title: Lymphatic mapping and sentinel node biopsy in squamous cell carcinoma of the vulva: systematic review and meta-analysis of the literature.
abstract: OBJECTIVE
  We reviewed the available literature on the accuracy of sentinel node (SN) mapping in the inguinal lymph node staging of vulvar squamous cell carcinoma (SCC).
  
  
  METHODS
  Medline and SCOPUS were searched by using "sentinel AND vulv*" as key words. Studies evaluating the accuracy of SN mapping in the inguinal lymph node staging of vulvar SCC were included if enough data could be extracted for calculation of detection rate and/or sensitivity. Only studies validated by inguinal lymph node dissection were included for sensitivity meta-analysis.
  
  
  RESULTS
  Forty-nine studies were included in the systematic review. Pooled patient and groin basis SN detection rates were 94.4% [92.4-95.9] and 84.6% [80.5-88], respectively. Pooled patient and groin basis sensitivity were 92% [90-95] and 92% [89-94], respectively (or 8% [5-10] and 8% [6-11] false negative rates). Pooled negative predictive values were 97% [96-98] and 98% [97-99] for patient and groin basis analyses respectively. SN detection rate and sensitivity were related to mapping method (blue dye, radiotracer, or both) and location of the tumor (midline vs. lateral tumors). Patients with palpable inguinal nodes had lower detection rate and sensitivity.
  
  
  CONCLUSIONS
  SN mapping is an accurate method for inguinal node staging in vulvar SCC. Combining radiotracer and blue dye methods and excluding patients with palpable inguinal nodes result in the highest detection rate and sensitivity. For midline tumors possible false negative results of SN mapping should be taken into account.
authors.affiliation: Women's Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Malihe
authors.initials: M
authors.lastname: Hassanzade
authors.forename: Matin
authors.initials: M
authors.lastname: Attaran
authors.forename: Giorgio
authors.initials: G
authors.lastname: Treglia
authors.forename: Zohreh
authors.initials: Z
authors.lastname: Yousefi
authors.forename: Ramin
authors.initials: R
authors.lastname: Sadeghi
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D014846:Vulvar Neoplasms / Q000473:pathology*