Sentinel lymph node biopsy in vulvar cancer: Systematic review, meta-analysis and guideline recommendations

Groin Recurrences in Node Negative Vulvar Cancer Patients After Sole Sentinel Lymph Node Dissection

“…8,11 Large studies analyzing the diagnostic accuracy of SLND by sequential groin LND stated a high sensitivity and a low to moderate false-negative rate for this approach. 3Y5,10 According to a recent review by Covens et al, 11 the overall detection rates using a dual-tracer approach were 87% (95% CI, 82%Y92%) and the false-negative rate resulted in 6% (95% CI, 4%Y9%). A few trials, most of them including less than 25 patients, also evaluated the follow-up of patients after sole SLND.…”

“…The groin recurrence rates ranged from 0% to 12%. 11 We analyzed the available studies which published groin recurrences after sole SLND to better understand risk factors for false-negative SLNs. The large GROINSS-V-I study provided the most reliable data due to its prospective multicenter design.…”

“…3Y5,10 A recent review by Covens et al found a falsenegative rate using a dual-tracer approach of 6% (95% confidence interval [CI], 4%Y9%), whereas Levenback et al only identified 2% false-negative sentinel lymph nodes (SLNs) for tumors smaller than 4 cm in a large multicenter study. 5,11 In addition, a few studies also published promising data on the survival and complication rates after SLND alone. 1,12Y15 Especially, Van der Zee et al presented low postoperative complication rates and low isolated groin recurrence rates (2.4%) in a large multicenter trial.…”

“…Additionally, a dual-tracer approach and experienced surgeons may reduce the false-negative rate. 1,5,6,11,16 Furthermore, a restricted patient selection has to be performed to exclude patients with a high risk for LN metastases.…”

New technologies in radioguided surgery in complex anatomic areas

“…Over the last decade, SLNB has also emerged as an alternative to LN dissection in numerous other malignancies, such as female or male urogenital malignancies and head and neck (HN) cancers [3,4,[10][11][12]. Whereas SLNB in penile [10] and vulvar cancer [13] is established in daily clinical routine, SLNB in other urogenital malignancies such as cervical cancer or prostate cancer is still in the evaluation phase.…”