[Interpretation of sentinel node identification in vulvar cancer].
OBJECTIVE
Sentinel node (SN) identification in vulvar carcinoma would avoid groin dissection and its complications in early stages, but we first have to validate the method, as an unrecognised node metastasis is detrimental to survival.


METHODS
Since June 2002, 38 patients with T1 or T2 lesions underwent SN identification by radioactive tracer injection and scintigraphy with, on the following day, per operative use of a handheld probe +/- patent blue dye. In case of a midline lesion, a bilateral inguinal dissection was performed whatever the result of SN identification. SN free from disease were ultrastaged with immunohistochemistry.


RESULTS
1 or more SN were identified in 36 out of 38 patients. 64 groins were analysed, 15 with node metastases. In 9 out of these 15 cases the SN was metastatic, in 5 it had not been identified, and in 1 it was a false negative. In these last 6 cases, there were massively metastatic nodes in the groin. In 19 out of the 26 midline lesions the surgeon identified only unilateral SN. The side without SN contained metastatic nodes in 5 cases.


CONCLUSIONS
Failure in SN identification is sometimes related to a massively invaded node. This should be taken into account especially in the management of midline tumors where a seemingly unilateral drainage at scintigraphy warrants nevertheless a surgical assessment of the mute groin.
Louis-Sylvestre
C
C
Service de gynécologie-obstétrique, CHI de Créteil, 40, avenue de Verdun, 94010 Créteil cedex, France. louissylvestre@chicreteil.fr
Evangelista
E
E
Léonard
F
F
Itti
E
E
Meignan
M
M
Paniel
B-J
BJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006119:Groin; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy; D014846:Vulvar Neoplasms / Q000473:pathology*