Sakae Chieko, Yamaguchi Ken, Matsumura Noriomi, Nakai Hidekatsu, Yoshioka Yumiko, Kondoh Eiji, Hamanishi Junzo, Abiko Kaoru, Koshiyama Masafumi, Baba Tsukasa, Kido Aki, Mandai Masaki, Konishi Ikuo
Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan.
Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
J Gynecol Oncol. 2016 Nov;27(6):e57. doi: 10.3802/jgo.2016.27.e57. Epub 2016 Jun 29.
To identify suitable diagnostic tools and evaluate the efficacy of sentinel lymph node (SLN) biopsy for inguinal lymph node metastasis in vulvar cancer.
Data from 41 patients with vulvar cancer were evaluated retrospectively, including magnetic resonance imaging (MRI) measurements, SLN biopsy status, groin lymph node metastasis, and prognosis.
SLN biopsy was conducted in 12 patients who had stage I to III disease. Groin lymphadenectomy was omitted in five of the nine patients with negative SLNs. All SLN-negative patients who did not undergo groin lymphadenectomy showed no evidence of disease after treatment. On MRI, the long and short diameters of the inguinal node were significantly longer in metastasis-positive cases, compared with negative cases, in 25 patients whose nodes were evaluated pathologically (long diameter, 12.8 mm vs. 8.8 mm, p=0.025; short diameter, 9.2 mm vs. 6.7 mm, p=0.041). The threshold of >10.0 mm for the long axis gave a sensitivity, specificity, positive predictive value, and negative predictive value of 87.5%, 70.6%, 58.3%, and 92.3%, respectively, using a binary classification test. Decision tree analysis revealed a sensitivity, specificity, and accuracy of 87.5%, 70.6%, and 76.0%, respectively, with the threshold of >10.0 mm for the long axis on MRI. The criteria of >10.0 mm for the long axis on MRI predicted an advanced stage and poorer prognosis using a validation set of 15 cases (p=0.028).
Minimally invasive surgery after preoperative evaluation on MRI and SLN biopsy is a feasible strategy for patients with vulvar cancer.
确定合适的诊断工具，并评估前哨淋巴结（SLN）活检对外阴癌腹股沟淋巴结转移的疗效。
回顾性评估41例外阴癌患者的数据，包括磁共振成像（MRI）测量、SLN活检状态、腹股沟淋巴结转移情况及预后。
对12例Ⅰ至Ⅲ期疾病患者进行了SLN活检。9例SLN阴性患者中有5例未进行腹股沟淋巴结清扫术。所有未进行腹股沟淋巴结清扫术的SLN阴性患者治疗后均无疾病证据。在MRI上，经病理评估的25例患者中，转移阳性病例的腹股沟淋巴结长径和短径明显长于阴性病例（长径，12.8 mm对8.8 mm，p = 0.025；短径，9.2 mm对6.7 mm，p = 0.041）。使用二元分类测试，长轴>10.0 mm的阈值的敏感性、特异性、阳性预测值和阴性预测值分别为87.5%、70.6%、58.3%和92.3%。决策树分析显示，MRI上长轴>10.0 mm的阈值的敏感性、特异性和准确性分别为87.5%、70.6%和76.0%。MRI上长轴>10.0 mm的标准在15例验证组病例中预测为晚期且预后较差（p = 0.028）。
对外阴癌患者，术前MRI评估和SLN活检后进行微创手术是一种可行的策略。
