Sentinel node mapping in vulvar cancers: report of two cases and literature review

Document Type: Case Report

Authors

1 Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Women's Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences

Abstract

Vulvar cancer is a rare gynecological malignancy with mainly lymphatic spread. Sentinel node mapping plays an important role in the management of this gynecological malignancy. In the current study, we reported our experience in sentinel node mapping of vulvar cancer and review the literature accordingly. Since the introduction of sentinel node mapping to the surgical oncology community of our university in 2004, we had two operable vulvar cancer patients who were candidate for sentinel node mapping for inguinal lymph node staging. In the current study, we reported these two cases in details and a brief review of literature on sentinel node mapping in vulvar cancer was done. We specifically discussed the overall accuracy, importance of blue dye injection, learning curve effect, frozen section, excisional biopsy and location of the tumors. Overall sentinel node mapping is a safe and effective method for inguinal lymph node staging in vulvar cancers. In order to perform sentinel node mapping efficiently, paying attention to the details is of utmost importance.

Keywords

Main Subjects


Yousefi Z, Ahmadi S. A prospective study of female genital cancers at ghaem hospital in Mashad. J Sabzevar Univ Med Sci. 2002;4(22):8-15.

Yousefi Z, Homaei F, Sharifi N, Kadkhodayan S. Four cases of intraepithelial neoplasia of vulva: Case report. J Babol Univ Med Sci. 2004;3(23):59-63.

Balat O. Contemporary management of groin lymph nodes in early vulvar cancer: diagnosis and treatment. Eur J Gynaecol Oncol. 2002;23(5):378-82.

Walker KF, Day H, Abu J, Nunns D, Williamson K, Duncan T. Do surgical techniques used in groin lymphadenectomy for vulval cancer affect morbidity rates? Int J Gynecol Cancer. 2011 Nov;21(8):1495-9.

Gonzalez Bosquet J, Kinney WK, Russell AH, Gaffey TA, Magrina JF, Podratz KC. Risk of occult inguinofemoral lymph node metastasis from squamous carcinoma of the vulva. Int J Radiat Oncol Biol Phys. 2003 Oct 1;57(2):419-24.

Sadeghi R, Gholami H, Zakavi SR, Kakhki VR, Tabasi KT, Horenblas S. Accuracy of sentinel lymph node biopsy for inguinal lymph node staging of penile squamous cell carcinoma: systematic review and meta-analysis of the literature. J Urol. 2012 Jan;187(1):25-31.

Sadeghi R, Tabasi KT, Bazaz SM, Kakhki VR, Massoom AF, Gholami H, Zakavi SR. Sentinel node mapping in the prostate cancer. Meta-analysis. Nuklearmedizin. 2011;50(3):107-15.

Decesare SL, Fiorica JV, Roberts WS, Reintgen D, Arango H, Hoffman MS, Puleo C, Cavanagh D. A pilot study utilizing intraoperative lymphoscintigraphy for identification of the sentinel lymph nodes in vulvar cancer. Gynecol Oncol. 1997 Sep;66(3):425-8.

de Hullu JA, Doting E, Piers DA, Hollema H, Aalders JG, Koops HS, Boonstra H, van der Zee AG. Sentinel lymph node identification with technetium-99m-labeled nanocolloid in squamous cell cancer of the vulva. J Nucl Med. 1998 Aug;39(8):1381-5.

Ansink AC, Sie-Go DM, van der Velden J, Sijmons EA, de Barros Lopes A, Monaghan JM, Kenter GG, Murdoch JB, ten Kate FJ, Heintz AP. Identification of sentinel lymph nodes in vulvar carcinoma patients with the aid of a patent blue V injection: a multicenter study. Cancer. 1999 Aug 15;86(4):652-6.

Echt ML, Finan MA, Hoffman MS, Kline RC, Roberts WS, Fiorica JV. Detection of sentinel lymph nodes with lymphazurin in cervical, uterine, and vulvar malignancies. South Med J. 1999 Feb;92(2):204-8.

