Sentinel lymph node procedure is highly accurate squamous cell carcinoma of the vulva

J. A. De Hullu, H. Hollema, D. A. Piers, R. H M Verheijen, P. J. Van Diest, M. J E Mourits, J. G. Aalders, A. G J Van der Zee

Research output: Contribution to journalArticle

Abstract

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 immonohistochemistry. 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 defaced 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 immunohistochemistry showed four additional metastases in 102 sentinel lymph nodes (4%; 95% CI, 1% to 9%) that were negative at the time of routine histopathologic examination. Conclusion: Sentinel lymph node procedure with the combined technique is highly accurate in predicting the inguinofemoral lymph node status in patients with early-stage vulvar cancer. Future trials should focus on the safe clinical implementation of the sentinel lymph node procedure in these patient. Step sectioning and immunohistochemistry slightly increase the sensitivity of detecting metastases in sentinel lymph nodes and should be induced in these trials. (C) 2000 by American Society of Clinical Oncology.

Original languageEnglish (US)
Pages (from-to)2811-2816
Number of pages6
JournalJournal of Clinical Oncology
Volume18
Issue number15
StatePublished - 2000
Externally publishedYes

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Vulva
Squamous Cell Carcinoma
Lymph Node Excision
Vulvar Neoplasms
Neoplasm Metastasis
Immunohistochemistry
Sentinel Lymph Node
Lymph Nodes
Confidence Intervals
Lymphoscintigraphy
Groin
Technetium
Coloring Agents

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

De Hullu, J. A., Hollema, H., Piers, D. A., Verheijen, R. H. M., Van Diest, P. J., Mourits, M. J. E., ... Van der Zee, A. G. J. (2000). Sentinel lymph node procedure is highly accurate squamous cell carcinoma of the vulva. Journal of Clinical Oncology, 18(15), 2811-2816.

Sentinel lymph node procedure is highly accurate squamous cell carcinoma of the vulva. / De Hullu, J. A.; Hollema, H.; Piers, D. A.; Verheijen, R. H M; Van Diest, P. J.; Mourits, M. J E; Aalders, J. G.; Van der Zee, A. G J.

In: Journal of Clinical Oncology, Vol. 18, No. 15, 2000, p. 2811-2816.

Research output: Contribution to journalArticle

De Hullu, JA, Hollema, H, Piers, DA, Verheijen, RHM, Van Diest, PJ, Mourits, MJE, Aalders, JG & Van der Zee, AGJ 2000, 'Sentinel lymph node procedure is highly accurate squamous cell carcinoma of the vulva', Journal of Clinical Oncology, vol. 18, no. 15, pp. 2811-2816.
De Hullu JA, Hollema H, Piers DA, Verheijen RHM, Van Diest PJ, Mourits MJE et al. Sentinel lymph node procedure is highly accurate squamous cell carcinoma of the vulva. Journal of Clinical Oncology. 2000;18(15):2811-2816.
De Hullu, J. A. ; Hollema, H. ; Piers, D. A. ; Verheijen, R. H M ; Van Diest, P. J. ; Mourits, M. J E ; Aalders, J. G. ; Van der Zee, A. G J. / Sentinel lymph node procedure is highly accurate squamous cell carcinoma of the vulva. In: Journal of Clinical Oncology. 2000 ; Vol. 18, No. 15. pp. 2811-2816.
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abstract = "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 immonohistochemistry. 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 defaced 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 immunohistochemistry showed four additional metastases in 102 sentinel lymph nodes (4{\%}; 95{\%} CI, 1{\%} to 9{\%}) that were negative at the time of routine histopathologic examination. Conclusion: Sentinel lymph node procedure with the combined technique is highly accurate in predicting the inguinofemoral lymph node status in patients with early-stage vulvar cancer. Future trials should focus on the safe clinical implementation of the sentinel lymph node procedure in these patient. Step sectioning and immunohistochemistry slightly increase the sensitivity of detecting metastases in sentinel lymph nodes and should be induced in these trials. (C) 2000 by American Society of Clinical Oncology.",
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T1 - Sentinel lymph node procedure is highly accurate squamous cell carcinoma of the vulva

AU - De Hullu, J. A.

AU - Hollema, H.

AU - Piers, D. A.

AU - Verheijen, R. H M

AU - Van Diest, P. J.

AU - Mourits, M. J E

AU - Aalders, J. G.

AU - Van der Zee, A. G J

PY - 2000

Y1 - 2000

N2 - 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 immonohistochemistry. 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 defaced 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 immunohistochemistry showed four additional metastases in 102 sentinel lymph nodes (4%; 95% CI, 1% to 9%) that were negative at the time of routine histopathologic examination. Conclusion: Sentinel lymph node procedure with the combined technique is highly accurate in predicting the inguinofemoral lymph node status in patients with early-stage vulvar cancer. Future trials should focus on the safe clinical implementation of the sentinel lymph node procedure in these patient. Step sectioning and immunohistochemistry slightly increase the sensitivity of detecting metastases in sentinel lymph nodes and should be induced in these trials. (C) 2000 by American Society of Clinical Oncology.

AB - 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 immonohistochemistry. 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 defaced 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 immunohistochemistry showed four additional metastases in 102 sentinel lymph nodes (4%; 95% CI, 1% to 9%) that were negative at the time of routine histopathologic examination. Conclusion: Sentinel lymph node procedure with the combined technique is highly accurate in predicting the inguinofemoral lymph node status in patients with early-stage vulvar cancer. Future trials should focus on the safe clinical implementation of the sentinel lymph node procedure in these patient. Step sectioning and immunohistochemistry slightly increase the sensitivity of detecting metastases in sentinel lymph nodes and should be induced in these trials. (C) 2000 by American Society of Clinical Oncology.

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