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Sentinel Lymph Node Evaluation in Early-Stage Vulvar Cancer

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Opinion Statement

Sentinel lymph node mapping (SLNM) and dissection (SLND) should be used as an alternative to full inguinofemoral lymph node dissection (IFLND) in select patients with early-stage vulvar cancer. IFLND is associated with high postoperative complications such as wound breakdown, lymphedema, lymphocyst formation, and infection. SLND in select patients offers a safe, effective, and less morbid alternative. Candidates for SLND include patients with a unifocal vulvar tumor less than four centimeters, clinically negative lymph nodes, and no prior inguinofemoral surgeries. SLND should ideally be performed by a high-volume SLN surgeon. Most commonly, SLND is performed using both radiocolloid lymphoscintigraphy (e.g., Technetium-99) and a visual tracer such as blue dye; however, near infrared imaging with indocyanine green injection is becoming more widely adopted. Further prospective studies are needed to examine the safety and efficacy of various techniques for SLND. SLND has been demonstrated to be cost-effective, especially when including perioperative complications. Further studies are needed to demonstrate quality of life differences between IFLND and SLND.

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References  and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17–48.

    Article  PubMed  Google Scholar 

  2. Bray F, Laversanne M, Weiderpass E, Arbyn M. Geographic and temporal variations in the incidence of vulvar and vaginal cancers. Int J Cancer. 2020;147(10):2764–71.

    Article  CAS  PubMed  Google Scholar 

  3. de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017;141(4):664–70.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Farias-Eisner R, Cirisano FD, Grouse D, Leuchter RS, Karlan BY, Lagasse LD, et al. Conservative and individualized surgery for early squamous carcinoma of the vulva: the treatment of choice for stage I and II (T1–2N0-1M0) disease. Gynecol Oncol. 1994;53(1):55–8.

    Article  CAS  PubMed  Google Scholar 

  5. Network NCC. NCCN Clinical Practice Guidelines in Oncology for Vulvar Cancer. NCCN; 2024.

  6. Van der Zee AG, Oonk MH, De Hullu JA, Ansink AC, Vergote I, Verheijen RH, et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol. 2008;26(6):884–9 This article is of outstanding importance as it is the first of two landmark trials demonstratinng the safety and efficacy of sentinel lymph node dissection iin select patients with early vulvar cancer.

    Article  PubMed  Google Scholar 

  7. Cham S, Chen L, Burke WM, Hou JY, Tergas AI, Hu JC, et al. Utilization and outcomes of sentinel lymph node biopsy for vulvar cancer. Obstet Gynecol. 2016;128(4):754–60.

    Article  PubMed  PubMed Central  Google Scholar 

  8. McCann GA, Cohn DE, Jewell EL, Havrilesky LJ. Lymphatic mapping and sentinel lymph node dissection compared to complete lymphadenectomy in the management of early-stage vulvar cancer: A cost-utility analysis. Gynecol Oncol. 2015;136(2):300–4.

    Article  PubMed  Google Scholar 

  9. •• Levenback CF, Ali S, Coleman RL, Gold MA, Fowler JM, Judson PL, et al. Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: a gynecologic oncology group study. J Clin Oncol. 2012;30(31):3786-91. This article is of outstanding importance as it is the second of two landmark trials demonstratinng the safety and efficacy of sentinel lymph node dissection iin select patients with early vulvar cancer.

  10. Klapdor R, Hillemanns P, Wölber L, Jückstock J, Hilpert F, de Gregorio N, et al. Outcome after sentinel lymph node dissection in vulvar cancer: a subgroup analysis of the AGO-CaRE-1 study. Ann Surg Oncol. 2017;24(5):1314–21.

    Article  PubMed  Google Scholar 

  11. Covens A, Vella ET, Kennedy EB, Reade CJ, Jimenez W, Le T. Sentinel lymph node biopsy in vulvar cancer: systematic review, meta-analysis and guideline recommendations. Gynecol Oncol. 2015;137(2):351–61.

