Pascoal Erica, Alyafi Mohammad, Pokoradi Alida, Eiriksson Lua, Helpman Limor
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, McMaster University, Hamilton, Ontario, Canada
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, McMaster University, Hamilton, Ontario, Canada.
Int J Gynecol Cancer. 2022 Dec 5;32(12):1512-1518. doi: 10.1136/ijgc-2022-003836.
Performing inguinofemoral sentinel lymph node biopsy for vulvar cancer following a previous vulvar excision, often referred to as 'scar injection', is debated.
To assess the feasibility of sentinel lymph node biopsy following scar injection and the long-term outcomes in patients undergoing this procedure.
We conducted a retrospective observational cohort study of patients with vulvar cancer. We assessed detection rates and outcomes in patients who underwent sentinel lymph node biopsy by scar injection and compared them with patients who had injection around a visible tumor and with patients who had an inguinofemoral lymphadenectomy following previous vulvar excision. Sentinel node detection rates are described per patient and per groin and are compared using Χ analysis. Cox regression analysis was used to assess the association of recurrence and survival with surgical technique and recognized pathological variables.
Data were analyzed for 173 groins in 97 patients. At least one sentinel lymph node was detected in 162 (94%) groins examined, and detection rate did not differ whether the groin was assessed following tumor injection (n=122, 94%) or scar injection (n=40, 93%; p=0.85). Patients in the scar-injection group had less frequent lymph node metastases (p<0.02), smaller tumors (p<0.001), and more superficial invasion (p<0.02). Median follow-up was 34.7 months (range 0-108). Scar injection was not independently associated with recurrence or death on multivariable analysis, and depth of invasion was the only independent predictor of disease recurrence (hazards ratio (HR)=1.14, p=0.03). Recurrence and survival were also comparable for patients who had a sentinel lymph node biopsy or inguinofemoral lymphadenectomy following previous vulvar excision (log rank p=0.30; p=0.67).
Sentinel lymph node biopsy by scar injection is feasible and demonstrates similar long-term outcomes in patients having scar or tumor injections, and in patients following previous tumor excision undergoing sentinel lymph node biopsy or lymphadenectomy.
对于既往有外阴切除术的外阴癌患者，进行腹股沟股前哨淋巴结活检（常称为“瘢痕注射”）存在争议。
评估瘢痕注射后前哨淋巴结活检的可行性以及接受该手术患者的长期预后。
我们对外阴癌患者进行了一项回顾性观察队列研究。我们评估了通过瘢痕注射进行前哨淋巴结活检患者的检测率和预后，并将其与在可见肿瘤周围注射的患者以及既往有外阴切除术后进行腹股沟股淋巴结清扫术的患者进行比较。前哨淋巴结检测率按每位患者和每个腹股沟进行描述，并使用Χ分析进行比较。采用Cox回归分析评估复发和生存与手术技术及公认的病理变量之间的关联。
对97例患者的173个腹股沟的数据进行了分析。在检查的162个（94%）腹股沟中至少检测到一个前哨淋巴结，无论腹股沟是在肿瘤注射后评估（n = 122，94%）还是瘢痕注射后评估（n = 40，93%；p = 0.85），检测率均无差异。瘢痕注射组患者的淋巴结转移频率较低（p < 0.02），肿瘤较小（p < 0.001），且浸润较浅（p < 0.02）。中位随访时间为34.7个月（范围0 - 108个月）。多变量分析显示，瘢痕注射与复发或死亡无独立关联，浸润深度是疾病复发的唯一独立预测因素（风险比（HR）= 1.14，p = 0.03）。既往有外阴切除术后进行前哨淋巴结活检或腹股沟股淋巴结清扫术的患者，其复发和生存情况也具有可比性（对数秩检验p = 0.30；p = 0.67）。
通过瘢痕注射进行前哨淋巴结活检是可行的，并且在接受瘢痕或肿瘤注射的患者以及既往有肿瘤切除术后进行前哨淋巴结活检或淋巴结清扫术的患者中显示出相似的长期预后。
