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Is There a Place for Sentinel Technique in Treatment of Vaginal Cancer?: Feasibility, Clinical Experience, and Results
  1. Hermann Hertel, MD*,
  2. Philipp Soergel, MD*,
  3. Johanna Muecke*,
  4. Michael Schneider, MD,
  5. Frank Papendorf,
  6. Florian Laenger, MD§,
  7. Klaus-Friedrich Gratz, MD and
  8. Peter Hillemanns, MD*
  1. *Department of Obstetrics and Gynecology,
  2. Institut of Biometry,
  3. Tumour Centre,
  4. §Institute of Pathology, and
  5. Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany.
  1. Address correspondence and reprint requests to Hermann Hertel, MD, Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany. E-mail: hertel.hermann{at}


Objective To evaluate the clinical feasibility of sentinel lymph node (SLN) technique and the role of single-photon emission computed tomography with CT (SPECT/CT) compared to lymphoscintigraphy for detection of SLN in vaginal cancer.

Methods The study was performed in a prospective, unicentric setting. Patients with vaginal carcinoma were scheduled for surgery and SLN labeling by peritumoral injection of 10-MBq technetium Tc 99m nanocolloid and patent blue. After 30 minutes, lymphoscintigraphy and SPECT/CT were carried out. We evaluated the number of SLNs in lymphoscintigraphy, SPECT/CT, and intraoperative histology of SLN and non-SLN as well as the impact of these results to therapeutic approach.

Results Between January 2009 and December 2012, the SLN technique was used for 7 of 11 patients treated due to vaginal cancer. Detection rate was 100% (7/7). Lymphoscintigraphy and SPECT/CT showed at least one SLN in each patient. Lymphoscintigraphy detected 2.6 SLNs (range, 2–4 SLNs) per patient compared to 4.3 SLNs (range, 2–8 SLNs) in SPECT/CT (P = 0.053). Sentinel lymph nodes were detected in all patients during surgery with a mean number of 4.3 (range, 1–5). Pelvic SLNs were detected in all 6 patients with infiltration of middle or proximal vaginal third (100%). If the distal vaginal third was additional (3/7 patients) or exclusively (1/7 patients) infiltrated, the inguinal SLN detection rate was 33% and 100%, respectively. All patients with nodal metastases had at least one SLN positive for tumor. There were no false negatives. In 2 (29%) of 7 patients, treatment approach was modified owing to affected SLN.

Conclusion The SLN technique was favorably used in vaginal cancer in this series. It assists in identifying an inguinal and/or pelvic lymphatic drainage. When performed accurately (technetium Tc 99m nanocolloid, lymphoscintigraphy and/or SPECT/CT, blue dye), this technique predicts regional nodal status. This allows tumor stage–adjusted therapy. Single photon emission computed tomography/CT improves preoperative planning and facilitates detection, thus enhancing the clinical value of the SLN technique and improving the oncologic safety of surgery.

  • Vaginal cancer
  • Sentinel concept

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  • The authors declare no conflicts of interest.