Radioguided sentinel lymph node detection in vulvar cancer

Abstract

Lymph node status is the most important prognostic factor in vulvar cancer. Histologically, sentinel nodes may be representative of the status of the other regional nodes. Identification and histopathologic evaluation of sentinel nodes could then have a significant impact on clinical management and surgery. The aim of this study was to evaluate the feasibility and diagnostic accuracy of sentinel lymph node detection by preoperative lymphoscintigraphy with technetium-99 m–labeled nanocolloid, followed by radioguided intraoperative detection. Nine patients with stage T1, N0, M0, and 11 patients with stage T2, N0, M0 squamous cell carcinoma of the vulva were included in the study. Only three cases had lesions exceeding 3.5 cm in diameter. Sentinel nodes were detected in 100% of cases. A total of 30 inguinofemoral lymphadenectomies were performed, with a mean of 10 surgically removed nodes. Histological examination revealed 17 true negative sentinel nodes, 2 true positive, and 1 false negative. In our case series, sentinel lymph node detection had a 95% diagnostic accuracy, with only one false negative. Based on literature evidence, the sentinel node procedure is feasible and reliable in vulvar cancer; however, the value of sentinel node dissection in the treatment of early-stage vulvar cancer still needs to be confirmed.

Sentinel lymph node in vulvar cancer

“…Moore et al29 used a combination of technetium and blue dye, without any false‐negative findings, but calculated that if only blue dye would have been used in their study they would have had a much higher false‐negativity rate. Taking into account that 2 of these false‐negative results were encountered in a study30 that used blue dye only and the third false‐negative finding occurred in a study that used technetium only,15 we hypothesize that with a combination of radiolabeled technetium and blue dye (if required), plus the requirement for full inguinofemoral dissection if no SLN is detected, the false‐negative rate should be very low.…”

“…Several groups have reported their findings regarding SLNs in vulvar cancer 15, 17, 20, 26–33. In what to our knowledge is 1 of the earliest studies concerning SLN for vulvar cancer, Ansink et al30 reported their experience using blue dye only in 51 patients.…”

“…The morbidity of inguinal lymph node dissections through separate incisions is less than with the classic ‘butterfly’ incision, but lymph edema, infection, and wound breakdown are still common complications in 25% to 35%, 40% to 60%, and 15% to 25% of cases, respectively 11–14. While trying to maintain the sensitivity of detecting lymph node metastases, gynecologic oncologists have attempted to reduce morbidity from complete inguinofemoral groin dissections by performing sentinel lymph node (SLN) procedures in patients with vulvar cancer 15–22. Because lymph edema can be a lifelong complication of inguinofemoral groin dissections,11 the purpose of SLN procedures is to minimize the extent of the lymphadenectomy, thereby reducing resultant complications, without jeopardizing detection rates of metastatic lymph nodes.…”

Characteristics of sentinel lymph nodes’ metastatic involvement in early stage of vulvar cancer

“…In our study, the bilateral detection of SLN in midline tumour was 83%. In these midline lesions with unilateral detection of SLN only, there is a risk of metastatic involvement of contralateral groin 8,18,19 . In our study, we did not record a case of midline lesion with unilateral detection of SLN only with metastatic involvement in contralateral groin.…”

Indocyanine green utility in sentinel node detection for cervical cancer patients

“…The benefits of detecting the sentinel node were demonstrated in cases of solid tumors almost a century ago. More recently, the method again proved safe and effective in treating other gynecologic malignancies such as breast cancer and vulvar cancer (1)(2)(3)(4).…”