Skip to main content
PMC home page
British Journal of Cancer logoLink to British Journal of Cancer
. 2000 Jan 18;82(2):295–299. doi: 10.1054/bjoc.1999.0918

Sentinel node biopsy in early vulvar cancer

C De Cicco 2, M Sideri 1, M Bartolomei 2, C Grana 2, M Cremonesi 2, M Fiorenza 2, A Maggioni 1, L Bocciolone 1, C Mangioni 3, N Colombo 1, G Paganelli 2
PMCID: PMC2363267  PMID: 10646880

Abstract

Lymph node pathologic status is the most important prognostic factor in vulvar cancer; however, complete inguinofemoral node dissection is associated with significant morbidity. Lymphoscintigraphy associated with gamma-probe guided surgery reliably detects sentinel nodes in melanoma and breast cancer patients. This study evaluates the feasibility of the surgical identification of sentinel groin nodes using lymphoscintigraphy and a gamma-detecting probe in patients with early vulvar cancer. Technetium-99m-labelled colloid human albumin was administered perilesionally in 37 patients with invasive epidermoid vulvar cancer (T1–T2) and lymphoscintigraphy performed the day before surgery. An intraoperative gamma-detecting probe was used to identify sentinel nodes during surgery. A complete inguinofemoral node dissection was then performed. Sentinel nodes were submitted separately to pathologic evaluation. A total of 55 groins were dissected in 37 patients. Localization of the SN was successful in all cases. Eight cases had positive nodes: in all the sentinel node as positive; the sentinel node was the only positive node in five cases. Twenty-nine patients showed negative sentinel nodes: all of them were negative for lymph node metastases. Lymphoscintigraphy and sentinel-node biopsy under gamma-detecting probe guidance proved to be an easy and reliable method for the detection of sentinel node in early vulvar cancer. This technique may represent a true advance in the direction of less aggressive treatments in patients with vulvar cancer. © 2000 Cancer Research Campaign

Keywords: vulvar cancer, lymph node, lymphoscintigraphy, sentinel node, lymphadenectomy

Full Text

The Full Text of this article is available as a PDF (90.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Albertini J. J., Lyman G. H., Cox C., Yeatman T., Balducci L., Ku N., Shivers S., Berman C., Wells K., Rapaport D. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA. 1996 Dec 11;276(22):1818–1822. [PubMed] [Google Scholar]
  2. Alex J. C., Weaver D. L., Fairbank J. T., Rankin B. S., Krag D. N. Gamma-probe-guided lymph node localization in malignant melanoma. Surg Oncol. 1993 Oct;2(5):303–308. doi: 10.1016/s0960-7404(06)80006-x. [DOI] [PubMed] [Google Scholar]
  3. Bartolomei M., Testori A., Chinol M., Gennari R., De Cicco C., Leonardi L., Zoboli S., Paganelli G. Sentinel node localization in cutaneous melanoma: lymphoscintigraphy with colloids and antibody fragments versus blue dye mapping. Eur J Nucl Med. 1998 Nov;25(11):1489–1494. doi: 10.1007/s002590050326. [DOI] [PubMed] [Google Scholar]
  4. Barton D. P., Berman C., Cavanagh D., Roberts W. S., Hoffman M. S., Fiorica J. V., Finan M. A. Lymphoscintigraphy in vulvar cancer: a pilot study. Gynecol Oncol. 1992 Sep;46(3):341–344. doi: 10.1016/0090-8258(92)90229-c. [DOI] [PubMed] [Google Scholar]
  5. Burke T. W., Levenback C., Coleman R. L., Morris M., Silva E. G., Gershenson D. M. Surgical therapy of T1 and T2 vulvar carcinoma: further experience with radical wide excision and selective inguinal lymphadenectomy. Gynecol Oncol. 1995 May;57(2):215–220. doi: 10.1006/gyno.1995.1128. [DOI] [PubMed] [Google Scholar]
  6. Cabanas R. M. An approach for the treatment of penile carcinoma. Cancer. 1977 Feb;39(2):456–466. doi: 10.1002/1097-0142(197702)39:2<456::aid-cncr2820390214>3.0.co;2-i. [DOI] [PubMed] [Google Scholar]
  7. Cavanagh D. Vulvar cancer-continuing evolution in management. Gynecol Oncol. 1997 Sep;66(3):362–367. doi: 10.1006/gyno.1997.4762. [DOI] [PubMed] [Google Scholar]
  8. Decesare S. L., Fiorica J. V., Roberts W. S., Reintgen D., Arango H., Hoffman M. S., Puleo C., Cavanagh D. A pilot study utilizing intraoperative lymphoscintigraphy for identification of the sentinel lymph nodes in vulvar cancer. Gynecol Oncol. 1997 Sep;66(3):425–428. doi: 10.1006/gyno.1997.4798. [DOI] [PubMed] [Google Scholar]
  9. DiSaia P. J., Creasman W. T., Rich W. M. An alternate approach to early cancer of the vulva. Am J Obstet Gynecol. 1979 Apr 1;133(7):825–832. doi: 10.1016/0002-9378(79)90119-4. [DOI] [PubMed] [Google Scholar]
  10. Iversen T., Aas M. Lymph drainage from the vulva. Gynecol Oncol. 1983 Oct;16(2):179–189. doi: 10.1016/0090-8258(83)90092-6. [DOI] [PubMed] [Google Scholar]
  11. Krag D., Weaver D., Ashikaga T., Moffat F., Klimberg V. S., Shriver C., Feldman S., Kusminsky R., Gadd M., Kuhn J. The sentinel node in breast cancer--a multicenter validation study. N Engl J Med. 1998 Oct 1;339(14):941–946. doi: 10.1056/NEJM199810013391401. [DOI] [PubMed] [Google Scholar]
  12. Levenback C., Burke T. W., Gershenson D. M., Morris M., Malpica A., Ross M. I. Intraoperative lymphatic mapping for vulvar cancer. Obstet Gynecol. 1994 Aug;84(2):163–167. [PubMed] [Google Scholar]
  13. Levenback C., Burke T. W., Morris M., Malpica A., Lucas K. R., Gershenson D. M. Potential applications of intraoperative lymphatic mapping in vulvar cancer. Gynecol Oncol. 1995 Nov;59(2):216–220. doi: 10.1006/gyno.1995.0011. [DOI] [PubMed] [Google Scholar]
  14. Micheletti L., Borgno G., Barbero M., Preti M., Cavanna L., Nicolaci P., Benedetto C., Ghiringhello B., Bocci A. Deep femoral lymphadenectomy with preservation of the fascia lata. Preliminary report on 42 invasive vulvar carcinomas. J Reprod Med. 1990 Dec;35(12):1130–1133. [PubMed] [Google Scholar]
  15. Morton D. L., Wen D. R., Wong J. H., Economou J. S., Cagle L. A., Storm F. K., Foshag L. J., Cochran A. J. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992 Apr;127(4):392–399. doi: 10.1001/archsurg.1992.01420040034005. [DOI] [PubMed] [Google Scholar]
  16. Podratz K. C., Symmonds R. E., Taylor W. F. Carcinoma of the vulva: analysis of treatment failures. Am J Obstet Gynecol. 1982 Jun 1;143(3):340–351. doi: 10.1016/0002-9378(82)90823-7. [DOI] [PubMed] [Google Scholar]
  17. Stehman F. B., Bundy B. N., Dvoretsky P. M., Creasman W. T. Early stage I carcinoma of the vulva treated with ipsilateral superficial inguinal lymphadenectomy and modified radical hemivulvectomy: a prospective study of the Gynecologic Oncology Group. Obstet Gynecol. 1992 Apr;79(4):490–497. [PubMed] [Google Scholar]
  18. Sutton G. P., Miser M. R., Stehman F. B., Look K. Y., Ehrlich C. E. Trends in the operative management of invasive squamous carcinoma of the vulva at Indiana University, 1974 to 1988. Am J Obstet Gynecol. 1991 Jun;164(6 Pt 1):1472–1481. doi: 10.1016/0002-9378(91)91426-w. [DOI] [PubMed] [Google Scholar]
  19. Veronesi U., Paganelli G., Galimberti V., Viale G., Zurrida S., Bedoni M., Costa A., de Cicco C., Geraghty J. G., Luini A. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet. 1997 Jun 28;349(9069):1864–1867. doi: 10.1016/S0140-6736(97)01004-0. [DOI] [PubMed] [Google Scholar]
  20. de Hullu J. A., Doting E., Piers D. A., Hollema H., Aalders J. G., Koops H. S., Boonstra H., van der Zee A. G. Sentinel lymph node identification with technetium-99m-labeled nanocolloid in squamous cell cancer of the vulva. J Nucl Med. 1998 Aug;39(8):1381–1385. [PubMed] [Google Scholar]
  21. van der Veen H., Hoekstra O. S., Paul M. A., Cuesta M. A., Meijer S. Gamma probe-guided sentinel node biopsy to select patients with melanoma for lymphadenectomy. Br J Surg. 1994 Dec;81(12):1769–1770. doi: 10.1002/bjs.1800811220. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES