Objectives To characterize our institutional experience with sentinel lymph node (SLN) biopsy in patients with vulvar cancer. We describe the oncologic outcomes of these patients and the utilization of SLN detection techniques over time.
Methods A retrospective analysis of all patients who underwent inguinofemoral SLN biopsy as part of their treatment for vulvar cancer at Memorial Sloan Kettering Cancer Center from January 1, 2000 to April 1, 2019. Patients were included in this analysis if they underwent inguinofemoral SLN biopsy for vulvar cancer, irrespective of presenting factors such as histology, tumor size or laterality. An “at-risk groin” was defined as either the right or left groin for which SLN biopsy of inguinofemoral lymph nodes was performed.
Results A total of 160 patients were included in our analysis, representing 265 at-risk groins. 114 patients had squamous cell histology representing 195 at-risk groins. Of the 169 negative groins in patients with squamous cell carcinoma, the 2 year isolated groin recurrence rate was 1.2%. SLN detection rate, irrespective of modality, was 96.2%. Technetium-99 (TC-99) + blue dye detected SLNs in 91.8% of groins; TC-99 + indocyanine green detected SLNs in 100% of groins (p=0.157). Among the 110 groins that underwent mapping with TC-99 and blue dye, 4 patients had failed mapping with blue dye and mapped with TC-99 alone (3.6%). Among the 96 groins that underwent mapping with TC-99 and ICG, 14 patients failed to map with TC-99 and mapped with indocyanine green alone (14.6%).
Conclusions SLN mapping in vulvar cancer is reliable and oncologically effective. The utilization of indocyanine green for mapping has increased over the past decade and is associated with high rates of SLN detection.
- vulvar and vaginal cancer
- sentinel lymph node
- lymph nodes
- surgical procedures, operative
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Editor's note This paper will feature in a special issue on sentinel lymph node mapping in 2020.
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Contributors VAB: Conception and design; analysis and interpretation of data; drafting of manuscript; revising manuscript critically for important intellectual content; final approval of version to be published; agrees to be accountable for all aspects of the work. NRA-R: Assistance in conception of design, contribution of patients included in this study, assistance in editing of the manuscript. YS: Contribution of patients included in this study, assistance in editing the manuscript. CLB: Contribution of patients included in this study, assistance in editing the manuscript. EJ: Contribution of patients included in this study, assistance in editing the manuscript. GJG: Contribution of patients included in this study, assistance in editing the manuscript. DSC: Contribution of patients included in this study, assistance in editing the manuscript. OZ: Contribution of patients included in this study, assistance in editing the manuscript. MML: Assistance in conception of design, contribution of patients included in this study, assistance in editing of the manuscript.
Funding This study was funded by National Cancer Institute (grant no: P30 CA008748).
Competing interests NRA-R reports grants from Stryker/Novadaq, grants from Olympus, grants from GRAIL, outside the submitted work. DSC reports personal fees from Bovie Medical Co, personal fees from Verthermia Inc. (now Apyx Medical Corp), personal fees from C Surgeries, other from Intuitive Surgical, Inc, other from TransEnterix, Inc, personal fees from Biom 'Up, outside the submitted work. EJ is a consultant for Intuitive Surgical and Covidien, outside the submitted work. ML is a consultant for Intuitive Surgical, outside the submitted work.
Patient consent for publication Not required.
Provenance and peer review Commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article.