Update on sentinel lymph node biopsy for early-stage vulvar cancer

Slomovitz, Brian M.; Coleman, Robert L.; Oonk, Maaike H. M.; Zee, Ate van der; Levenback, Charles

doi:10.1016/j.ygyno.2015.05.017

Cited by 38 publications

(27 citation statements)

References 30 publications

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“…6 Subsequent meta-analyses and a Cochrane review in 2014 have indicated similar safety and efficacy and recommended its use for early-stage tumors. 7-10 …”

Section: Discussionmentioning

confidence: 99%

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Utilization and Outcomes of Sentinel Lymph Node Biopsy for Vulvar Cancer

Cham

Chen

Burke

et al. 2016

Obstetrics &Amp; Gynecology

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Objective To examine the use and predictors of sentinel node biopsy in women with vulvar cancer. Methods The Perspective database, an all-payer database that collects data from over 500 hospitals, was used to perform a retrospective cohort study of women with vulvar cancer who underwent vulvectomy and lymph node assessment from 2006 to 2015. Multivariable models were used to determine factors associated with sentinel node biopsy. Length of stay and cost were compared between women who underwent sentinel node biopsy and lymphadenectomy. Results Among 2,273 women, sentinel node biopsy was utilized in 618 (27.2%), while 1655 (72.8%) underwent inguinofemoral lymphadenectomy. Performance of sentinel node biopsy increased from 17.0% (95% CI, 12.0-22.0%) in 2006 to 39.1% (95% CI, 27.1-51.0%) in 2015. In a multivariable model, women treated more recently were more likely to undergo sentinel node biopsy while women with more comorbidities and those treated at rural hospitals were less likely to undergo the procedure. The median length of stay was shorter for those undergoing sentinel node biopsy (median 2 days; IQR 1-3) compared to women who underwent inguinofemoral lymphadenectomy (median 3 days, IQR 2-4). The cost of sentinel node biopsy was $7599 (IQR, $5739-$9922) versus $8095 (IQR, $5917-$11,281) for lymphadenectomy. Conclusion The use of sentinel node biopsy for vulvar cancer has more than doubled since 2006. Sentinel lymph node biopsy is associated with a shorter hospital stay and decreased cost compared to inguinofemoral lymphadenectomy.

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“…6 Subsequent meta-analyses and a Cochrane review in 2014 have indicated similar safety and efficacy and recommended its use for early-stage tumors. 7-10 …”

Section: Discussionmentioning

confidence: 99%

“…Several prospective trials and systematic reviews have suggested that sentinel node biopsy is associated with a high sensitivity and low false negative rate for the detection of metastatic disease. 4-10 In a Cochrane review of the procedure, the pooled sensitivity was 91-95% depending on the modality of sentinel node detection. 7 …”

Section: Introductionmentioning

confidence: 99%

Utilization and Outcomes of Sentinel Lymph Node Biopsy for Vulvar Cancer

Cham

Chen

Burke

et al. 2016

Obstetrics &Amp; Gynecology

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“…Sentinel node mapping for early‐stage vulvar cancer now represents the standard of care for selected patients with this disease . Candidates for SLN mapping in cases of vulvar cancer include patients with negative clinical groin examination and imaging, a primary unifocal vulvar tumour <4 cm and no previous vulvar surgery that may have altered the lymphatic flow to the inguinal region .…”

Section: Vulvamentioning

confidence: 99%

“…This technique should be performed by a high‐volume surgeon, as it has been demonstrated that there is a direct correlation between surgeon experience and sentinel node detection . The sensitivity of SLN detection is increased when both radiocolloid and dye are used . The most frequently used radiocolloid is technetium‐99msulphur colloid, which is usually injected into the vulvar tumour 2–4 h prior to the vulvar surgical procedure and LN retrieval …”

Section: Vulvamentioning

confidence: 99%

Gynaecological malignancies and sentinel lymph node mapping: an update

Euscher

Malpica

2019

Histopathology

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Assessment of pelvic, para‐aortic or inguinal lymph nodes (LNs) provides not only important prognostic information, but also determines the need for adjuvant treatment. Sentinel lymph node (SLN) biopsy has the potential to provide this prognostic information, while reducing morbidity compared with extended LN dissection. This review discusses the clinical and pathological aspects of SLN biopsy in gynaecological cancer.

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“…If biopsy fails to detect the presence of invasive disease, the therapeutic approach and follow-up schedule may be suboptimal and survival rates will dramatically decrease [7]. By implication, biopsy should be directed—under vulvoscopic guidance—to the area at highest risk of invasion in order to obtain representative specimens for histologic evaluation [8910].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for unrecognized invasive carcinoma in patients with vulvar high-grade squamous intraepithelial lesion at vulvoscopy-directed biopsy

et al. 2017

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ObjectiveTo evaluate the prevalence and risk factors for unrecognized invasive carcinoma in a series of patients undergoing surgical excision after an office biopsy of vulvar high-grade squamous intraepithelial lesion (VHSIL).MethodsTwo hundred and sixteen consecutive patients treated in a tertiary-level referral center for vulvar disease in north-western Italy were recruited. Patients' records were reviewed by trained personnel. Factors showing a statistically significant (p<0.05) association with detection of stromal invasion at excisional surgery in univariate analysis were further examined in a backward stepwise multiple logistic regression model.ResultsThe median patient age was 50 years (range, 19–88). More than 25% patients with VHSIL at biopsy had associated cervical/vaginal intraepithelial neoplasia, and more than 35% had a multifocal lesion. Invasive carcinoma was detected in surgical specimens from 24 patients (11%). The depth of stromal invasion varied between 0.1 mm and 3.0 mm with a median of 0.5 mm. In multivariate analysis, the risk of invasive carcinoma detection was greater for patients in the highest tertile of age (p=0.008), for patients with a lesion ≥20 mm in size (p=0.013) and with clitoral involvement (p<0.001), and for patients presenting with a nodular lesion (p=0.078).ConclusionOur study suggests that patient age, lesion size, clitoral involvement and nodular appearance in patients with VHSIL at vulvoscopy-directed biopsy are independently associated with the risk of unrecognized invasive carcinoma.

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Update on sentinel lymph node biopsy for early-stage vulvar cancer

Cited by 38 publications

References 30 publications

Utilization and Outcomes of Sentinel Lymph Node Biopsy for Vulvar Cancer

Utilization and Outcomes of Sentinel Lymph Node Biopsy for Vulvar Cancer

Gynaecological malignancies and sentinel lymph node mapping: an update

Risk factors for unrecognized invasive carcinoma in patients with vulvar high-grade squamous intraepithelial lesion at vulvoscopy-directed biopsy

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