Article Text

Download PDFPDF
Inguinofemoral sentinel lymph node biopsy by scar injection in vulvar cancer: an assessment of feasibility and long-term outcomes
  1. Erica Pascoal1,
  2. Mohammad Alyafi1,2,
  3. Alida Pokoradi1,
  4. Lua Eiriksson3 and
  5. Limor Helpman3,4
  1. 1Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, McMaster University, Hamilton, Ontario, Canada
  2. 2Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
  3. 3Department of Gynecologic Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
  4. 4Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel
  1. Correspondence to Dr Erica Pascoal, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada; erica.pascoal{at}


Background Performing inguinofemoral sentinel lymph node biopsy for vulvar cancer following a previous vulvar excision, often referred to as ‘scar injection’, is debated.

Objective To assess the feasibility of sentinel lymph node biopsy following scar injection and the long-term outcomes in patients undergoing this procedure.

Methods We conducted a retrospective observational cohort study of patients with vulvar cancer. We assessed detection rates and outcomes in patients who underwent sentinel lymph node biopsy by scar injection and compared them with patients who had injection around a visible tumor and with patients who had an inguinofemoral lymphadenectomy following previous vulvar excision. Sentinel node detection rates are described per patient and per groin and are compared using Χ2 analysis. Cox regression analysis was used to assess the association of recurrence and survival with surgical technique and recognized pathological variables.

Results Data were analyzed for 173 groins in 97 patients. At least one sentinel lymph node was detected in 162 (94%) groins examined, and detection rate did not differ whether the groin was assessed following tumor injection (n=122, 94%) or scar injection (n=40, 93%; p=0.85). Patients in the scar-injection group had less frequent lymph node metastases (p<0.02), smaller tumors (p<0.001), and more superficial invasion (p<0.02). Median follow-up was 34.7 months (range 0–108). Scar injection was not independently associated with recurrence or death on multivariable analysis, and depth of invasion was the only independent predictor of disease recurrence (hazards ratio (HR)=1.14, p=0.03). Recurrence and survival were also comparable for patients who had a sentinel lymph node biopsy or inguinofemoral lymphadenectomy following previous vulvar excision (log rank p=0.30; p=0.67).

Conclusions Sentinel lymph node biopsy by scar injection is feasible and demonstrates similar long-term outcomes in patients having scar or tumor injections, and in patients following previous tumor excision undergoing sentinel lymph node biopsy or lymphadenectomy.

  • vulvar neoplasms
  • sentinel lymph node
  • neoplasm recurrence, local
  • vulvar and vaginal cancer

Data availability statement

Data are available upon reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request.

View Full Text


  • Contributors EP, MA: conceptualization, data curation, formal analysis, writing-original draft, review, and editing. AP: formal analysis, writing, review, and editing. LE, LH: conceptualization, supervision, writing, review, and editing. LH: guarantor

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.