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Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology
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Current Limitations of Sentinel Node Biopsy in Vulvar Cancer.

Myriam Gracia1, Maria Alonso-Espías1, Ignacio Zapardiel1

  • 1Gynecologic Oncology Unit, La Paz University Hospital, 28015 Madrid, Spain.

Current Oncology (Toronto, Ont.)
|April 25, 2025
PubMed
Summary

Sentinel lymph node biopsy (SLNB) is a safe and effective minimally invasive staging method for early-stage vulvar cancer. It offers favorable oncologic outcomes with reduced morbidity compared to traditional lymphadenectomy.

Keywords:
inguinofemoral lymphadenectomyrecurrent vulvar cancersentinel lymph node biopsyvulvar cancer

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Area of Science:

  • Gynecologic Oncology
  • Surgical Oncology
  • Evidence-Based Medicine

Background:

  • Vulvar cancer, a rare malignancy, shows increasing incidence.
  • Lymph node status is a critical prognostic factor.
  • Inguinofemoral lymphadenectomy carries significant morbidity; sentinel lymph node biopsy (SLNB) offers a less invasive alternative.

Purpose of the Study:

  • To review current evidence on SLNB for vulvar cancer.
  • To summarize indications, techniques, safety, and oncologic outcomes.
  • To address controversial scenarios like recurrent and larger tumors.

Main Methods:

  • Conducted a narrative review of PubMed-indexed studies (last 35 years).
  • Included original research, systematic reviews, meta-analyses, RCTs, and case-control studies.
  • Focused on English-language publications.

Main Results:

  • SLNB is recommended for unifocal vulvar tumors < 4 cm with stromal invasion > 1 mm and negative nodes.
  • Landmark trials (GROINSS-V-I, GOG-173) confirmed SLNB accuracy and lower morbidity.
  • SLNB utilization has increased post-guideline inclusion, decreasing lymphadenectomy rates; combined detection techniques are mandatory, with indocyanine green (ICG) as an emerging option.

Conclusions:

  • SLNB is a validated, minimally invasive staging approach for early-stage vulvar cancer.
  • Further research is needed to refine SLNB in high-risk cases and optimize detection methods.