The role of preoperative ultrasound evaluation of inguinal lymph nodes in patients with vulvar malignancy.
OBJECTIVE
Inguinal lymphadenectomy in vulvar malignancies is associated with significant morbidity, especially in patients over 70 years old. Under certain conditions, surgical guidelines recommend biopsy and evaluation of the sentinel node in early vulvar cancer. The purpose of our study is to evaluate ultrasonography as a predictor of inguinal lymph node involvement.


METHODS
A retrospective study was performed with 60 patients who had vulvar malignancies (92% of which were squamous cell carcinomas) and who were treated at our hospital between 2002 and 2012. The patients ranged in age from 35 to 89 years, with a median age of 76 years. In total, 118 groin scans were retrospectively evaluated for sonographic evidence of lymph node involvement (i.e., absence of fatty hilum, irregular shape, cortical region diameter and vascularization pattern). The results were then compared with histopathologically confirmed lymph node status.


RESULTS
Histopathologically confirmed lymph node status was available for 107 of the inguinal nodes examined by ultrasound, and lymph node metastases were found in 38 (35.5%) cases. The presence or absence of inguinal lymph node metastases was correctly identified by sonography in 92 (86.0%) of the scanned areas. Sensitivity was 76.3%, specificity was 91.3%, and positive and negative predictive values were 82.9% and 87.5%, respectively.


CONCLUSIONS
Ultrasonography of the inguinal lymph nodes showed a relatively high sensitivity and specificity for predicting inguinal tumor metastases. However, our results indicate that surgical lymph node staging is still needed to precisely determine inguinal lymph node status in vulvar cancer, especially because a missed lymph node-metastasis is often fatal.
Universitätsfrauenklinik Ulm, Prittwitzstrasse 43, 89075fl, Germany. Electronic address: Nikolaus.de-gregorio@uniklinik-ulm.de.
Nikolaus
N
de Gregorio
Florian
F
Ebner
Lukas
L
Schwentner
Thomas W P
TW
Friedl
Miriam
M
Deniz
Krisztián
K
Látó
Rolf
R
Kreienberg
Wolfgang
W
Janni
Dominic
D
Varga
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000556:secondary; D005260:Female; D006801:Humans; D007264:Inguinal Canal / Q000000981:diagnostic imaging*; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D014463:Ultrasonography; D014846:Vulvar Neoplasms / Q000473:pathology*
Inguinal lymph nodes; Inguinal ultrasound; Sentinel lymph node biopsy; Vulvar cancer