Prediction of lymph node metastases in vulvar cancer: a review

Oonk, Maaike H. M.; Hollema, Harry; Hullu, Joanne A. de; Zee, Ate G.J. van der

doi:10.1111/j.1525-1438.2006.00387.x

Cited by 54 publications

(15 citation statements)

References 80 publications

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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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Section: Discussionmentioning

confidence: 99%

Squamous Cell Vulval Carcinoma and Pregnancy — A Review

Palmer¹,

Vatish²,

Tidy³

2010

European Oncology &Amp; Haematology

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“…In a recent review [5], it was shown that currently available non-invasive diagnostic tests (palpation, ultrasound (with or without FNA cytology), CT, MRI, PET) are not able to exclude inguinofemoral lymph node metastases with a certainty that is high enough to safely omit complete inguinofemoral lymphadenectomy, while the safety of the sentinel node technique is currently being evaluated in phase II studies [6][7][8]. Studies on different histopathogical parameters of the primary vulvar tumor showed a very low (< 1%) risk for inguinofemoral metastases in tumors with a depth of invasion less than 1 mm [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

EGFR expression is associated with groin node metastases in vulvar cancer, but does not improve their prediction

Oonk

Bock²,

Veen

et al. 2007

Gynecologic Oncology

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Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. AbstractObjectives. High morbidity of elective inguinofemoral lymphadenectomy in early stage vulvar cancer patients urges the need for defining a group of low-risk patients in whom inguinofemoral lymphadenectomy can be safely omitted. Aim of the study was to evaluate whether in addition to 'classic' clinicopathological factors determination of EGFR expression in vulvar cancer can be helpful in defining such a 'low-risk' group.Methods. Formalin-fixed paraffin-embedded tumor tissue samples of 197 surgically treated T1/2 patients were collected in a Tissue Micro Array (TMA). On this TMA, immunohistochemistry for EGFR was performed. Logistic regression analyses were performed including histopathological characteristics with the presence of nodal metastases as outcome. A predictive model was constructed, and absolute risks were calculated.Results. EGFR expression was present in 68% of the vulvar tumors and related to the presence of lymph node metastases (OR 2.12, 95% CI 1.09-4.10). Our predictive model with only clinicopathological factors was able to define a group of patients with a likelihood of absence of lymph node metastases of 13% (95% CI 5-36), which could be decreased to 6% (95% CI 0-29) after inclusion of EGFR expression (p = 0.07).Conclusions. EGFR expression is present in the majority of vulvar tumors and is associated with groin node metastases in vulvar cancer. Current classic clinicopathological predictive factors for inguinofemoral lymph node metastases with or without EGFR analysis are not strong enough for identification of "sufficiently low" risk T1/2 vulvar cancer patients. Our predictive model approach however is excellent for evaluation of new cell biological parameters, associated with clinical outcome.

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“…A considerable overtreatment of patients with non-metastatic tumours has been discussed,10 – 12 and with concern to the postoperative sequela and mutilation associated with radical surgery, new tumour markers that could serve as prognostic indicators would be of considerable value to guide treatment decisions. The purpose of this review is to provide a brief summary of some of the molecular pathological markers studied in vulvar squamous cell carcinoma (VSCC) and address their impact as prognostic markers.…”

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confidence: 99%

A review of molecular pathological markers in vulvar carcinoma: lack of application in clinical practice: Table 1

et al. 2009

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Vulvar carcinoma is a rare female genital neoplasia. Radical surgery, which has been the standard treatment approach, is often accompanied by considerable morbidity. To reduce the incidence of complications there has been a movement toward individualised therapy and less radical surgery. Associated with this, new tumour markers that could serve as prognostic indicators would be of considerable value to guide treatment decision. In this review, a brief update of molecular pathological markers of vulvar carcinomas is provided, and their impact as prognostic markers is addressed. p16, p21, p14, p27, cyclin A, cyclin D1, p53, vascular endothelial growth factor (VEGF), transforming growth factor alpha, HER-2 and epidermal growth factor receptor (EGFR) have been found to be important in the pathogenesis and/or progression of vulvar carcinomas. Furthermore, human papillomavirus, p16, p21, p14, p53, VEGF, CD44v3, CD44v6, CD44v4, CD44v9, CD44v10, HER-2, EGFR, matrix metalloproteinase-12, caspase 3, Bcl-2 and nm23-H1 have been correlated to clinical outcome of patients with vulvar carcinomas. However, due to the relative small number of studies reported for each molecular pathological marker, and the relative small number of vulvar carcinomas included and the lack of multivariate analysis in the majority of these studies, no conclusion regarding the prognostic value of these markers can be drawn. Therefore, the investigated markers have not yet earned a place in standard clinical diagnostics or treatment, and further studies are needed to clarify the clinical value of these markers.

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Prediction of lymph node metastases in vulvar cancer: a review

Cited by 54 publications

References 80 publications

Squamous Cell Vulval Carcinoma and Pregnancy — A Review

Squamous Cell Vulval Carcinoma and Pregnancy — A Review

EGFR expression is associated with groin node metastases in vulvar cancer, but does not improve their prediction

A review of molecular pathological markers in vulvar carcinoma: lack of application in clinical practice: Table 1

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