Trends and Outcomes of Sentinel Lymph Node Biopsy in Early-stage Vulvar Squamous Cell Carcinoma: A Population-based Study

Abstract

Purpose: To compare trends and outcomes between lymphadenectomy and sentinel lymph node biopsy (SLNB) in node-negative early-stage vulvar squamous cell carcinoma (SCC) using a population-based cancer registry.Methods: Patients with vulvar SCC registered on the Surveillance, Epidemiology, and End Results program between 2003 and 2013 were identified. Statistical analysis was performed using Cox regression proportional hazards to calculate hazard ratio (HR) and 95% confidence interval (CI). A 1:1 propensity score matching (PSM) method was performed to minimize selection bias.Results: A total of 1475 patients were identified, including 1346 (91.3%) who received lymphadenectomy and 129 (8.7%) who underwent SLNB. The proportion of patients receiving SLNB increased between 2008 and 2013 compared with the years 2003-2007 (13.9% vs. 3.7%, p < 0.001). Five-year cause-specific survival (CSS) in patients who received lymphadenectomy and SLNB was 91.8% and 92.9%, respectively (p = 0.912), and 5-year overall survival (OS) was 77.5% and 82.5%, respectively (p = 0.403). SLNB was not associated with an decrease in CSS (HR 1.024, 95% CI 0.474-2.213, p = 0.952) or OS (HR 0.874, 95% CI 0.541-1.410, p = 0.581) in univariate and multivariate analyses. A total of 115 pairs were selected by PSM and survival analysis also showed comparable CSS (p = 0.481) and OS (p = 0.545) between lymphadenectomy and SLNB.Conclusions: There is an increasing trend toward SLNB in the treatment of patients with node-negative early-stage vulvar SCC, and survival is comparable between lymphadenectomy and SLNB.

Ultrasound‐guided FNA cytology of groin lymph nodes improves the management of squamous cell carcinoma of the vulva: Results from a comparative cytohistological study

“…Moreover, according to literature data, only 20% to 30% of patients, regardless of disease stage, have lymph node involvement; therefore, an accurate preoperative assessment of suspicious lymph nodes would represent a crucial factor for personalized therapy and the selective choice of patients for surgery with a reduction of unnecessary procedures …”

“…4 Moreover, according to literature data, only 20% to 30% of patients, regardless of disease stage, have lymph node involvement; therefore, an accurate preoperative assessment of suspicious lymph nodes would represent a crucial factor for personalized therapy and the selective choice of patients for surgery with a reduction of unnecessary procedures. 5,6 Nonetheless, diagnostic techniques such as clinical examination, computed tomography, and magnetic resonance imaging have demonstrated low specificity, so that most malignant criteria are still based on size. 7 Actually, the most reliable technique to identify those patients who have lymph node metastases is represented by the sentinel lymph node biopsy procedure, which has become increasingly accepted in the management of vulvar cancer.…”

Prognostic Value of the Number of Removed Lymph Nodes in Vulvar Squamous Cell Carcinoma Patients With Node-Positive Disease: A Population-Based Study

“…Several previous studies have found that in patients with node-negative vulvar SCC, an increased number of removed lymph nodes (RLNs) was significantly associated with better outcomes ( 4 – 8 ). In patients with early-stage vulvar SCC, sentinel lymph node biopsy (SLNB) has been confirmed as safe and feasible ( 9 – 11 ), with no significant difference in clinical outcomes between inguinal-femoral lymphadenectomy and SLNB ( 12 ). Therefore, inguinal–femoral lymphadenectomy may be avoided in patients with early-stage vulvar SCC after careful lymph node assessment.…”