Rodier JF, Janser JC, Routiot T, David E, Ott G, Schneegans O, Ghnassia JP. Sentinel node biopsy in vulvar malignancies: a preliminary feasibility study. Oncol Rep. 1999 Nov-Dec;6(6):1249-52.

Hassanzade M, Attaran M, Treglia G, Yousefi Z, Sadeghi R. Lymphatic mapping and sentinel node biopsy in squamous cell carcinoma of the vulva: systematic review and meta-analysis of the literature. Gynecol Oncol. 2013 Jul;130(1):237-45.

Oonk MH, van Hemel BM, Hollema H, de Hullu JA, Ansink AC, Vergote I, Verheijen RH, Maggioni A, Gaarenstroom KN, Baldwin PJ, van Dorst EB, van der Velden J, Hermans RH, van der Putten HW, Drouin P, Runnebaum IB, Sluiter WJ, van der Zee AG. Size of sentinel-node metastasis and chances of non-sentinel-node involvement and survival in early stage vulvar cancer: results from GROINSS-V, a multicentre observational study. Lancet Oncol. 2010 Jul;11(7):646-52.

Kakhki VRD, Jangjoo A, Tavassoli A, Asadi M, Sadri K, Masoom AF, Mehrabibahar M, Memar B, Ansari M, Sadeghi R. Sentinel node mapping for early breast cancer patients using 99mTc-phytate: Single center experience on 165 patients. Iran J Nucl Med. 2012;20(2):25-9.

Sadeghi R. Sentinel node biopsy in medical practice: more than 6 years of practice in Mashhad. Iran J Nucl Med. 2010;18(Suppl 1):56.

Momennezhad M, Zakavi SR, Dabbagh Kakhki VR, Jangjoo A, Ghavamnasiri MR, Sadeghi R. Scatterogram: a method for outlining the body during lymphoscintigraphy without using external flood source. Radiol Oncol. 2011 Sep;45(3):184-8.

Trifirò G, Travaini LL, Sanvito F, Pacifici M, Mallia A, Ferrari ME, Vertua A, Maggioni A, Paganelli G, Sideri MG. Sentinel node detection by lymphoscintigraphy and sentinel lymph node biopsy in vulvar melanoma. Eur J Nucl Med Mol Imaging. 2010 Apr;37(4):736-41.

Sadeghi R, Forghani MN, Memar B, Rajabi Mashhadi MT, Dabbagh Kakhki VR, Abdollahi A, Zakavi SR. How long the lymphoscintigraphy imaging should be continued for sentinel lymph node mapping? Ann Nucl Med. 2009 Aug;23(6):507-10.

Sadeghi R, Forghani MN, Memar B, Abdollahi A, Zakavi SR, Mashhadi MT, Raziee HR, Tavassoli A, Kakhki VR. Comparison of pre-operative lymphoscintigraphy with inter-operative gamma probe and dye technique regarding the number of detected sentinel lymph nodes. Hell J Nucl Med. 2009 Jan-Apr;12(1):30-2.

Javan H, Gholami H, Assadi M, Pakdel AF, Sadeghi R, Keshtgar M. The accuracy of sentinel node biopsy in breast cancer patients with the history of previous surgical biopsy of the primary lesion: systematic review and meta-analysis of the literature. Eur J Surg Oncol. 2012 Feb;38(2):95-109.

Woelber L, Grimm D, Vettorazzi E, Wisotzki C, Trillsch F, Jaenicke F, Schwarz J, Choschzick M, Mahner S. Secondary sentinel node biopsy after previous excision of the primary tumor in squamous cell carcinoma of the vulva. Ann Surg Oncol. 2013 May;20(5):1701-6.

Memar B, Sadeghi R, Ayati NK, Aledavood SA, Tghizadeh A, Naseri S, Forghani MN, Homaee F, Abdollahi A. The value of touch imprint cytology and frozen section for intra-operative evaluation of axillary sentinel lymph nodes. Pol J Pathol. 2010;61(3):161-5.

