Sentinel node biopsy identifies patients in which cancer of the vulva has spread

A new diagnostic tool now being used in patients with melanoma or breast cancer to determine if a cancer has spread is also highly accurate in women with squamous cancer of the vulva, report researchers from the Netherlands.

If confirmed through further testing, a "sentinel node" biopsy may spare up to 80% of women with early-stage vulva cancer from having to have all their lymph nodes removed to check for evidence of metastasis, or spread. This is of great significance as lymph node removal can be associated with debilitating side effects such as infection and swelling.

The procedure, performed during surgery to remove a tumor, involves the identification and removal of the first draining lymph node closest to the tumor and checking it for the presence of metastasis. If no cancer cells are detected, no additional lymph nodes are removed, but if cancer is detected then the rest of the lymph nodes are also surgically removed.

Currently, all patients with early-stage vulva cancer have radical removal of lymph nodes in their groin, even though only about 20% will show evidence of metastasis, according to study leader Ate van der Zee, MD, of the Department of Gynecologic Oncology at the University Hospital Groningen in the Netherlands.

In this study of 59 women with squamous cell carcinoma, the most common type of vulva cancer, a sentinel node biopsy precisely identified 27 patients whose cancer had spread. Researchers were able to check their results because after the sentinel node procedure, they removed all groin lymph nodes from the patients, and were able to biopsy each node.

Although van der Zee says the study, the largest of its kind, shows encouraging results, he cautions that follow-up research is needed in which only the sentinel node is removed.

"Sentinel Lymph Node Procedure Is Highly Accurate in Squamous Cell Carcinoma of the Vulva;" A.G.J. van der Zee, MD, et al.; Department of Gynecologic Oncology, University Hospital Groningen, the Netherlands; Vol. 18, No. 15 (August), 2000: pp. 2811-2816.