Sentinel lymph node in vulvar cancer

Abstract

BACKGROUND. The aim of the study was to assess the feasibility, efficacy, and accuracy of the sentinel lymph node (SLN) procedure in vulvar cancer. METHODS. From April 2004 to September 2006, all patients with vulvar cancer, clinical stages I and II, underwent SLN detection, followed by a complete inguinofemoral lymphadenectomy. Demographic, surgical, and pathologic data on all patients were prospectively entered in a database. RESULTS. Forty‐two patients underwent the SLN procedure. One patient was excluded from further analysis due to metastases to the vulva. The detection rate for at least 1 SLN per patient was 95%, with bilateral SLNs detected in 46% of patients. There was a trend toward improved ability to detect bilateral SLNs and proximity of the cancer to the midline (r = 0.996; P = .057). No contralateral SLNs were identified in patients with lateral vulvar lesions (>1 cm from the midline). For ‘close‐to‐midline’ (≤1 cm from the midline) lesions, SLNs were detected in 93% of ipsilateral groins and bilateral SLNs were found in 46% of patients, whereas lesions abutting the midline had unilateral and bilateral SLN detected in 100% and 93%, respectively. Sixteen of 41 patients (39%) and 18 of 68 groins (26%) revealed metastatic disease in the lymph nodes; all were correctly identified by the SLN procedure. There were no false‐negative SLN results. CONCLUSIONS. SLN dissection is feasible and safe to perform in vulvar cancer. The ability to identify bilateral sentinel inguinal lymph nodes appears to be related to the proximity of the vulvar cancer to the midline. Cancer 2007. © 2007 American Cancer Society.

Reply to Sentinel Lymph Node in Vulvar Cancer

“…1 We do agree with Dr. Mahajan that the sentinel lymph node procedure can add a significant cost to the treatment. This increase in cost is both due to the injection of radioactive colloid and the subsequent invol-2008 American Cancer Society vement of nuclear imaging, the equipment (gamma probe), and the added workload created for the pathology department to process and review the sentinel lymph nodes according to the protocol mentioned in our article.…”

“…read with great interest the article published in the journal by Hauspy and colleagues, 1 and I agree that the sentinel lymph node (SLN) procedure is safe for patients with vulvar cancer and should reduce morbidity compared with full inguinofemoral dissection. Now, with those authors' results, we can perform the selective removal of SLNs in patients with clinical stage T1 and T2 vulvar cancer (International Federation of Gynecology and Obstetrics staging) if they have a positive SLN by using a combination of technetium sulfur colloid and/or lymphazurin instead of complete inguinofemoral lymphadenectomy, thereby reducing resultant complications.…”

“…This increase in cost is both due to the injection of radioactive colloid and the subsequent invol-2008 American Cancer Society vement of nuclear imaging, the equipment (gamma probe), and the added workload created for the pathology department to process and review the sentinel lymph nodes according to the protocol mentioned in our article. 1 The needs and issues regarding healthcare in developing countries are vastly different from developed countries. In the former, delivery of basic needs is an issue.…”

A comparison of quality of life between vulvar cancer patients after sentinel lymph node procedure only and inguinofemoral lymphadenectomy

“…In the other 65-75% this intervention will (in retrospect) probably be only diagnostic. In order to reduce morbidity the sentinel lymph node (SLN) procedure was introduced in vulvar cancer treatment with promising results in different accuracy-studies [3][4][5][6][7][8][9][10]. Its safety has recently been shown in the Groningen International Study on Sentinel Nodes in Vulvar cancer (GROINSS-V) with a false negative rate of 2.8% in patients with unifocal early stage disease [11].…”

Sentinel lymph node in vulvar cancer

“…I read with great interest the article published in the journal by Hauspy and colleagues, 1 and I agree that the sentinel lymph node (SLN) procedure is safe for patients with vulvar cancer and should reduce morbidity compared with full inguinofemoral dissection. Now, with those authors' results, we can perform the selective removal of SLNs in patients with clinical stage T1 and T2 vulvar cancer (International Federation of Gynecology and Obstetrics staging) if they have a positive SLN by using a combination of technetium sulfur colloid and/or lymphazurin instead of complete inguinofemoral lymphadenectomy, thereby reducing resultant complications.…”