Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva

A gynecologic oncology group study

Charles F. Levenback, Shamshad Ali, Robert L. Coleman, Michael A. Gold, Jeffrey M. Fowler, Patricia L. Judson, Maria C. Bell, Koen De Geest, Nick M. Spirtos, Ronald K. Potkul, Mario M. Leitao, Jamie N. Bakkum-Gamez, Emma C. Rossi, Samuel S. Lentz, James J. Burke, Linda Van Le, Cornelia L Trimble

Research output: Contribution to journalArticle

Abstract

Purpose: To determine the safety of sentinel lymph node biopsy as a replacement for inguinal femoral lymphadenectomy in selected women with vulvar cancer. Patients and Methods: Eligible women had squamous cell carcinoma, at least 1-mm invasion, and tumor size ≥ 2 cm and <6 cm. The primary tumor was limited to the vulva, and there were no groin lymph nodes that were clinically suggestive of cancer. All women underwent intraoperative lymphatic mapping, sentinel lymph node biopsy, and inguinal femoral lymphadenectomy. Histologic ultra staging of the sentinel lymph node was prescribed. Results: In all, 452 women underwent the planned procedures, and 418 had at least one sentinel lymph node identified. There were 132 node-positive women, including 11 (8.3%) with false-negative nodes. Twenty-three percent of the true-positive patients were detected by immunohistochemical analysis of the sentinel lymph node. The sensitivity was 91.7% (90% lower confidence bound, 86.7%) and the false-negative predictive value (1-negative predictive value) was 3.7% (90% upper confidence bound, 6.1%). In women with tumor less than 4 cm, the false-negative predictive value was 2.0% (90% upper confidence bound, 4.5%). Conclusion: Sentinel lymph node biopsy is a reasonable alternative to inguinal femoral lymphadenectomy in selected women with squamous cell carcinoma of the vulva.

Original languageEnglish (US)
Pages (from-to)3786-3791
Number of pages6
JournalJournal of Clinical Oncology
Volume30
Issue number31
DOIs
StatePublished - Nov 1 2012

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Sentinel Lymph Node Biopsy
Vulva
Squamous Cell Carcinoma
Groin
Thigh
Lymph Node Excision
Neoplasms
Vulvar Neoplasms
Lymph Nodes
Safety

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva : A gynecologic oncology group study. / Levenback, Charles F.; Ali, Shamshad; Coleman, Robert L.; Gold, Michael A.; Fowler, Jeffrey M.; Judson, Patricia L.; Bell, Maria C.; De Geest, Koen; Spirtos, Nick M.; Potkul, Ronald K.; Leitao, Mario M.; Bakkum-Gamez, Jamie N.; Rossi, Emma C.; Lentz, Samuel S.; Burke, James J.; Van Le, Linda; Trimble, Cornelia L.

In: Journal of Clinical Oncology, Vol. 30, No. 31, 01.11.2012, p. 3786-3791.

Research output: Contribution to journalArticle

Levenback, CF, Ali, S, Coleman, RL, Gold, MA, Fowler, JM, Judson, PL, Bell, MC, De Geest, K, Spirtos, NM, Potkul, RK, Leitao, MM, Bakkum-Gamez, JN, Rossi, EC, Lentz, SS, Burke, JJ, Van Le, L & Trimble, CL 2012, 'Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: A gynecologic oncology group study', Journal of Clinical Oncology, vol. 30, no. 31, pp. 3786-3791. https://doi.org/10.1200/JCO.2011.41.2528
Levenback, Charles F. ; Ali, Shamshad ; Coleman, Robert L. ; Gold, Michael A. ; Fowler, Jeffrey M. ; Judson, Patricia L. ; Bell, Maria C. ; De Geest, Koen ; Spirtos, Nick M. ; Potkul, Ronald K. ; Leitao, Mario M. ; Bakkum-Gamez, Jamie N. ; Rossi, Emma C. ; Lentz, Samuel S. ; Burke, James J. ; Van Le, Linda ; Trimble, Cornelia L. / Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva : A gynecologic oncology group study. In: Journal of Clinical Oncology. 2012 ; Vol. 30, No. 31. pp. 3786-3791.
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abstract = "Purpose: To determine the safety of sentinel lymph node biopsy as a replacement for inguinal femoral lymphadenectomy in selected women with vulvar cancer. Patients and Methods: Eligible women had squamous cell carcinoma, at least 1-mm invasion, and tumor size ≥ 2 cm and <6 cm. The primary tumor was limited to the vulva, and there were no groin lymph nodes that were clinically suggestive of cancer. All women underwent intraoperative lymphatic mapping, sentinel lymph node biopsy, and inguinal femoral lymphadenectomy. Histologic ultra staging of the sentinel lymph node was prescribed. Results: In all, 452 women underwent the planned procedures, and 418 had at least one sentinel lymph node identified. There were 132 node-positive women, including 11 (8.3{\%}) with false-negative nodes. Twenty-three percent of the true-positive patients were detected by immunohistochemical analysis of the sentinel lymph node. The sensitivity was 91.7{\%} (90{\%} lower confidence bound, 86.7{\%}) and the false-negative predictive value (1-negative predictive value) was 3.7{\%} (90{\%} upper confidence bound, 6.1{\%}). In women with tumor less than 4 cm, the false-negative predictive value was 2.0{\%} (90{\%} upper confidence bound, 4.5{\%}). Conclusion: Sentinel lymph node biopsy is a reasonable alternative to inguinal femoral lymphadenectomy in selected women with squamous cell carcinoma of the vulva.",
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T1 - Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva

