Evaluation of preoperative lymphoscintigraphy and sentinel node procedure in vulvar cancer.
OBJECTIVE
To assess the value of preoperative lymphoscintigraphy, and to evaluate the validity and feasibility of the sentinel node (SN) procedure in vulvar carcinoma.


METHODS
Retrospective clinical and histopathological review of 77 patients with invasive squamous cell carcinoma in vulva who were treated at Karolinska University Hospital Stockholm, Sweden, from 2000 to 2007. The patients underwent SN mapping preoperatively with radioactive tracer and blue dye (n=60) or only blue dye (n=17). The SN was removed separately followed by complete inguinofemoral lymphadenectomy.


RESULTS
The relation between SNs detected on the scintigram and those found during surgery showed good agreement using weighted kappa. The detection rate of SN was 98% for radioisotope plus blue dye, and 94% for blue dye alone. Two cases of false negative SN (false negative rate 2.7%) were found, both with large midline tumors.


CONCLUSIONS
Preoperative scintigram is a valuable help to identify and localize the SNs and gives the best estimate of the accurate number but cannot determine if unilateral or bilateral groins should be explored in cases of midline tumors. Our results are in favor of using radioisotope and blue dye to identify the SNs. This study support previous reports that the method is not recommended for tumors larger than 40 mm to optimize detection of SN and minimize the false negative detection rate.
Lindell
Gunnel
G
Department of Women's and Children's Health, Division for Obstetrics and Gynecology, Karolinska Institutet, 17176 Stockholm, Sweden. gunnel.lindell@karolinska.se
Jonsson
Cathrine
C
Ehrsson
Radmila Jovanovic
RJ
Jacobsson
Hans
H
Danielsson
Kristina Gemzell
KG
Källström
Britta Nordström
BN
Larson
Barbro
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D006119:Groin; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D014846:Vulvar Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology