Camara 2009.

Study characteristics
Patient sampling	Prospective pilot study
Patient characteristics and setting	17 women with vulval cancer stage I/II: 16 with SCC, 1 with melanoma; number of groins dissected was not reported. It is unclear whether any women with stage IA were included Median age: 75 years (37 to 83) Setting: a tertiary institution in Germany from February 2003 to March 2007
Index tests	Tc‐99m and blue dye Histological methods and ultrastaging not described.
Target condition and reference standard(s)	TC: groin lymph node involvement RS: complete IFL
Flow and timing	Tc‐99m and blue dye injected intradermally at 4 sites around the tumour. Timing and other details were not reported SND and RS were performed during the same operation Withdrawals, if any, were not described
Comparative
Notes	Brief report. Results were not reported per groin
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Unclear
Was a case‐control design avoided?	Yes
Did the study avoid inappropriate exclusions?	Unclear
		Unclear	Unclear
DOMAIN 2: Index Test Test group
Had the test operator performed 10 or more procedures?	Unclear
		Unclear	Low
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition?	Yes
Were the reference standard results interpreted without knowledge of the results of the index tests?	Unclear
		Low	Low
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard?	Yes
Did all patients receive the same reference standard?	Yes
Were all patients included in the analysis?	Yes
Were other imaging tests performed prior to the index test to rule out groin lymph node metastases?	Unclear
		Unclear