title: Sentinel lymph node biopsy in vulvar cancer: Systematic review, meta-analysis and guideline recommendations.
abstract: OBJECTIVE
  Traditionally, treatment for early stage vulvar cancer has included removal of the primary tumor and inguinofemoral lymph node dissection (IFLD). Sentinel lymph node biopsy (SLNB) has been proposed as an alternative to IFLD for early stage vulvar cancer patients. The aim of this project was to systematically review and assess the potential for harms and benefits with the SLNB procedure in order to make recommendations regarding the adoption of the procedure, selection of patients and appropriate technique and procedures.
  
  
  METHODS
  A working group with expertise in gynecologic oncology and health research methodology was formed to lead the systematic review and process of guideline development. MEDLINE, Embase and The Cochrane Database of Systematic Reviews were searched for relevant articles published up to September 2014. Outcomes of interest included detection, false negative, complication and recurrence rates and indicators related to pathology. Meta-analyses were conducted where appropriate.
  
  
  RESULTS
  The evidence-base of a previously published health technology assessment was adopted. An additional search to update the HTA's evidence base located three systematic reviews, and eleven individual studies that met the inclusion criteria. According to a meta-analysis, per groin detection rate for SLNB using radiocolloid tracer and blue dye was 87% [82-92]. The false negative rate with SLNB was 6.4% [4.4-8.8], and the recurrence rates with SLNB and IFLD were 2.8% [1.5-4.4] and 1.4% [0.5-2.6], respectively. An internal and external review process elicited concerns about the necessity of performing this procedure in an appropriate organizational context.
  
  
  CONCLUSIONS
  SLNB is recommended for women with unifocal tumors<4 cm and clinically non-suspicious nodes in the groin, provided that specific infrastructure and human resource needs are met. Some recommendations for appropriate techniques and procedures are also provided.
authors.affiliation: University of Toronto, Odette Cancer Centre, Division of Gynecologic Oncology, Canada.
authors.forename: Al
authors.initials: A
authors.lastname: Covens
authors.affiliation: McMaster University, Cancer Care Ontario, Hamilton, Ontario, Canada.
authors.forename: Emily T
authors.initials: ET
authors.lastname: Vella
authors.affiliation: McMaster University, Cancer Care Ontario, Hamilton, Ontario, Canada. Electronic address: ekenne@mcmaster.ca.
authors.forename: Erin B
authors.initials: EB
authors.lastname: Kennedy
authors.affiliation: Juravinski Cancer Centre, Hamilton, Ontario, Canada.
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Reade
authors.affiliation: McMaster University, Juravinski Cancer Centre, Division of Gynecologic Oncology, Hamilton, Ontario, Canada.
authors.forename: Waldo
authors.initials: W
authors.lastname: Jimenez
authors.affiliation: Department of Obstetrics and Gynecology University of Ottawa, Ottawa Regional Cancer Centre, Canada.
authors.forename: Tien
authors.initials: T
authors.lastname: Le
mesh_terms: D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D014846:Vulvar Neoplasms / Q000473:pathology*
keywords: Guideline; Meta-analysis; Sentinel lymph node biopsy (SLNB); Systematic review; Vulvar cancer