Department of Obstetrics and Gynaecology, Division of Gynecologic Oncology, University of Toronto, Toronto, ON, Canada.
Department of Obstetrics and Gynaecology, Division of Gynecologic Oncology, University of Toronto, Toronto, ON, Canada; Gynecologic Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Gynecol Oncol. 2022 Feb;164(2):393-397. doi: 10.1016/j.ygyno.2021.11.020. Epub 2021 Dec 8.
To assess the diagnostic accuracy of intraoperative pathologic examination of sentinel lymph nodes (SLNs) and patient outcomes in vulva cancer.
This retrospective study included patients with unifocal, <4 cm, invasive vulvar squamous cell carcinoma and clinically negative groin nodes treated with SLN biopsy from January 2008-March 2020. Intraoperative SLN frozen section and final pathology were compared. If the SLN was negative, inguinal femoral lymphadenectomy (IFLD) was omitted. Recurrence location and groin recurrence free survival (RFS) were assessed.
The SLN cohort included 173 patients, with 258 groins. On frozen section, there were 36/258 positive and 222 negative groins. On final pathology, there were 39/258 positive: 31 macrometastases, 6 micrometastases, 2 isolated tumor cells (ITCs) and 219 negative groins. The sensitivity, specificity, PPV and NPV for intraoperative detection of metastatic disease, was 89.7% and 99.5%, 97.2% and 98.2%, respectively. There was 1 false positive and 4 false negative frozen section results where final pathology revealed 2 ITCs, 1 micrometastasis and 1 macrometastasis. Based on intraoperative results, thirty patients (17.3%) underwent immediate IFLD. Median follow up was 38.0 (1-137.8) months. The 3-year groin RFS was 91.6% (95% CI 86.2-97.4%) for negative SLNs and 64.6% (95% CI 46.5-89.7%) for positive SLNs on frozen section. Similarly, the 3-year groin RFS was 91.7% (95% CI 86.3-97.4%) for negative, 58.4% (95% CI 38.5-87.7%) for macrometastases and 100% for micrometastases/ITCs on final pathology.
Intraoperative assessment of SLNs is accurate to determine need for IFLD and does not compromise patient outcomes in vulvar cancer.
评估外阴癌前哨淋巴结（SLN）术中病理检查及患者结局的诊断准确性。
本回顾性研究纳入了 2008 年 1 月至 2020 年 3 月期间接受 SLN 活检治疗的单灶、<4cm、浸润性外阴鳞状细胞癌且临床腹股沟淋巴结阴性的患者。比较术中 SLN 冷冻切片和最终病理结果。如果 SLN 为阴性，则省略腹股沟股部淋巴结清扫术（IFLD）。评估复发部位和腹股沟无复发生存率（RFS）。
SLN 队列包括 173 例患者，共 258 个腹股沟。在冷冻切片中，258 个腹股沟中有 36 个为阳性，222 个为阴性。在最终病理中，258 个腹股沟中有 39 个为阳性：31 个大转移灶、6 个微转移灶、2 个孤立肿瘤细胞（ITC）和 219 个阴性腹股沟。术中检测转移性疾病的敏感性、特异性、PPV 和 NPV 分别为 89.7%和 99.5%、97.2%和 98.2%。有 1 例冷冻切片假阳性和 4 例假阴性结果，最终病理显示 2 个 ITC、1 个微转移灶和 1 个大转移灶。根据术中结果，30 例（17.3%）患者立即行 IFLD。中位随访时间为 38.0（1-137.8）个月。阴性 SLN 的 3 年腹股沟 RFS 为 91.6%（95%CI 86.2-97.4%），冷冻切片阳性 SLN 的 3 年腹股沟 RFS 为 64.6%（95%CI 46.5-89.7%）。同样，阴性 SLN 的 3 年腹股沟 RFS 为 91.7%（95%CI 86.3-97.4%）、大转移灶为 58.4%（95%CI 38.5-87.7%）、微转移灶/ITC 为 100%。
术中 SLN 评估可准确确定是否需要进行 IFLD，且不会影响外阴癌患者的结局。
