Sentinel lymph node biopsy for early stage vulvar squamous cell carcinoma

Area of Science:

• Gynecologic Oncology
• Surgical Pathology
• Cancer Research

Background:

• Regional lymph node involvement in vulvar squamous cell carcinoma (SCC) significantly impacts survival rates (48% 5-year relative survival).
• Sentinel lymph node (SLN) biopsy is emerging as a less invasive alternative to traditional inguinofemoral lymphadenectomy for staging vulvar SCC.
• Identifying predictors of positive SLN is crucial for optimizing patient management.

Purpose of the Study:

• To identify clinical and pathological risk factors associated with a positive sentinel lymph node (SLN) biopsy in patients diagnosed with vulvar squamous cell carcinoma (SCC).

Main Methods:

• A retrospective chart review was conducted on 29 patients with vulvar SCC treated between 2016 and 2021 at a single tertiary care center.
• Clinicopathological data, including tumor characteristics and SLN status, were collected and analyzed.
• Patients with recurrent disease or those who did not map on lymphoscintigraphy were excluded from the final analysis.

Main Results:

• The study included 23 patients after exclusions, with an average tumor invasion depth of 7.9 mm and tumor size of 1.8 cm.
• Lymphovascular invasion was present in 4 of 23 patients, and perineural invasion in 3 of 23.
• Only one patient (4.3%) had a positive SLN, presenting with deep invasion (17 mm), larger tumor size (5.1 cm), and lymphovascular invasion.

Conclusions:

• The majority of patients with early-stage vulvar squamous cell carcinoma (SCC) demonstrated negative sentinel lymph node (SLN) biopsy results.
• Further research is warranted to define specific patient subgroups who may be able to safely forgo SLN biopsy, thereby reducing surgical morbidity.