Lymphoscintigraphy and sentinel lymph node biopsy in vulvar carcinoma: update from a European expert panel

Abstract

Purpose This study aimed to update the clinical practice applications and technical procedures of sentinel lymph node (SLN) biopsy in vulvar cancer from European experts. Methods A systematic data search using PubMed/MEDLINE database was performed up to May 29, 2019. Only original studies focused on SLN biopsy in vulvar cancer, published in the English language and with a minimum of nine patients were selected. Results Among 280 citations, 65 studies fulfilled the inclusion criteria. On the basis of the published evidences and consensus of European experts, this study provides an updated overview on clinical applications and technical procedures of SLN biopsy in vulvar cancer. Conclusions SLN biopsy is nowadays the standard treatment for well-selected women with clinically negative lymph nodes. Negative SLN is associated with a low groin recurrence rate and a good 5-year disease-specific survival rate. SLN biopsy is the most cost-effective approach than lymphadenectomy in early-stage vulvar cancer. However, future trials should focus on the safe extension of the indication of SLN biopsy in vulvar cancer. Although radiotracers and optical agents are widely used in the clinical routine, there is an increasing interest for hybrid tracers like indocyanine-99m Tc-nanocolloid. Finally, it is essential to standardise the acquisition protocol including SPECT/CT images, and due to the low incidence of this type of malignancy to centralise this procedure in experienced centres for personalised approach.This article is part of the Topical Collection on Oncology -Genitourinary.

The potential of contralateral non-sentinel groin node metastasis in women with early primary vulvar cancer following unilateral sentinel node metastasis: a single center evaluation in University Hospital of Düsseldorf

“…The latest European expert panel recommends that SLN detection could be improved by use of indocyanine green (ICG) and additional application of SPECT/CT imaging can reduce the false negative results. 18 It is also worth noting that the recurrence rate of metastasis was 2.7% with SLNB and 1.4% with IFL. 8,17 The survival rate, in the case of isolated groin lesion recurrence, was reported worser in women with primary local VC > 4cm than < 4cm in initial negative SLNs with 9% versus 5% respectively.…”

The potential risk of contralateral non-sentinel groin node metastasis in women with early primary vulvar cancer following unilateral sentinel node metastasis: a single center evaluation in University Hospital of Düsseldorf

“…Secondly, the necessity for IFL remains controversial in the case of positive unilateral SLNB, as to whether it should be done ipsilaterally or bilaterally [1][2][3][4][5][6][7][8]. This is due to the fact that when recurrent groin metastasis occurs, the survival rates of these patients decrease significantly [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][30][31][32][33].The long-term follow-up of GROINSS-V showed that the 10-year diseasespecific survival rates in the cases of local recurrence was reduced from 90.4 to 68.7% and in patients with positive SLNB from 77.7 to 44.6% [10].…”

“…In the GOG-173 study of Levenback et al [17], the false negative rate of SLNB was about 8.3%. The latest European expert panel recommends that SLN detection could be improved by use of indocyanine green (ICG) and additional application of SPECT/CT imaging can reduce the false negative results [18]. It is also worth noting that the recurrence rate of metastasis was 2.7% with SLNB and 1.4% with IFL [8,17].…”

Is it time to include [18F]FDG-PET/CT in the diagnostic work-up for lymph node staging in cN0 vulvar cancer patients?

“…Fig. 1 Flowchart of sentinel node biopsy (SNB) in cN0 vulvar cancer, adapted from the EANM experts panel consensus [11]. Situations where preoperative 18 F-FDG-PET/CT could be useful have been highlighted in blue colour…”

“…Based on the recent consensus of the EANM experts on SLNB in VC [11], one might assume that pre-operative PET could be used in specific situations such as exploration of the contralateral groin in midline tumours unilateral, in case of SLN detected unilaterally, and to expand the use of SLN to patients with larger tumours (Fig. 1).…”