Skip to main content

Advertisement

SpringerLink
Log in

Detection of sentinel lymph node in vulvar cancer using 99mTc-labeled colloid lymphoscintigraphy, blue dye, and indocyanine-green fluorescence: a meta-analysis of studies published in 2010–2020

  • Review
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objectives

Sentinel lymph node (SLN) biopsy is widely accepted in the surgical staging of early vulvar cancer, although the most accurate method for its identification is not yet defined. This meta-analysis aimed to determine the technique with the highest pooled detection rate (DR) for the identification of SLN and compare the average number of SLNs detected by planar lymphoscintigraphy (PL), single-photon emission computed tomography/computed tomography (SPECT/CT), blue dye and indocyanine green (ICG) fluorescence.

Methods

The meta-analysis was conducted according to the PRISMA guideline. The search string was: “sentinel” and “vulv*”, with date restriction from 1st January 2010 until Dec 31st, 2020. Three investigators selected studies based on: (1) a study cohort or a subset of a minimum of 10 patients with vulvar cancer undergoing either PL, SPECT/CT, blue-dye, or ICG fluorescence for the identification of SLN; (2) the possibility to extrapolate the DR or the average number of SLNs detected by a single technique (3) no evidence of other malignancies in the patient history.

Results

A total of 30 studies were selected. In a per-patient and a per-groin analysis, the DR for SLN of PL was respectively 96.13% and 92.57%; for the blue dye was 90.44% and 66.21%; for the ICG, the DR was 91.90% and 94.80%. The pooled DR of SPECT/CT was not calculated, since only two studies were performed in this setting.

At a patient-based analysis, no significant difference was documented among PL, blue dye, and ICG (p = 0.28). At a per-groin analysis, PL and ICG demonstrated a significantly higher DR compared to blue dye (p < 0.05). The average number of SLNs, on a per-patient analysis, was available only for PL and ICG with a median number of 2.61 and 1.78 lymph nodes detected, respectively, and no significant statistical difference.

Conclusions

This meta-analysis favors the use of ICG and PL alone and in combination over blue dye for the identification of the SLN in vulvar cancer. Future studies may investigate whether the combined approach allows the highest DR of SLN in patients with vulvar cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Siegel RL et al (2018) Cancer statistics, 2018. CA Cancer J Clin 68:7–30

    Article  PubMed  Google Scholar 

  2. Moher D et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097

    Article  PubMed  PubMed Central  Google Scholar 

  3. Akrivos N et al (2011) Detection and credibility of sentinel node in vulvar cancer: a single institutional study and short review of literature. Arch Gynecol Obstet 284:1551–1556

    Article  PubMed  Google Scholar 

  4. Bogliolo S et al (2015) Sentinel node mapping with radiotracer alone in vulvar cancer: a five year single-centre experience and literature review. Eur J Gynaecol Oncol 36:10–15

    CAS  PubMed  Google Scholar 

  5. Boran N et al (2013) Sentinel lymph node detection and accuracy in vulvar cancer: experience of a tertiary center in Turkey. J Turkish German Gynecol Assoc 14:146–152

    Article  Google Scholar 

  6. Brammen L et al (2014) Sentinel lymph node detection in vulvar cancer patients: a 20 years analysis. Hell J Nucl Med 17(3):184–189. https://doi.org/10.1967/s002449910143

    Article  PubMed  Google Scholar 

  7. Coleman RL et al (2013) Is bilateral lymphadenectomy for midline squamous carcinoma of the vulva always necessary? An analysis from gynecologic oncology group (GOG) 173. Gynecol Oncol 128:155–159

    Article  PubMed  Google Scholar 

  8. Collarino A et al (2015) The use of SPECT/CT for anatomical mapping of lymphatic drainage in vulvar cancer: possible implications for the extent of inguinal lymph node dissection. Eur J Nucl Med Mol Imaging 42:2064–2071

    Article  PubMed  Google Scholar 

  9. Crane LM et al (2011) Intraoperative near-infrared fluorescence imaging for sentinel lymph node detection in vulvar cancer: first clinical results. Gynecol Oncol 120:291–295

