonatal outcomes are also difficult to substantiate. Centralised data collection would be beneficial in these rare tumours, and in other malignant tumours diagnosed and treated during pregnancy. KeywordsVulval/vulvar carcin...

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“…77 To reduce morbidity, attempts have been made to limit surgery to superficial inguinal resection; however, deep inguinal or femoral node metastases may be present in patients with negative superficial nodes, and recurrences are relatively frequent after superficial node dissection. 78 Attempts at lymphatic mapping with isosulfan blue dye, 79 radioisotope, 80 and both 77,81 have proven moderately successful in identifying SLNs, and preliminary studies have had very low false-negative rates for metastases.…”

Section: Gynecologic Cancersmentioning

confidence: 98%

The place of lymphatic mapping and sentinel node biopsy in oncology

Cochran

Roberts

Saida

2003

International Journal of Clinical Oncology

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The techniques of sentinel lymphatic mapping (LM) and sentinel lymph node biopsy (SLNB) have become almost routine for the staging of clinically node-negative patients with high-risk cutaneous melanoma. The techniques are also widely applied to staging of the axilla in breast cancer. Investigations of the use of LM and SLNB for other solid malignancies have also shown promise. LM/SLNB requires a multidisciplinary effort involving experienced surgeons, nuclear medicine physicians, and surgical pathologists. The techniques require a learning curve for all involved personnel, requiring experience with at least 30 cases followed by complete nodal dissection after SLNB to achieve full competency. Surgical pathologists play a pivotal role in determining optimum sentinel node analysis. The techniques have lower morbidity and greater accuracy than traditional complete regional node dissection. Pathologists are receiving increasing numbers of SLN specimens and are expected to evaluate the results of the application of the LM/SLNB techniques to a range of solid tumors. We have reviewed LM/SLNB in regard to melanoma and breast cancer and other types of malignancies. The techniques have much to offer, but despite their seeming simplicity, need considerable technical skill and clinical judgment if they are to be effectively applied. They also provide unique opportunities for basic and translational research.

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A Pilot Study Utilizing Intraoperative Lymphoscintigraphy for Identification of the Sentinel Lymph Nodes in Vulvar Cancer

Cited by 152 publications

References 14 publications

Ex Vivo Sentinel Node Mapping in Carcinoma of the Colon and Rectum

Ex Vivo Sentinel Node Mapping in Carcinoma of the Colon and Rectum

Squamous Cell Vulval Carcinoma and Pregnancy — A Review

The place of lymphatic mapping and sentinel node biopsy in oncology

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