SENTINEL LYMPHADENECTOMY IN VULVAR CANCER

G. Ralph, MD, A. Bader, MD, R. Winter, MD,
R.M. Aigner, MD, S. Lax, MD, and K. Tamussino, MD

   Objective: We evaluated the sentinel lymph node concept in patients with malignancies of the vulva.

   Materials and Methods: Sentinel lymphadenectomy was performed in 30 groins in 19 patients (median age 70 years; range, 44-88) with malignancies of the vulva (16 carcinomas T1/2, 3 malignant melanomas). Both lymphoscintigraphy with Tc99-labeled colloid and lymphatic mapping with lymphazurin were used. Sentinel specimens were submitted for intraoperative frozen-section analysis. Systematic inguinofemoral lymphadenectomy was performed for 25 groins. Sentinel nodes negative for tumor at routine HE section were analyzed further using serial sections at 100/200 µm and immunohistochemistry for cytokeratin, S100 and HMB-45.

   Results: With lymphoscintigraphy sentinel lymph nodes were identified readily in all 30 groins; blue nodes were identified in 16 groins (53%). All 10 groins (7 patients) with positive groin nodes had a positive sentinel node; there were no false negative results. Of the 10 groins with positive sentinel lymph nodes, 7 were identified at intraoperative frozen section and 3 at postoperative step-serial sectioning and HE staining; immunohistochemistry identified no additional positive nodes.

   Conclusion: These results and those of other groups support the validity of the sentinel lymph node concept in patients with vulvar cancer. Lymphoscintigraphy appears superior to lymphatic mapping with dye only.

   Key Words: Vulvar cancer; Sentinel lymph node; Groin dissection