    Article  CAS  PubMed  Google Scholar 

  10. Devaja O et al (2011) A prospective study of sentinel lymph node detection in vulval carcinoma: is it time for a change in clinical practice? Int J Gynecol Cancer 21:559–564

    Article  PubMed  Google Scholar 

  11. Ennik TA et al (2011) Effects of previous surgery on the detection of sentinel nodes in women with vulvar cancer. Int J Gynecol Cancer 21:1679–1683

    Article  PubMed  Google Scholar 

  12. Froeding LP et al (2020) Recurrence and survival rates in node negative patients after sentinel node biopsy for early-stage vulva cancer—a nationwide study. Gynecol Oncol 156:124–130

    Article  PubMed  Google Scholar 

  13. García-Iglesias A et al (2012) Sentinel node disection in the treatment of early stages of vulvar cancer. Eur J Gynaecol Oncol 33:151–154

    PubMed  Google Scholar 

  14. Garganese G et al (2017) Groin sentinel node biopsy and (18)F-FDG PET/CT-supported preoperative lymph node assessment in cN0 patients with vulvar cancer currently unfit for minimally invasive inguinal surgery: the GroSNaPET study. Eur J Surg Oncol 43:1776–1783

    Article  CAS  PubMed  Google Scholar 

  15. Jedryka MA et al (2020) Superparamagnetic iron oxide: a novel tracer for sentinel lymph node detection in vulvar cancer. Int J Gynecol Cancer 30(9):1280–1284. https://doi.org/10.1136/ijgc-2020-001458

    Article  PubMed  Google Scholar 

  16. Klapdor R et al (2015) SPECT/CT for SLN dissection in vulvar cancer: Improved SLN detection and dissection by preoperative three-dimensional anatomical localisation. Gynecol Oncol 138:590–596

    Article  CAS  PubMed  Google Scholar 

  17. Klar M et al (2011) Sentinel lymph node detection in patients with vulvar carcinoma; feasibility of intra-operative mapping with technetium-99m-labeled nanocolloid. Eur J Surg Oncol 37:818–823

    Article  CAS  PubMed  Google Scholar 

  18. Mathéron HM et al (2013) Multimodal surgical guidance towards the sentinel node in vulvar cancer. Gynecol Oncol 131:720–725

    Article  PubMed  Google Scholar 

  19. Orta N et al (2020) Sentinel lymph node biopsy procedure in squamous vulvar cancer. 10 years follow-up analysis. Rev Esp Med Nucl Imagen Mol 39:360–6

    CAS  PubMed  Google Scholar 

  20. Piatek S et al (2020) Retrospective analysis of the diagnostic effectiveness of the sentinel lymph node biopsy (SLNB) in vulvar cancer. Ginekol Pol 91:379–382

    Article  PubMed  Google Scholar 

  21. Piechowicz M et al (2020) Metastatic and non-metastatic sentinel inguinofemoral lymph nodes in vulvar cancer show an increased lymphangiogenesis. Ann Agric Environl Med AAEM 27:123–128

    Article  Google Scholar 

  22. Prader S et al (2020) Sentinel lymph node mapping with fluorescent and radioactive tracers in vulvar cancer patients. Arch Gynecol Obstet 301:729–736

    Article  CAS  PubMed  Google Scholar 

  23. Robison K et al (2014) Long-term follow-up of vulvar cancer patients evaluated with sentinel lymph node biopsy alone. Gynecol Oncol 133:416–420

    Article  PubMed  Google Scholar 

  24. Schaafsma BE et al (2013) Near-infrared fluorescence sentinel lymph node biopsy in vulvar cancer: a randomised comparison of lymphatic tracers. BJOG 120:758–764

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Soergel P et al (2017) Sentinel lymphadenectomy in vulvar cancer using near-infrared fluorescence from indocyanine green compared with technetium 99m nanocolloid. Int J Gynecol Cancer 27:805–812

    Article  PubMed  Google Scholar 

  26. Sykes P et al (2019) Pathological process has a crucial role in sentinel node biopsy for vulvar cancer. Gynecol Oncol 153:292–296

