Sentinel lymph nodes in vulvar cancer: management dilemmas
in patients with positive nodes and larger tumors
Andra Nica, Matthew Cesari, Allan Covens, Danielle Vicus, Rachel Kupets, Ray Osborne, Lilian T. Gien
Division of Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
•Although sentinel lymph node (SLN) biopsy has been routinely used in the treatment of invasive vulvar squamous cell carcinoma (SCC), questions still remain regarding the management of patients with positive nodes, as well as regarding its use in patients with larger vulvar tumors.
•The objective of this study is to determine the rate of groin recurrence of women with SLN biopsy in invasive SCC of the vulva, particularly those with positive SLNs, and those with large (≥4cm) primary tumors.
•Patients with positive SLN are more likely to be of older age, have larger primary vulvar tumors, with larger depth of invasion, and higher grade.
•It may be reasonable to omit a full groin dissection for micrometastatic disease in the SLN as the risk of groin recurrence in these patients is low.
Unilateral positive SLN
•The risk of positive contralateral node and risk of contralateral groin recurrence is low; in these patients, full contralateral groin dissection may be omitted.
•The risk of isolated groin recurrence when SLN biopsy is negative may be increased in patients with large (>4cm) tumors. Further studies are needed to clarify the role of SLN use in these patients.