Further data on the usefulness of sentinel lymph node identification and ultrastaging in vulvar squamous cell carcinoma.
OBJECTIVE
The aim was to determine the feasibility of surgical identification and pathological ultrastaging of sentinel nodes (SNs) in vulvar carcinoma and to evaluate whether SN negativity rules out the possibility of metastasis in other nodes and can therefore avoid conventional lymphadenectomy.


METHODS
In 26 patients with vulvar squamous cell carcinoma the SNs were detected using both peritumoral injection of (99m)Tc and blue dye (isosulfan or methylene) before the surgical procedure. Dissection of the SNs was followed by standard lymphadenectomy and vulvar exeresis. For pathological ultrastaging at least eight histological sections of every node separated 400 microm were evaluated using hematoxylin & eosin and immunostaining against cytokeratin.


RESULTS
We identified the SNs in 25/26 patients (96%). In 19 patients (76%) the SN was unilateral and in 6 (24%) it was bilateral. A total of 46 SNs were isolated. Metastatic carcinoma was identified in 9 SNs from 8 patients (30.8%). Thirty-eight percent (3 of 8) patients with metastatic SNs presented micrometastasis detected only in ultrastaging. Seven (3.3%) of 239 nonsentinel nodes (non-SNs) showed metastasis. No metastatic implant was detected in non-SNs when SNs were negative in patients without clinical suspicious adenopathy (100% negative predictive value).


CONCLUSIONS
Inguinofemoral lymph nodes can be confidently avoided when sentinel node metastases are excluded by histological ultrastaging. This may reduce the surgical morbidity of conventional inguinofemoral lymphadenectomy, without worsening vulvar cancer prognosis.
Puig-Tintoré
Luis M
LM
Section of Gynecologic Oncology, Institut Clínic de Ginecologia, Obstetrícia i Neonatología (ICGON), Hospital Clínic, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain. lmpuigt@medicina.ub.es
Ordi
Jaume
J
Vidal-Sicart
Sergi
S
Lejárcegui
José A
JA
Torné
Aureli
A
Pahisa
Jaume
J
Iglesias
Xavier
X
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D004396:Coloring Agents; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008751:Methylene Blue; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013668:Technetium Tc 99m Aggregated Albumin; D014846:Vulvar Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery
D004396:Coloring Agents; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid; C025484:iso-sulfan blue; D008751:Methylene Blue