Lymphatic Mapping and Sentinel Lymph Node Biopsy in Women with Squamous Cell Carcinoma of the Vulva
November 1, 2012
Is sentinel lymph node biopsy safe as a replacement for inguinofemoral lymphadenectomy in women with early vulvar cancer?
SLN mapping w/isosulfan blue
Subsequent completion lymphadenectomy
NPV
Single-site, vulva-limited SCC
Depth of invasion ≥1mm
Tumor 2 - 6cm
clinically negative inguinal LNs
Prior groin irradiation or dissection
Recurrent vulvar cancer
Grossly inflamed tumor
n=452 (772 groin dissections (320 bilateral, 132 unilateral)):
SLN Detection rate: 92.5%
LN metastases: 31.6%
LN metastases, 2-3.9cm tumor: 26.4%
LN metastases, 4-6cm tumor: 40.9%
False negative rate, SLN: 8.3%
False NPV: 3.7% (2.7% when analyzed by groin rather than patient)(2% for tumors <4cm, 7.4% for tumors 4-6cm)
SLN should be offered to well-selected patients by well-trained providers.