Brincat Mark R, Muscat Baron Yves
Mater Dei Hospital, Msida, Malta.
Int J Gynecol Cancer. 2017 Oct;27(8):1769-1773. doi: 10.1097/IGC.0000000000001075.
Lymph node metastasis has been shown to represent the most significant prognostic factor in vulvar carcinoma. Because only 25% to 35% of patients with early stage disease have lymph node metastases, a significant 65% to 75% possibly do not benefit from elective inguinofemoral lymphadenectomy considering the related morbidities of wound infection, breakdown, and lower limb lymphedema. This review article aims to present and summarize the evidence available with regard to sentinel lymph node (SLN)-guided management of vulvar carcinoma.
A literature search was performed in MEDLINE resources using the subject headings "vulvar neoplasms," "sentinel lymph node," "sentinel lymph node biopsy," and "lymphatic metastasis." This search returned 886 articles that were published through January 2017. Prospective studies investigating sentinel node identification techniques and their impact on vulvar cancer management and prognosis were considered. Case reports were excluded from the review.
Technetium-99-m-labeled nanocolloid with or without blue dye and more recently indocyanine green fluorescence have been the main techniques used for SLN identification in vulvar carcinoma. Radioisotope and near-infrared techniques have been shown to be superior to blue dye particularly with midline lesions that drain bilaterally or that drain directly to a deep pelvic node. Patients with a small unifocal primary tumor (<4 cm) and no obvious preoperative metastasis have been shown to have low groin recurrence rates and excellent disease-specific survival rates with minimal treatment-related morbidity when undergoing SLN biopsy-guided management.
Sentinel lymph node biopsy-guided management seems to be safe when restricted to International Federation of Gynecology and Obstetrics IB to II cases where tumors are unifocal, less than 4 cm in size, and when there is no evidence of lymph node metastasis on clinical/radiological assessment. This reduces operative morbidity in this cohort of patients.
淋巴结转移已被证明是外阴癌最重要的预后因素。由于只有25%至35%的早期疾病患者有淋巴结转移，考虑到伤口感染、裂开以及下肢淋巴水肿等相关并发症，多达65%至75%的患者可能无法从选择性腹股沟股淋巴结清扫术中获益。这篇综述文章旨在呈现并总结关于前哨淋巴结（SLN）引导下外阴癌治疗的现有证据。
在MEDLINE资源中进行文献检索，使用主题词“外阴肿瘤”“前哨淋巴结”“前哨淋巴结活检”和“淋巴转移”。此次检索返回了截至2017年1月发表的886篇文章。纳入了调查前哨淋巴结识别技术及其对外阴癌治疗和预后影响的前瞻性研究。病例报告被排除在综述之外。
99m锝标记的纳米胶体联合或不联合蓝色染料，以及最近的吲哚菁绿荧光，一直是外阴癌中用于识别前哨淋巴结的主要技术。放射性同位素和近红外技术已被证明优于蓝色染料，特别是对于双侧引流或直接引流至盆腔深部淋巴结的中线病变。已表明，对于单灶性原发性小肿瘤（<4 cm）且术前无明显转移的患者，在接受前哨淋巴结活检引导下的治疗时，腹股沟复发率低，疾病特异性生存率高，且治疗相关并发症最少。
对于国际妇产科联盟（FIGO）分期为IB至II期、肿瘤为单灶性、大小小于4 cm且临床/影像学评估无淋巴结转移证据的患者，前哨淋巴结活检引导下的治疗似乎是安全的。这降低了该组患者的手术并发症发生率。
