Sentinel node disection in the treatment of early stages of vulvar cancer

Objectives: To assess the results of sentinel lymph node (SLN) detection in the initial stages of vulvar cancer and the recurrences that may appear. Study design: 76 patients with vulvar carcinoma, Stage I and II. Between 2000 and 2010, identification of the SLN was performed with a perilesional injection of Tc99m and vital dye. Ninety sentinel lymph nodes were found. They were removed separately, and lymphadenectomy was performed depending on the involved areas. Vulvar tumour was also removed. Results: 76 patients were included in the study; 20 (22.22%) out of 90 SLNs presented metastases and 70 (77.77%) did not. There were no false negatives, and the sensitivity and negative predictive value reached 100%. Thirty-six months after treatment, one patient presented recurrence with a negative SLN, and two with positive SLNs. Conclusion: Biopsy of the SLN is a reasonable alternative to lymphadenectomy in patients with vulvar cancer Stage I and II.

Vulvar cancer; Sentinel lymph node; SLN biopsy

[1] Jemal A., Siegel R., Ward E., Murray T., Xu J., Thun M.J.: “Cancer statistics 2007”. CA Cancer J. Clin., 2007, 57, 43.

[2] Camara O., Gonnert H., Herrmann J., Egbe A., Diebolder H., Gajada M. et al.: “SLN biopsy in vulvar cancer: a pilot study”. Eur. J. Gynaecol. Oncol., 2009, 30, 622.

[3] Hauspy J., Beiner M., Harley I., Ehrlich L., Rasty G., Covens A.: “SLN in vulvar cancer”. Cancer, 2007, 110, 1016.

[4] Van der Zee J., Maaike H., Oonk J.A., De Hullu A.C., Ansink I.V., Vergote I. et al.: “Sentinel node dissection is safe in the treatment of early-stage. Vulvar cancer”. J. Clin. Oncol., 2008, 26, 884.

[5] Atienza Merino G.: “Aplicabilidad de la técnica de identificacióny biopsia del ganglio centinela en el cáncer vulva”. Prog. Obst y Ginec., 2010, 53, 403.

[6] Iyibozkurt A.C., Dural O.C., Topuz S., Berkaman S., Bengisu E.: “Groin recurrence following Stage IA squamous cell carcinoma of the vulva with negative nodes on superficial inguinal lymphadenectomy”. Eur. J. Gynaecol. Oncol., 2010, 31, 354.

[7] Oonk M.H., van Hemel B.M., Hollema H., Hullu J.A., Ansin A.C., Vergote I. et al.: “Size of sentinel-node metastasis and chances of non-sentinel-node involvement and survival in early stage vulvar cancer: results from GROINSS-Va multicentre observational study”. Lancet Oncol., 2010, 11, 646.

[8] Knopp S., Nesland J.M., Trope C.: “SLNB and the importance of micrometastases in vulvar squamous cell carcinoma”. Surg. Oncol., 2008, 17, 219.

[9] Gadducci A., Cionini L., Romanini A., Fanucchi A., Genazzani A.R.: “Old and new perspectives in the management of high-risk locally advanced or recurrent and metastatic vulvar cancer”. Crit. Rev. Oncol. Hematol., 2006, 60, 227.

[10] Parara S., de Bree E., Takos D., Giakaki E., Melissas J., Tsiffissis D.D.: “Melanoma of the vulva: a pigmented lesion is also significant in a non sun exposed area”. Arch. Gynecol. Obstet., 2009, 280, 831.

[11] Li B., Wu L.Y., Liu L., Zhang R., Zahhang G.Y., Yu G.Z.: “An initial experience of the use of SLN biopsy in squamous cell cancer of the vulva”. Zhonghoa Fu Chan Ke Za Zhi, 2009, 44, 364.

