Sentinel Lymph Node Procedure Is Highly Accurate in Squamous Cell Carcinoma of the Vulva

作者：Joanne A. de Hullu, H. Hollema, D.A. Piers, R.H.M. Verheijen, P.J. van Diest, Marian J.E. Mourits, J.G. Aalders, Ate G.J. van der Zee · 发表于：Journal of Clinical Oncology · 年份：2000 · DOI：10.1200/jco.2000.18.15.2811 · 被引用次数：345 · 研究领域：Endometrial and Cervical Cancer Treatments、Cervical Cancer and HPV Research、Colorectal and Anal Carcinomas

PURPOSE: To determine the diagnostic accuracy of the sentinel lymph node procedure in patients with squamous cell carcinoma of the vulva and to investigate whether step sectioning and immunohistochemistry of sentinel lymph nodes increase the sensitivity for detection of metastases. PATIENTS AND METHODS: Between July 1996 and July 1999, 59 patients with primary vulvar cancer were entered onto a two-center prospective study. All patients underwent sentinel lymph node procedure with the combined technique (preoperative lymphoscintigraphy with technetium-99m-labeled nanocolloid and intraoperative blue dye). Radical excision of the primary tumor with uni- or bilateral inguinofemoral lymphadenectomy was performed subsequently. Sentinel lymph nodes and lymphadenectomy specimens were sent for histopathologic examination separately. Sentinel lymph nodes, negative at the time of routine pathologic examination, were re-examined with step sectioning and immunohistochemistry. RESULTS: In 59 patients, 107 inguinofemoral lymphadenectomies were performed (11 unilateral and 48 bilateral). All sentinel lymph nodes, as observed on preoperative lymphoscintigram, were identified successfully intraoperatively. Routine histopathologic examination showed lymph node metastases in 27 groins, all of which were detected by the sentinel lymph node procedure. The negative predictive value for a negative sentinel lymph node was 100% (97.5% confidence interval [CI], 95% to 100%). Step sectioning and immunoh...