T2 - A gynecologic oncology group study

AU - Levenback, Charles F.

AU - Ali, Shamshad

AU - Coleman, Robert L.

AU - Gold, Michael A.

AU - Fowler, Jeffrey M.

AU - Judson, Patricia L.

AU - Bell, Maria C.

AU - De Geest, Koen

AU - Spirtos, Nick M.

AU - Potkul, Ronald K.

AU - Leitao, Mario M.

AU - Bakkum-Gamez, Jamie N.

AU - Rossi, Emma C.

AU - Lentz, Samuel S.

AU - Burke, James J.

AU - Van Le, Linda

AU - Trimble, Cornelia L

PY - 2012/11/1

Y1 - 2012/11/1

N2 - Purpose: To determine the safety of sentinel lymph node biopsy as a replacement for inguinal femoral lymphadenectomy in selected women with vulvar cancer. Patients and Methods: Eligible women had squamous cell carcinoma, at least 1-mm invasion, and tumor size ≥ 2 cm and <6 cm. The primary tumor was limited to the vulva, and there were no groin lymph nodes that were clinically suggestive of cancer. All women underwent intraoperative lymphatic mapping, sentinel lymph node biopsy, and inguinal femoral lymphadenectomy. Histologic ultra staging of the sentinel lymph node was prescribed. Results: In all, 452 women underwent the planned procedures, and 418 had at least one sentinel lymph node identified. There were 132 node-positive women, including 11 (8.3%) with false-negative nodes. Twenty-three percent of the true-positive patients were detected by immunohistochemical analysis of the sentinel lymph node. The sensitivity was 91.7% (90% lower confidence bound, 86.7%) and the false-negative predictive value (1-negative predictive value) was 3.7% (90% upper confidence bound, 6.1%). In women with tumor less than 4 cm, the false-negative predictive value was 2.0% (90% upper confidence bound, 4.5%). Conclusion: Sentinel lymph node biopsy is a reasonable alternative to inguinal femoral lymphadenectomy in selected women with squamous cell carcinoma of the vulva.

AB - Purpose: To determine the safety of sentinel lymph node biopsy as a replacement for inguinal femoral lymphadenectomy in selected women with vulvar cancer. Patients and Methods: Eligible women had squamous cell carcinoma, at least 1-mm invasion, and tumor size ≥ 2 cm and <6 cm. The primary tumor was limited to the vulva, and there were no groin lymph nodes that were clinically suggestive of cancer. All women underwent intraoperative lymphatic mapping, sentinel lymph node biopsy, and inguinal femoral lymphadenectomy. Histologic ultra staging of the sentinel lymph node was prescribed. Results: In all, 452 women underwent the planned procedures, and 418 had at least one sentinel lymph node identified. There were 132 node-positive women, including 11 (8.3%) with false-negative nodes. Twenty-three percent of the true-positive patients were detected by immunohistochemical analysis of the sentinel lymph node. The sensitivity was 91.7% (90% lower confidence bound, 86.7%) and the false-negative predictive value (1-negative predictive value) was 3.7% (90% upper confidence bound, 6.1%). In women with tumor less than 4 cm, the false-negative predictive value was 2.0% (90% upper confidence bound, 4.5%). Conclusion: Sentinel lymph node biopsy is a reasonable alternative to inguinal femoral lymphadenectomy in selected women with squamous cell carcinoma of the vulva.

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