Gracia Myriam, Alonso-Espías Maria, Zapardiel Ignacio
Gynecologic Oncology Unit, La Paz University Hospital, 28015 Madrid, Spain.
Curr Oncol. 2025 Apr 8;32(4):215. doi: 10.3390/curroncol32040215.
Vulvar cancer is a rare gynecologic malignancy with increasing incidence. Lymph node status is the most critical prognostic factor, traditionally assessed through inguinofemoral lymphadenectomy, a procedure associated with significant morbidity. Sentinel lymph node biopsy (SLNB), in selected cases, has emerged as a less invasive alternative with favorable oncologic outcomes. This review summarizes current evidence on the indications, technique, safety, and oncologic outcomes of SLNB in vulvar cancer, with a focus on controversial scenarios such as recurrent and larger tumors. A narrative review of PubMed-indexed studies published in English over the last 35 years was conducted. Eligible studies included original research, systematic reviews, meta-analyses, randomized controlled trials, and case-control studies. SLNB is recommended for unifocal vulvar tumors < 4 cm with stromal invasion > 1 mm and clinically negative nodes. Landmark trials, including GROINSS-V-I and GOG-173, confirmed its accuracy and lower morbidity compared to lymphadenectomy. SLNB utilization has increased since its inclusion in guidelines, with a concurrent decline in lymphadenectomy rates. Combined detection techniques are mandatory, while indocyanine green (ICG) is an emerging option. Future studies should focus on refining patient selection criteria, improving detection techniques, and clarifying the implications of low-volume nodal disease to further optimize outcomes for patients with vulvar cancer. SLNB is a validated, minimally invasive staging approach in early-stage vulvar cancer. Further research is needed to refine its role in high-risk cases and optimize detection methods.
外阴癌是一种发病率不断上升的罕见妇科恶性肿瘤。淋巴结状态是最关键的预后因素，传统上通过腹股沟股淋巴结清扫术进行评估，该手术会带来显著的发病率。在特定病例中，前哨淋巴结活检（SLNB）已成为一种侵入性较小的替代方法，且肿瘤学结局良好。本综述总结了目前关于外阴癌SLNB的适应证、技术、安全性和肿瘤学结局的证据，重点关注复发性肿瘤和较大肿瘤等有争议的情况。对过去35年以英文发表在PubMed上的研究进行了叙述性综述。符合条件的研究包括原创研究、系统评价、荟萃分析、随机对照试验和病例对照研究。对于直径<4 cm、间质浸润>1 mm且临床淋巴结阴性的单灶性外阴肿瘤，推荐进行SLNB。包括GROINSS-V-I和GOG-173在内的标志性试验证实了其准确性以及与淋巴结清扫术相比更低的发病率。自被纳入指南以来，SLNB的应用有所增加，同时淋巴结清扫率有所下降。联合检测技术是必需的，而吲哚菁绿（ICG）是一种新兴选择。未来的研究应专注于完善患者选择标准、改进检测技术以及阐明少量淋巴结疾病的影响，以进一步优化外阴癌患者的结局。SLNB是早期外阴癌一种经过验证的微创分期方法。需要进一步研究以完善其在高危病例中的作用并优化检测方法。
