Occult lymph node metastases in early stage vulvar carcinoma patients.
OBJECTIVE
In early stage vulvar carcinoma patients, there is at trend towards individualized treatment in order to reduce morbidity and sequela following inguinal lymph node dissection. However, recurrences in the groin are almost always fatal. In the present study, we address the occult lymph node metastases in vulvar squamous cell carcinoma patients by using serial sectioning and immunostaining of lymph nodes in a larger series of vulvar carcinoma patients and relate the findings to clinical follow-up data.


METHODS
From 75 vulvar squamous cell carcinoma patients staged surgical FIGO I-III, 421 lymph nodes found negative at the hematoxylin & eosin (H&E) routine investigation were scrutinized. From formalin-fixed and paraffin-embedded tissues, sections were cut with 150 mum interval and stained with H&E and cytokeratin AE1/AE3. Two classes were used to describe the amount of tumor cells: <100 cells and >100 cells.


RESULTS
Positive cytokeratin AE1/AE3 staining was found in 25/421 (6%) of the lymph nodes. Occult lymph node metastases were found in 17/75 (23%) of the patients. Correlation was found between lymph node metastasis and site of recurrence (P = 0.01). Twenty-eight percent of the patients had relapse.


CONCLUSIONS
The present study underlines the importance of serial sectioning and immunostaining of lymph nodes in the search for micrometastases in vulvar carcinoma patients. However, the results of the present study do not suggest a more thorough examination of non-sentinel lymph nodes in vulvar carcinoma patients where the sentinel lymph nodes are thoroughly examined.
Knopp
Synne
S
Department of Pathology, University of Oslo, Faculty Division, The Norwegian Radium Hospital, Montebello, 0310 Oslo, Norway. synne.knopp@klinmed.uio.no
Holm
Ruth
R
Tropé
Claes
C
Nesland
Jahn M
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000556:secondary*; D004801:Eosine Yellowish-(YS); D005260:Female; D006416:Hematoxylin; D006801:Humans; D007633:Keratins; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013194:Staining and Labeling / Q000379:methods; D014846:Vulvar Neoplasms / Q000473:pathology*
D007633:Keratins; D004801:Eosine Yellowish-(YS); D006416:Hematoxylin