title: Groin lymph node detection and sentinel lymph node biopsy in vulvar cancer.
abstract: OBJECTIVE
  To identify suitable diagnostic tools and evaluate the efficacy of sentinel lymph node (SLN) biopsy for inguinal lymph node metastasis in vulvar cancer.
  
  
  METHODS
  Data from 41 patients with vulvar cancer were evaluated retrospectively, including magnetic resonance imaging (MRI) measurements, SLN biopsy status, groin lymph node metastasis, and prognosis.
  
  
  RESULTS
  SLN biopsy was conducted in 12 patients who had stage I to III disease. Groin lymphadenectomy was omitted in five of the nine patients with negative SLNs. All SLN-negative patients who did not undergo groin lymphadenectomy showed no evidence of disease after treatment. On MRI, the long and short diameters of the inguinal node were significantly longer in metastasis-positive cases, compared with negative cases, in 25 patients whose nodes were evaluated pathologically (long diameter, 12.8 mm vs. 8.8 mm, p=0.025; short diameter, 9.2 mm vs. 6.7 mm, p=0.041). The threshold of >10.0 mm for the long axis gave a sensitivity, specificity, positive predictive value, and negative predictive value of 87.5%, 70.6%, 58.3%, and 92.3%, respectively, using a binary classification test. Decision tree analysis revealed a sensitivity, specificity, and accuracy of 87.5%, 70.6%, and 76.0%, respectively, with the threshold of >10.0 mm for the long axis on MRI. The criteria of >10.0 mm for the long axis on MRI predicted an advanced stage and poorer prognosis using a validation set of 15 cases (p=0.028).
  
  
  CONCLUSIONS
  Minimally invasive surgery after preoperative evaluation on MRI and SLN biopsy is a feasible strategy for patients with vulvar cancer.
authors.affiliation: Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan.
authors.forename: Chieko
authors.identifier: http://orcid.org/0000-0001-9858-8049
authors.initials: C
authors.lastname: Sakae
authors.affiliation: Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan. soulken@kuhp.kyoto-u.ac.jp.
authors.forename: Ken
authors.identifier: http://orcid.org/0000-0002-7669-1405
authors.initials: K
authors.lastname: Yamaguchi
authors.affiliation: Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan.
authors.forename: Noriomi
authors.initials: N
authors.lastname: Matsumura
authors.affiliation: Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
authors.forename: Hidekatsu
authors.identifier: http://orcid.org/0000-0002-9994-2131
authors.initials: H
authors.lastname: Nakai
authors.affiliation: Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan.
authors.forename: Yumiko
authors.identifier: http://orcid.org/0000-0002-4654-0585
authors.initials: Y
authors.lastname: Yoshioka
authors.affiliation: Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan.
authors.forename: Eiji
authors.identifier: http://orcid.org/0000-0001-9399-1015
authors.initials: E
authors.lastname: Kondoh
authors.affiliation: Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan.
authors.forename: Junzo
authors.identifier: http://orcid.org/0000-0002-7750-0623
authors.initials: J
authors.lastname: Hamanishi
authors.affiliation: Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan.
authors.forename: Kaoru
authors.identifier: http://orcid.org/0000-0001-9648-158X
authors.initials: K
authors.lastname: Abiko
authors.affiliation: Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan.
authors.forename: Masafumi
authors.identifier: http://orcid.org/0000-0003-2412-4430
authors.initials: M
authors.lastname: Koshiyama
authors.affiliation: Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan.
authors.forename: Tsukasa
authors.identifier: http://orcid.org/0000-0003-0066-3747
authors.initials: T
authors.lastname: Baba
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Aki
authors.identifier: http://orcid.org/0000-0001-5131-2870
authors.initials: A
authors.lastname: Kido
authors.affiliation: Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Mandai
authors.affiliation: Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Konishi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006119:Groin; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000071036:Sentinel Lymph Node / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D014846:Vulvar Neoplasms / Q000473:pathology* / Q000601:surgery
keywords: Groin; Lymph Node; Sentinel Lymph Node Biopsy; Vulvar Neoplasms