Sedlis A, Homesley H, Bundy B N, Marshall R, Yordan E, Hacker N, Lee J H, Whitney C
Am J Obstet Gynecol. 1987 May;156(5):1159-64. doi: 10.1016/0002-9378(87)90132-3.
The term microinvasive carcinoma is inappropriate when applied to all vulvar cancers less than or equal to 5 mm thick because approximately 50% of vulvar carcinomas are no thicker than 5 mm and 20% of those superficial tumors metastasize to the lymph nodes. The significant predictors of groin node metastases in patients with superficial vulvar cancer are tumor thickness, histologic grade (proportion of undifferentiated tumor pattern), capillary-like space involvement with the tumor, clitoral or perineal location, and clinically suspicious nodes, according to the linear logistic model analysis of clinicopathologic data in 272 women. No lymph node metastases occurred in approximately one fourth of patients with a combination of low-risk factors: no clinically suspicious nodes, negative capillary-like space, and nonmidline vulvar cancers that were either grade 1 and 1 to 5 mm thick or grade 2 and 1 to 2 mm thick. In contrast, all 10 patients with clinically suspicious nodes and grade 4 tumors had positive groin nodes. The risk of lymph node metastases is best determined by simultaneous evaluation of all risk factors rather than a single factor such as tumor thickness.
当将微浸润癌这一术语用于所有厚度小于或等于5mm的外阴癌时并不恰当，因为大约50%的外阴癌厚度不超过5mm，且这些浅表肿瘤中有20%会发生腹股沟淋巴结转移。根据对272名女性临床病理数据的线性逻辑模型分析，浅表性外阴癌患者腹股沟淋巴结转移的重要预测因素包括肿瘤厚度、组织学分级（未分化肿瘤模式的比例）、肿瘤累及毛细血管样间隙、阴蒂或会阴部位以及临床可疑淋巴结。大约四分之一具有低风险因素组合的患者未发生淋巴结转移，这些低风险因素包括：无临床可疑淋巴结、毛细血管样间隙阴性以及非中线部位的外阴癌，这些外阴癌要么为1级且厚度为1至5mm，要么为2级且厚度为1至2mm。相比之下，所有10名有临床可疑淋巴结且肿瘤为4级的患者腹股沟淋巴结均为阳性。淋巴结转移风险最好通过同时评估所有风险因素来确定，而不是仅依据单一因素如肿瘤厚度。
