title: Characteristics of sentinel lymph nodes' metastatic involvement in early stage of vulvar cancer.
abstract: BACKGROUND
  Nodal involvement is one of the most significant prognostic factors in early-stage vulvar cancer.
  
  
  OBJECTIVE
  To determine the diagnostic accuracy of sentinel lymph node (SLN) detection in early-stage vulvar cancer and to describe the characteristics of metastatic lymph node involvement.
  
  
  METHODS
  Of 23 women with early-stage squamous cell vulvar cancer included in the study, five had lateral lesions and 18 had midline lesions. SLN detection was performed by using a radioactive tracer and blue dye, followed by radical vulvectomy or radical wide excision with uni/bilateral inguinofemoral lymphadenectomy, depending on tumour size and localization. SLNs were subsequently examined with haematoxylin-eosin and immunohistochemistry.
  
  
  RESULTS
  The SLN detection was successful in all 23 women (100%) and in 38 of 41 groins (92.3%) tested. The total number of SLNs was 67, with an average of 1.76 per groin. In total, 20 positive SLNs were detected in 14 of 23 patients. From a total of 20 positive SLNs, micrometastases were found in five SLNs and isolated tumour cells in one SLN. We experienced one case with a false negativity of SLN. Sensitivity, negative predictive value, accuracy and false negativity of SLN detection were 93.3%, 88.8%, 95.6% and 7.1% respectively.
  
  
  CONCLUSIONS
  The SLN biopsy performed by an experienced team is a feasible method, with high accuracy in patients with early-stage vulvar cancer. Prognostic value of micrometastases should be confirmed in further studies.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava, Czech Republic.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Klát
authors.forename: Libor
authors.initials: L
authors.lastname: Sevcík
authors.forename: Ondrej
authors.initials: O
authors.lastname: Simetka
authors.forename: Petar
authors.initials: P
authors.lastname: Gráf
authors.forename: Tomás
authors.initials: T
authors.lastname: Waloschek
authors.forename: Otakar
authors.initials: O
authors.lastname: Kraft
authors.forename: Zdena
authors.initials: Z
authors.lastname: Jaluvková
authors.forename: Martin
authors.initials: M
authors.lastname: Procházka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006119:Groin; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D021701:Sentinel Lymph Node Biopsy; D014846:Vulvar Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery