Department of Gynaecological Oncology, The Christie NHS Foundation Trust, Manchester, UK.
Surg Oncol. 2010 Dec;19(4):e150-4. doi: 10.1016/j.suronc.2010.08.003. Epub 2010 Sep 15.
Restricting inguinofemoral lymphadenectomy to patients with malignant nodes would reduce treatment-related morbidity in vulval cancer patients. A prospective study was conducted to determine the diagnostic accuracy of the Sentinel Lymph Node (SLN) procedure in vulval cancer patients referred following either diagnostic or excision biopsy.
Patients with clinical stage I and II squamous cell carcinoma of the vulva underwent SLN identification with peri-scar/lesional injection of (99m)Technetium-labelled nanocolloid (pre-operative lymphoscintigraphy and intra-operative use of a hand-held probe) and intra-operative blue dye. Radical excision of the vulval tumour or scar and formal inguinofemoral lymphadenectomy was then performed as necessary. SLN were processed separately and further examined at multiple levels to exclude micrometastases (H&E/cytokeratin staining) if negative on routine analysis. Clinical follow-up was carried out to identify and treat recurrences or treatment-related morbidity.
Thirty-two women took part. Fifteen were referred following excision biopsy and seventeen following diagnostic biopsy of their primary vulval tumour. One or more SLN was successfully detected intra-operatively in 31 patients (97%) and 45 groins. An SLN could not be identified intra-operatively in one case (re-excision of scar). On average, more SLN were identified in patients with their primary vulval lesion in situ compared with those whose tumour had previously been excised (2.6 vs. 1.8, p = 0.03). Midline tumours were more likely (15/17) than lateral tumours (1/15) to have bilateral SLN identified pre-operatively. Two patients with midline tumours previously excised had unilateral SLN. Seven patients (23%) and ten groins had inguinofemoral lymph node metastases. The SLN procedure correctly identified inguinofemoral metastases in six patients (nine groins). In one case (midline tumour, re-excision of scar) the sentinel node was positive on one side but false negative on the other.
The SLN procedure may be used to identify malignant groins in selected patients with vulval cancer. The extent to which previous vulval surgery might influence the accuracy of the SLN procedure deserves further investigation.
对恶性淋巴结进行腹股沟淋巴结切除术可减少外阴癌患者的治疗相关发病率。进行了一项前瞻性研究，以确定前哨淋巴结（SLN）程序在诊断或切除活检后转介的外阴癌患者中的诊断准确性。
临床 I 期和 II 期外阴鳞癌患者接受 SLN 鉴定，在疤痕/病变处注射（99m）锝标记的纳米胶体（术前淋巴闪烁成像和术中使用手持式探头）和术中蓝色染料。然后根据需要进行外阴肿瘤或疤痕的根治性切除和正式的腹股沟 - 股部淋巴结切除术。单独处理 SLN，并在多个水平上进一步检查以排除微转移（H＆E/细胞角蛋白染色），如果常规分析为阴性。进行临床随访以识别和治疗复发或治疗相关的发病率。
32 名女性参加。15 名在切除活检后转介，17 名在原发性外阴肿瘤的诊断活检后转介。31 名患者（97％）和 45 个腹股沟中成功地在术中检测到一个或多个 SLN。一例（疤痕切除后再切除）术中无法识别 SLN。平均而言，与肿瘤已切除的患者相比，原发性外阴病变原位的患者识别到更多的 SLN（2.6 对 1.8，p = 0.03）。中线肿瘤比外侧肿瘤（15/17 对 1/15）更有可能在术前识别双侧 SLN。两名先前切除中线肿瘤的患者有单侧 SLN。7 名患者（23％）和 10 个腹股沟有腹股沟 - 股部淋巴结转移。SLN 程序正确识别了 6 名患者（9 个腹股沟）的腹股沟 - 股部转移。在一例（中线肿瘤，疤痕切除后再切除）中，一侧的前哨淋巴结为阳性，但另一侧为假阴性。
SLN 程序可用于识别选定的外阴癌患者中的恶性腹股沟。先前的外阴手术可能会影响 SLN 程序的准确性，这一点值得进一步研究。
