Lymphatic mapping and sentinel lymph node detection in women with vaginal cancer.
OBJECTIVE
To determine the patterns of lymphatic drainage from primary vaginal cancers utilizing lymphoscintigraphy and to determine if this clinical information would affect treatment planning.


METHODS
For women with newly diagnosed vaginal cancer, pretreatment lymphatic mapping and sentinel lymph node identification were performed using lymphoscintigraphy. In patients who underwent surgery, sentinel lymph nodes were identified intraoperatively using radiocolloid and patent blue dye. The impact of pretreatment lymphoscintigraphy findings on radiation planning in women who received radiation as initial treatment was noted.


RESULTS
Fourteen women were enrolled during the study period. At least 1 sentinel lymph node was identified on pretreatment lymphoscintigraphy in 11 patients (79%). The median number of sentinel nodes found per patient was 2, and bilateral sentinel nodes were found in 6 (55%) of the 11 patients with sentinel nodes identified. Among these 11 patients, 5 (45%) had sentinel nodes identified in the groin only, 4 (36%) had sentinel nodes identified in the pelvis only, and 2 (18%) had sentinel nodes identified in both the groin and the pelvis. No relationship was observed between sentinel lymph node location and primary tumor histologic subtype or location. Three (33%) of the 9 women treated initially with radiation therapy had their radiation field altered as a result of the lymphoscintigraphy findings.


CONCLUSIONS
In women with vaginal cancer, lymphatic drainage from the primary lesion does not always follow the lymphatic channels that would have been predicted anatomically. The addition of lymphoscintigraphy to the pretreatment evaluation for women with vaginal cancer may significantly improve comprehensive treatment planning.
Frumovitz
Michael
M
Department of Gynecologic Oncology, CPB6.3244, Unit 1362, The University of Texas M.D. Anderson Cancer Center, 1155 Herman Pressler, Houston, TX 77030, USA. mfrumovitz@mdanderson.org
Gayed
Isis W
IW
Jhingran
Anuja
A
Euscher
Elizabeth D
ED
Coleman
Robert L
RL
Ramirez
Pedro T
PT
Levenback
Charles F
CF
D000230:Adenocarcinoma / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000473:pathology; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging / Q000473:pathology*; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D013671:Technetium Tc 99m Sulfur Colloid; D014625:Vaginal Neoplasms / Q000473:pathology*
D013671:Technetium Tc 99m Sulfur Colloid