This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by de Hullu, J. A. Articles by van der Zee, A. G. J. Search for Related Content PubMed PubMed Citation Articles by de Hullu, J. A. Articles by van der Zee, A. G. J. Social Bookmarking                            What's this?

Sentinel Lymph Node Procedure Is Highly Accurate in Squamous Cell Carcinoma of the Vulva

From the Departments of Gynecologic Oncology, Pathology, and Nuclear Medicine, University Hospital Groningen, Groningen; and Departments of Gynecologic Oncology and Pathology, Academic Hospital Vrije Universiteit, Amsterdam, the Netherlands.

Address reprint requests to A.G.J. van der Zee, PhD, Department of Gynecologic Oncology, University Hospital Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands; email a.g.j.van.der.zee{at}og.azg.nl

PURPOSE: To determine the diagnostic accuracy of the sentinel lymph node procedure in patients with squamous cell carcinoma of the vulva and to investigate whether step sectioning and immunohistochemistry of sentinel lymph nodes increase the sensitivity for detection of metastases.

PATIENTS AND METHODS: Between July 1996 and July 1999, 59 patients with primary vulvar cancer were entered onto a two-center prospective study. All patients underwent sentinel lymph node procedure with the combined technique (preoperative lymphoscintigraphy with technetium-99m–labeled nanocolloid and intraoperative blue dye). Radical excision of the primary tumor with uni- or bilateral inguinofemoral lymphadenectomy was performed subsequently. Sentinel lymph nodes and lymphadenectomy specimens were sent for histopathologic examination separately. Sentinel lymph nodes, negative at the time of routine pathologic examination, were re-examined with step sectioning and immunohistochemistry.

RESULTS: In 59 patients, 107 inguinofemoral lymphadenectomies were performed (11 unilateral and 48 bilateral). All sentinel lymph nodes, as observed on preoperative lymphoscintigram, were identified successfully intraoperatively. Routine histopathologic examination showed lymph node metastases in 27 groins, all of which were detected by the sentinel lymph node procedure. The negative predictive value for a negative sentinel lymph node was 100% (97.5% confidence interval [CI], 95% to 100%). Step sectioning and immunohistochemistry showed four additional metastases in 102 sentinel lymph nodes (4%; 95% CI, 1% to 9%) that were negative at the time of routine histopathologic examination.

CONCLUSION: Sentinel lymph node procedure with the combined technique is highly accurate in predicting the inguinofemoral lymph node status in patients with early-stage vulvar cancer. Future trials should focus on the safe clinical implementation of the sentinel lymph node procedure in these patients. Step sectioning and immunohistochemistry slightly increase the sensitivity of detecting metastases in sentinel lymph nodes and should be included in these trials.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				O. Zivanovic, F. Khoury-Collado, N. R. Abu-Rustum, and M. L. Gemignani Sentinel Lymph Node Biopsy in the Management of Vulvar Carcinoma, Cervical Cancer, and Endometrial Cancer Oncologist, July 1, 2009; 14(7): 695 - 705. [Abstract] [Full Text] [PDF]

				L. T. Gien and A. Covens Quality Control in Sentinel Lymph Node Biopsy in Cervical Cancer J. Clin. Oncol., June 20, 2008; 26(18): 2930 - 2931. [Full Text] [PDF]

				A. G.J. Van der Zee, M. H. Oonk, J. A. De Hullu, A. C. Ansink, I. Vergote, R. H. Verheijen, A. Maggioni, K. N. Gaarenstroom, P. J. Baldwin, E. B. Van Dorst, et al. Sentinel Node Dissection Is Safe in the Treatment of Early-Stage Vulvar Cancer J. Clin. Oncol., February 20, 2008; 26(6): 884 - 889. [Abstract] [Full Text] [PDF]

				S. L. Chen, D. M. Iddings, R. P. Scheri, and A. J. Bilchik Lymphatic Mapping and Sentinel Node Analysis: Current Concepts and Applications CA Cancer J Clin, September 1, 2006; 56(5): 292 - 309. [Abstract] [Full Text] [PDF]

				E. Barranger, C. Coutant, A. Cortez, S. Uzan, and E. Darai Sentinel node biopsy is reliable in early-stage cervical cancer but not in locally advanced disease Ann. Onc., August 1, 2005; 16(8): 1237 - 1242. [Abstract] [Full Text] [PDF]

				J. D. Wagner, D. Z. Evdokimow, E. Weisberger, D. Moore, T.-Y. Chuang, S. Wenck, and J. J. Coleman III Sentinel Node Biopsy for High-Risk Nonmelanoma Cutaneous Malignancy Arch Dermatol, January 1, 2004; 140(1): 75 - 79. [Abstract] [Full Text] [PDF]

				P J Ell A revolution in surgical oncology: sentinel lymph node biopsy Imaging, September 1, 2001; 13(3): 197 - 205. [Abstract] [Full Text] [PDF]

				R. T. Penson, A. F. Fuller Jr, J. A. de Hullu, and A. G.J. van der Zee Nodal Metastasis Is Highly Consistent in Squamous Cell Carcinoma of the Vulva J. Clin. Oncol., May 15, 2001; 19(10): 2767 - 2768. [Full Text] [PDF]

				R. T. Penson and A. F. Fuller Jr Nodal Metastasis is Highly Consistent in Squamous Cell Carcinoma of the Vulva J. Clin. Oncol., April 15, 2001; 19(8): 2364 - 2365. [Full Text] [PDF]

				B. Cady Sentinel Lymph Node Procedure in Squamous Cell Carcinoma of the Vulva J. Clin. Oncol., August 15, 2000; 18(15): 2795 - 2797. [Full Text] [PDF]