[12] Radziezewskid J., Kowalewska M., Jedrzejaczak T., kozlowicz I., Nasierowsk A., Bidzinski M. et al.: “The accuracy of the SLN concept in early stage squamous cell vulvar carcinoma”. Gynecol. Oncol., 2010, 116, 473.

[13] Moore R.G., Robison K., Brown A.K., Disilvestro P., Steinhoff M., Noto R. et al.: “Isolated SLN dissection with conservative management in patients with squamous cell carcinoma of the vulva: a prospective trial”. Gynecol. Oncol., 2008, 109, 65.

[14] Brunner A.H., Polterauer S., Tempefer C., Joura E., Reinthaller A., Horvat R. et al.: “The accuracy of intraoperative frozen section of the inguinal SLN in vulvar cancer”. Anticancer Res., 2008, 28, 4091.

[15] Hampl M., Hantdchmann P., Micheels W., Hillemanns P.: “Validation of the accuracy of the SLN procedure in patients with vulvar cancer: results of a multicenter study in Germany”. Gynecol. Oncol., 2008, 111, 282.

[16] de Hullu J.A., Hollema H., Piers D.A., Verheijen R.H.M., Van Diest P.J., Mourits M.J.E. et al.: “SLN procedure is highly accurate in squamous cell carcinoma of the vulva”. J. Clin. Oncol., 2000, 18, 2811.

[17] Nyberg R.H., Livonen M., Parkkinen J., Kuoppala T., Maernpaa J.U.: “Sentinel node and vulvar cance: a series of 47 patiens”. Acta Obstet. Gynecol. Scand., 2007, 86, 615.

[18] Puig-Tintore L.M., Ordi J., Vidal S., Legarcegui J.A., Torne A., Pahisa J. et al.: “Further data on the usefulness of SLN identification and ultrastaging in vulvar squamous cell carcinoma”. Gynecol. Oncol., 2003, 88, 29.

[19] Rob L., Robova H., Pluta M., Strnad P., Kacirek J., Skapa P. et al.: “Further data on SLN mapping in vulvar cancer by blue dye and radiocolloid Tc99”. Int. J. Gynecol. Cancer, 2007, 17, 147.

[20] Martinez-Palones R.G., Perez-Benavente M.A., Gil-Moreno A., Diaz-Feijo B., Roca B., Garcia-Jimenez A. et al.: “Comparison of recurrence after vulvectomy and lymphadenectomy with and without sentinel node biopsy in early stage vulvar cancer”. Gynecol. Oncol., 2006, 103, 865.

[21] Knopp S., Neslannd J.M., Trope C.: “SLNB and the importance of micrometastases in vulvar squamous cell carcinoma”. Surg. Oncol., 2008, 17, 219.

[22] Suglyama V.E., Chan J.K., Kapp D.S.: “Management of melanomas of the female genital tract”. Curr. Opin. Oncol., 2008, 20, 565.

[23] Lindell G., Jonsson C., Ehrsson R.J., Jacobsson H., Danielsson K.G., Kallistron B.N., Larson B.: “Evaluation of preparative lymphoscintigraphy and sentinel node procedure in vulvar cancer”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2010, 152, 91.

[24] Bell J.G., Lea J.S., Reid G.C.: “Complete groin lymphadenectomy with preservation of the fascia lata in the treatment of vulvar carcinoma”. Gynecol. Oncol., 2000, 77, 314.

[25] Kirby T.O., Roccini R.P., Numnum T.C., Kendrick J.E., Wright J., Fowler W. et al.: “Outcomes of Stage I/II vulvar cancer patients after negative superficial inguinal lymphadenectomy”. Gynecol. Oncol., 2005, 98, 309.

[26] Levenbank C.F., Van der Zee A.G., Rob L., Plante M., Covens A., Schneider A. et al.: “SLN biopsy in patients with gynecology cancer expert panel statement from the International Sentinel Node Society Meeting, February 21, 2008”. Gynecol. Oncol., 2009, 114, 151.