Goni 2011.

Study characteristics
Patient sampling	Prospective study
Patient characteristics and setting	24 women with vulval cancer (22 SCC; 2 other), clinical stage I and II. Number of groins evaluated is unclear Excluded women with clinically suspicious groin nodes Mean age: 71 (43 to 85) Setting: a tertiary institution in Spain; enrolment from 2001 to 2011
Index tests	Tc‐99m only Standard histological methods were used for SN assessment and IHC staining was performed if H&E stain was negative
Target condition and reference standard(s)	TC: groin lymph node involvement RS: complete IFL
Flow and timing	Procedure: 24 hours pre‐operatively, Tc‐99m was injected and LSG performed (details not reported). Radioactivity was detected intra‐operatively by hand‐held gamma probe. SND and RS were performed during the same operation Withdrawals were not described Mean follow‐up was 23 months
Comparative
Notes	Conference abstract only The number of women with midline/lateralised tumours and who underwent bilateral or unilateral IFL is not stated Midline lesions were not defined
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	Low
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
		Unclear	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?	Unclear
Were other imaging tests performed prior to the index test to rule out groin lymph node metastases?	Unclear
		Unclear