    Article  PubMed  Google Scholar 

  27. Underwood M et al (2013) The use of sentinel node sampling in vulval cancer. J Obstetrics Gynaecol 33:892–897

    Article  CAS  Google Scholar 

  28. van Doorn HC et al (2016) Repeat sentinel lymph node procedure in patients with recurrent vulvar squamous cell carcinoma is feasible. Gynecol Oncol 140:415–419

    Article  PubMed  Google Scholar 

  29. Verbeek FP et al (2015) Sentinel lymph node biopsy in vulvar cancer using combined radioactive and fluorescence guidance. Int J Gynecol Cancer 25:1086–1093

    Article  PubMed  PubMed Central  Google Scholar 

  30. Woelber L et al (2013) Secondary sentinel node biopsy after previous excision of the primary tumor in squamous cell carcinoma of the vulva. Ann Surg Oncol 20:1701–1706

    Article  PubMed  Google Scholar 

  31. Zekan J et al (2012) Reliability of sentinel node assay in vulvar cancer: the first Croatian validation trial. Gynecol Oncol 126:99–102

    Article  PubMed  Google Scholar 

  32. Lahtinen O et al (2018) Preoperative sentinel lymph node localization in vulvar cancer: preliminary experience with inguinal intradermal contrast-enhanced ultrasound. Eur Radiol 28:2089–2095

    Article  CAS  PubMed  Google Scholar 

  33. Levenback CF et al (2012) Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: a gynecologic oncology group study. J Clin Oncol 30:3786–3791

    Article  PubMed  PubMed Central  Google Scholar 

  34. Broach V et al (2020) Evolution and outcomes of sentinel lymph node mapping in vulvar cancer. Int J Gynecol Cancer 30:383–386

    Article  PubMed  PubMed Central  Google Scholar 

  35. Quartuccio N et al (2020) Comparison of (99m)Tc-labeled colloid SPECT/CT and planar lymphoscintigraphy in sentinel lymph node detection in patients with melanoma: a meta-analysis. J Clin Med 9(6):1680. https://doi.org/10.3390/jcm9061680

    Article  CAS  Google Scholar 

  36. Meads C et al (2014) Sentinel lymph node biopsy in vulval cancer: systematic review and meta-analysis. Br J Cancer 110:2837–2846

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The authors report no external funding source for this study.

Author information

Author notes

  1. Mariano Catello Di Donna and Natale Quartuccio have equally contributed to this work.

Authors and Affiliations

  1. Department of Gynecologic Oncology, University of Palermo, Piazza Nicola Leotta, 3, 90127, Palermo, Italy

    Mariano Catello Di Donna, Vincenzo Giallombardo, Giulio Sozzi & Vito Chiantera

  2. Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy

    Mariano Catello Di Donna

  3. Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy

    Natale Quartuccio, Letterio Sturiale, Annachiara Arnone, Rosaria Ricapito & Gaspare Arnone

Authors
  1. Mariano Catello Di Donna
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Natale Quartuccio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vincenzo Giallombardo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Letterio Sturiale
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Annachiara Arnone
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rosaria Ricapito
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giulio Sozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gaspare Arnone
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Vito Chiantera
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MCDD: conception and design of the study; manuscript preparation; data collection; data analysis and interpretation. NQ: conception and design of the study; manuscript preparation; data collection; data analysis and interpretation. VG: manuscript preparation, data collection, data analysis, and interpretation. LS: data collection; data analysis and interpretation. AA: data collection; data analysis. RR: data collection. GS: conception and design of the study; manuscript preparation. GA: conception and design of the study; definitive manuscript evaluation. VC: conception and design of the study, data analysis, and interpretation, definitive manuscript evaluation.

Corresponding author

Correspondence to Mariano Catello Di Donna.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest and nothing to disclose.

Ethical approval

Formal Institutional Review Board approval was not required for this type of article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Di Donna, M.C., Quartuccio, N., Giallombardo, V. et al. Detection of sentinel lymph node in vulvar cancer using 99mTc-labeled colloid lymphoscintigraphy, blue dye, and indocyanine-green fluorescence: a meta-analysis of studies published in 2010–2020. Arch Gynecol Obstet 307, 1677–1686 (2023). https://doi.org/10.1007/s00404-022-06605-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-022-06605-1

Keywords

Search

Navigation