Rationale For Sentinel Lymph Node Biopsy In Vulvar Cancer Patients

Several of the characteristics of vulvar cancer as described earlier suggest the need for less invasive diagnostic techniques for evaluation of clinically unin-volved inguinofemoral lymph nodes. The majority of patients with vulvar cancer present with early-stage disease and have a low frequency of nodal involvement.

However, most clinicians are reluctant to abandon elective inguinofemoral lymphadenectomy and to follow a ''wait and watch'' policy because of the dismal prognosis in patients with a groin recurrence. Elective inguinofemoral lymphade-nectomy is associated with significant short-term and long-term morbidities. He-matogenous metastases are rare.

At present, no reliable noninvasive techniques for the detection of inguino-femoral lymph node metastases are available. Physical examination of the groins is inaccurate in 25% of cases [4]. The percentage of error in clinical appraisal increases progressively with the stage of disease: from 18% for Stage I to 44% for Stage IV [4]. Little information exists on the value of imaging techniques such as magnetic resonance imaging and computerized tomography. The results of the use of ultrasound and positron emission tomography are disappointing [42,43]. All these reasons provide a rationale for lymphatic mapping with sentinel lymphadenectomy in patients with vulvar cancer.

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