Brunner AH, Polterauer S, Tempfer C, Joura E, Reinthaller A, Horvat R, Hefler L. The accuracy of intraoperative frozen section of the inguinal sentinel lymph node in vulvar cancer. Anticancer Res. 2008 Nov-Dec;28(6B):4091-4.

Abdollahi A, Jangjoo A, Dabbagh Kakhki VR, Rasoul Zakavi S, Memar B, Naser Forghani M, Mehrabibahar M, Sadeghi R. Factors affecting sentinel lymph node detection failure in breast cancer patients using intradermal injection of the tracer. Rev Esp Med Nucl. 2010 Mar-Apr;29(2):73-7.

Reade CJ, Jimenez W, O'Reilly D, Covens A. Sentinel lymph node biopsy in vulvar cancer: a health technology assessment for the canadian health care context. J Obstet Gynaecol Can. 2012 Nov;34(11):1053-65.

Sawicki S, Romanowicz G, Wydra D, Lass P. The usefulness of sentinel lymph node detection in vulvar cancer - a short communication. Nucl Med Rev Cent East Eur. 2010;13(2):81-3.

Sadri K, Ayati NK, Shabani G, Zakavi SR, Sadeghi R. Sentinel node detection failure due to defective labeling and large particle size of Tc-99m antimony sulfide colloid. Iran J Nucl Med. 2011;19(1):6-11.

Schaafsma BE, Verbeek FP, Peters AA, van der Vorst JR, de Kroon CD, van Poelgeest MI, Trimbos JB, van de Velde CJ, Frangioni JV, Vahrmeijer AL, Gaarenstroom KN. Near-infrared fluorescence sentinel lymph node biopsy in vulvar cancer: a randomised comparison of lymphatic tracers. BJOG. 2013 May;120(6):758-64.

Moore DH. Reflections on vulvar tumors, lymphatic drainage, and sentinel lymph node biopsy. Gynecol Oncol. 2013 Feb;128(2):153-4.

Zekan J, Mutvar A, Huic D, Petrovic D, Karelovic D, Mitrovic L. Reliability of sentinel node assay in vulvar cancer: the first Croatian validation trial. Gynecol Oncol. 2012 Jul;126(1):99-102.

Jangjoo A, Forghani MN, Mehrabibahar M, Sadeghi R. Anaphylaxis reaction of a breast cancer patient to methylene blue during breast surgery with sentinel node mapping. Acta Oncol. 2010 Aug;49(6):877-8.

Rob L, Robova H, Pluta M, Strnad P, Kacirek J, Skapa P, Taborska K. Further data on sentinel lymph node mapping in vulvar cancer by blue dye and radiocolloid Tc99. Int J Gynecol Cancer. 2007 Jan-Feb;17(1):147-53.

Levenback C, Coleman RL, Burke TW, Bodurka-Bevers D, Wolf JK, Gershenson DM.Intraoperative lymphatic mapping and sentinel node identification with blue dye in patients with vulvar cancer. Gynecol Oncol. 2001 Nov;83(2):276-81.

Fons G, ter Rahe B, Sloof G, de Hullu J, van der Velden J. Failure in the detection of the sentinel lymph node with a combined technique of radioactive tracer and blue dye in a patient with cancer of the vulva and a single positive lymph node. Gynecol Oncol. 2004 Mar;92(3):981-4.

Coleman RL, Ali S, Levenback CF, Gold MA, Fowler JM, Judson PL, Bell MC, De Geest K, Spirtos NM, Potkul RK, Leitao MM Jr, Bakkum-Gamez JN, Rossi EC, Lentz SS, Burke JJ 2nd, Van Le L, Trimble CL. Is bilateral lymphadenectomy for midline squamous carcinoma of the vulva always necessary? An analysis from Gynecologic Oncology Group (GOG) 173. Gynecol Oncol. 2013 Feb;128(2):155-9.

Louis-Sylvestre C, Evangelista E, Leonard F, Itti E, Meignan M, Paniel BJ. Sentinel node localization should be interpreted with caution in midline vulvar cancer. Gynecol Oncol. 2005 Apr;97(1):151-4.