University of Toronto, Department of Obstetrics and Gynecology, Toronto, Ontario, Canada.
University of Toronto, Department of Obstetrics and Gynecology, Toronto, Ontario, Canada; Division of Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Gynecol Oncol. 2019 Jan;152(1):94-100. doi: 10.1016/j.ygyno.2018.10.047. Epub 2018 Nov 16.
Although sentinel lymph node (SLN) biopsy has been routinely used in the treatment of invasive squamous cell carcinoma (SCC), questions still remain regarding the management of patients with positive nodes, as well as its use in patients with larger tumors.
Retrospective study of all patients at a single institution with primary vulvar cancer who had SLN biopsy (2008-2015). Patient and tumor characteristics were collected from hospital records. For patients with positive SLN and for those with tumors ≥40 mm, recurrence rates and location were specifically recorded.
SLN biopsy was successful in 159 patients (245 groins). Median follow-up was 31 months. 120 patients (187 groins) had a negative SLN without an inguinofemoral lymph node dissection (IFL); there were 6 ipsilateral groin recurrences (5%). 7 patients had micrometastasis (≤2 mm) in the SLN and were treated by radiotherapy. There were no recurrences in the irradiated groins. 19 patients with a positive unilateral SLN had bilateral IFL. One (5.3%) had a positive node in the contralateral groin. 9 patients with positive unilateral SLN had subsequent ipsilateral IFL; there were no groin recurrences in the contralateral groin. 20 patients had tumor size ≥40 mm. 11 patients had a negative SLN biopsy, and thus no IFL; of these patients, 1 had an isolated groin recurrence (9%).
These data suggest it is reasonable to omit a full groin dissection for micrometastatic disease in the SLN, and to perform a unilateral groin dissection in patients with unilateral SLN metastasis. SLN alone in larger tumors may have a higher groin recurrence rate.
虽然前哨淋巴结（SLN）活检已常规用于治疗浸润性鳞状细胞癌（SCC），但对于阳性淋巴结患者的管理以及其在较大肿瘤患者中的应用仍存在疑问。
对单一机构中所有接受 SLN 活检的原发性外阴癌患者（2008-2015 年）进行回顾性研究。从医院记录中收集患者和肿瘤特征。对于 SLN 阳性的患者和肿瘤≥40mm 的患者，特别记录复发率和位置。
159 例患者（245 侧腹股沟）SLN 活检成功。中位随访时间为 31 个月。120 例（187 侧腹股沟）SLN 阴性且未行腹股沟-股部淋巴结清扫术（IFL）；同侧腹股沟复发 6 例（5%）。7 例 SLN 微转移（≤2mm）患者接受放疗。照射腹股沟无复发。19 例单侧 SLN 阳性患者行双侧 IFL。其中 1 例（5.3%）对侧腹股沟淋巴结阳性。9 例单侧 SLN 阳性患者行同侧 IFL；对侧腹股沟无复发。20 例患者肿瘤直径≥40mm。11 例 SLN 活检阴性，因此未行 IFL；这些患者中有 1 例孤立性腹股沟复发（9%）。
这些数据表明，对于 SLN 中的微转移疾病，可以合理地省略全腹股沟清扫术，并对单侧 SLN 转移的患者行单侧腹股沟清扫术。SLN 单独用于较大的肿瘤可能会增加腹股沟复发率。