    Article  PubMed  Google Scholar 

  12. Oonk MH, van Os MA, de Bock GH, de Hullu JA, Ansink AC, van der Zee AG. A comparison of quality of life between vulvar cancer patients after sentinel lymph node procedure only and inguinofemoral lymphadenectomy. Gynecol Oncol. 2009;113(3):301–5.

    Article  CAS  PubMed  Google Scholar 

  13. Erickson BK, Divine LM, Leath CA, Straughn JM. Cost-effectiveness analysis of sentinel lymph node biopsy in the treatment of early-stage vulvar cancer. Int J Gynecol Cancer. 2014;24(8):1480–5.

    Article  PubMed  PubMed Central  Google Scholar 

  14. de Hullu JA, Hollema H, Piers DA, Verheijen RH, van Diest PJ, Mourits MJ, et al. Sentinel lymph node procedure is highly accurate in squamous cell carcinoma of the vulva. J Clin Oncol. 2000;18(15):2811–6.

    Article  PubMed  Google Scholar 

  15. Crane LM, Themelis G, Arts HJ, Buddingh KT, Brouwers AH, Ntziachristos V, et al. Intraoperative near-infrared fluorescence imaging for sentinel lymph node detection in vulvar cancer: first clinical results. Gynecol Oncol. 2011;120(2):291–5.

    Article  CAS  PubMed  Google Scholar 

  16. • Schaafsma BE, Verbeek FP, Peters AA, van der Vorst JR, de Kroon CD, van Poelgeest MI, et al. Near-infrared fluorescence sentinel lymph node biopsy in vulvar cancer: a randomised comparison of lymphatic tracers. BJOG. 2013;120(6):758-64. This article is of importance as it demonstrates the potential use of a new way to potentially trace vulvar sentinel lymph nodes.

  17. Hutteman M, van der Vorst JR, Gaarenstroom KN, Peters AA, Mieog JS, Schaafsma BE, et al. Optimization of near-infrared fluorescent sentinel lymph node mapping for vulvar cancer. Am J Obstet Gynecol. 2012;206(1):89.e1-5.

    Article  PubMed  Google Scholar 

  18. Mathéron HM, van den Berg NS, Brouwer OR, Kleinjan GH, van Driel WJ, Trum JW, et al. Multimodal surgical guidance towards the sentinel node in vulvar cancer. Gynecol Oncol. 2013;131(3):720–5.

    Article  PubMed  Google Scholar 

  19. • Verbeek FP, Tummers QR, Rietbergen DD, Peters AA, Schaafsma BE, van de Velde CJ, et al. Sentinel lymph node biopsy in vulvar cancer using combined radioactive and fluorescence guidance. Int J Gynecol Cancer. 2015;25(6):1086-93. This article is of importance as it outlines the common techniques used to detect sentinel lymph nodes ini early stage vulvar cancer.

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Authors and Affiliations

  1. Vanderbilt University Medical Center, Vanderbilt Ingram Cancer Center, 1211 21 St Ave Suite B-1126, Nashville, TN, 37232, USA

    Courtney A. Penn MD, Mali K. Schneiter DO, MBA & Catherine H. Watson MD

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  1. Courtney A. Penn MD
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  2. Mali K. Schneiter DO, MBA
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  3. Catherine H. Watson MD
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CP, MS and CW all contributed to writing the main manuscript text. MS edited, revised and submitted the manuscript.

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Correspondence to Mali K. Schneiter DO, MBA.

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Penn, C.A., Schneiter, M.K. & Watson, C.H. Sentinel Lymph Node Evaluation in Early-Stage Vulvar Cancer. Curr. Treat. Options in Oncol. 25, 20–26 (2024). https://doi.org/10.1007/s11864-023-01165-1

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  • DOI: https://doi.org/10.1007/s11864-023-01165-1

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