Sentinel node biopsy has an established role in the management of breast cancer and an evolving role in melanoma management. It now also plays a key part in the management of selected vulval cancers.+It was introduced to Northern Ireland in 2015 and to date 20 patients with vulval cancer, ranging from FIGO stage 1b-3c, have received sentinel node localisation, using a peritumoural injection of Tecnetium-99 radiolabelled nanocolloid. The sentinel nodes were identified using a GE SPECT CT gamma camera system. In theatre, nodes are located using a hand-held detector, localising the most proximal draining node (sentinel) from the tumour. 90% of sentinel node biopsies were negative for disease. The 2 biopsy-positive patients were of a higher FIGO stage, they underwent groin node dissection and remain disease free.The GROINSS-V study found that 1-5 % of vulval cancers will metastasise to non-sentinel lymph nodes. This was reflected in our regional experience, with one biopsy-negative patient presenting with metastatic disease within 1 year. This should be interpreted in the context of a 10-15% recurrence rate in vulval cancer overall.Careful patient selection in accordance with local guidelines and patient counselling preoperatively is of utmost importance. Implementation of this technique has led to a dramatic reduction in rates of groin node dissection with its associated morbidity.
Authors: Maaike H Oonk; Bettien M van Hemel; Harry Hollema; Joanne A de Hullu; Anca C Ansink; Ignace Vergote; René H Verheijen; Angelo Maggioni; Katja N Gaarenstroom; Peter J Baldwin; Eleonora B van Dorst; Jacobus van der Velden; Ralph H Hermans; Hans W van der Putten; Pierre Drouin; Ingo B Runnebaum; Wim J Sluiter; Ate G van der Zee Journal: Lancet Oncol Date: 2010-05-25 Impact factor: 41.316