Sentinel Node Biopsy Can Reduce Surgical Complications in Vulvar Cancer

Sentinel node biopsy should become standard treatment for selected patients with early stage vulvar cancer, exhorts a new study.

Researchers from the University Medical Center (Groningen, Holland), Charité-Universitätsmedizin Berlin (Germany), and other institutions performed a total of 623 sentinel node procedures on 403 women with squamous cell cancer of the vulva at 15 participating centers (located throughout Europe) between March 2000 and June 2006. The sentinel node procedure involved injecting a radioactive tracer and blue dye in the area around the tumor, and then using a gamma detector to locate the first lymph or sentinel node to which it drains. The node was surgically removed, and if on pathological examination found to be free of cancer cells, the patient was left alone with regular observation for the next two years, at intervals of every two months.

The results showed that of the 259 patients with unifocal vulvar disease found to have a negative sentinel node in the study, only six groin recurrences were identified over a median follow up of 35 months. The three-year survival of this group was 97%. In a second part of the study, the investigators compared short and long-term complications between patients who just underwent sentinel node removal, and those found to have a positive sentinel node that went on to have inguinofermoral lymphadenectomy. An analysis of short term morbidity showed that wound breakdown was 11.7 % for those undergoing sentinel node procedures compared to 34 % for those undergoing lymphadenectomy, and cellulites was 4.5 % versus 21.3 % respectively. An analysis of long-term morbidity showed that recurrent erysipelas occurred in 0.4 % of patients just undergoing sentinel node procedures compared to 16.2 % undergoing lymphadenectomy, and lymphedema of the legs occurred in 1.9 % versus 25.2 % respectively. The study was published in the February 20, 2008, issue of The Journal of Clinical Oncology.

"In early-stage vulvar cancer patients with a negative sentinel node, the groin recurrence rate is low, survival is excellent, and treatment-related morbidity is minimal,” said lead author Ate Van der Zee, M.D., Ph.D, of Gronigen University. "We suggest that sentinel node dissection, performed by a quality-controlled multidisciplinary team, should be part of the standard treatment in selected patients with early-stage vulvar cancer.”

Squamous cell cancer of the vulva is a rare disease, affecting just 2 to 3 per 100,000 women each year. Treatment for early stage disease is surgical removal of the cancerous lesion followed by removal of the inguinofemoral lymph nodes that drain the groin. The lymph node removal places women at significant risk of complications, such as lymphedema of the legs, increasing their risk of developing erysipelas (an acute disease of the skin and subcutaneous tissue caused by haemolytic Streptococcus).


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