The impact of inguinal lymph node micrometastases in patients with vulvar cancer.
OBJECTIVE
Inguinofemoral metastases are a major determinant of vulvar cancer relapse. Until today, the impact of micrometastases of inguinal nodes on local recurrence rates of patients with vulvar cancer remains unknown. The purpose of this retrospective study is to evaluate the rates of micrometastases in a series of patients with vulvar cancer treated with radical vulvectomy and inguinofemoral LND and to assess the probability of cancer relapse among this specific category.


METHODS
We conducted a retrospective observational study on patients with vulvar cancer who attended the gynaecological department of Anticancer Hospital of St. Savvas between January 1989 and January 2007. Ultra-staging of lymph nodes for micrometastases was performed after cutting the remaining specimens with a microtome in multiple slices of 3 μm. Subsequently they were stained with traditional hematoxylin and eosin and CK AE1/AE3 antibodies for immunohistochemichal analysis.


RESULTS
Ninety-two patients with primary vulvar malignancies were included in the present retrospective study. Ultrastaging of the lymph nodes revealed micrometastases in five patients (5.4%). Neither the duration of the procedure, nor the number of retrieved lymph nodes was directly associated with the presence of micrometastases. The patients were followed up for more than 5 years. Sixteen recurrences (17.4%) occurred during this period. The presence of micrometastases did not influence the recurrence rate (OR 3.57, 95% CI 0.55-23.36, p = 0.184).


CONCLUSIONS
Ultrastaging of inguinal nodes does not seem to add any benefit in the prediction of local recurrence rates. Future multicenter studies are needed in the field to corroborate our findings.
Third Department of Ob/Gyn, Attikon University Hospital, National and Kapodistrian University of Athens, 66, Dimitriou Gounari Str., 15124, Marousi, Greece. grigorios.derdelis@yahoo.com.
Grigoris
G
Derdelis
Third Department of Ob/Gyn, Attikon University Hospital, National and Kapodistrian University of Athens, 66, Dimitriou Gounari Str., 15124, Marousi, Greece.
Vasilios
V
Pergialiotis
Second Department of Gynaecology, St. Savas Anticancer Hospital, 171 Alexandras Avenue, 11522, Athens, Greece.
Emmanouil
E
Terzakis
First Histopathology Department, Athens Medical School, Laiko Hospital, Athens, Greece.
Nektarios
N
Koufopoulos
First Histopathology Department, Athens Medical School, Laiko Hospital, Athens, Greece.
Ioanna
I
Martzoukou
First Histopathology Department, Athens Medical School, Laiko Hospital, Athens, Greece.
Chara
C
Gakiopoulou
First Histopathology Department, Athens Medical School, Laiko Hospital, Athens, Greece.
Andreas
A
Lazaris
First Histopathology Department, Athens Medical School, Laiko Hospital, Athens, Greece.
Efstratios
E
Patsouris
D000368:Aged; D005260:Female; D006119:Groin / Q000473:pathology; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D061206:Neoplasm Micrometastasis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012189:Retrospective Studies; D014846:Vulvar Neoplasms / Q000473:pathology*
Inguinal; Micrometastases; Ultrastaging; Vulvar cancer