Angela Collarino1, Valentina Fuoco2, Giorgia Garganese3,4, Lenka M Pereira Arias-Bouda5,6, Germano Perotti7, Gianpiero Manca8, Sergi Vidal-Sicart9, Francesco Giammarile10, Lioe-Fee de Geus-Oei5,11, Giovanni Scambia3,12, Alessandro Giordano7,2, Renato A Valdés-Olmos5,13,14, Marco Maccauro15. 1. Nuclear Medicine Unit, Department of Diagnostic Imaging, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. angela.collarino@policlinicogemelli.it. 2. Institute of Nuclear Medicine, Department of Diagnostic Imaging, Università Cattolica del Sacro Cuore, Rome, Italy. 3. Department of Woman and Child Health and Public Health, Vul.Can MDT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 4. Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy. 5. Division of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. 6. Department of Nuclear Medicine, Alrijne ziekenhuis, Leiderdorp, The Netherlands. 7. Nuclear Medicine Unit, Department of Diagnostic Imaging, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 8. Regional Center of Nuclear Medicine, Hospital University of Pisa, Pisa, Italy. 9. Nuclear Medicine Department, Hospital Clinic Barcelona, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. 10. Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria. 11. Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands. 12. Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy. 13. Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. 14. Department of Radiology and Nuclear Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. 15. Department of Nuclear Medicine, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy.
Abstract
PURPOSE: This study aimed to update the clinical practice applications and technical procedures of sentinel lymph node (SLN) biopsy in vulvar cancer from European experts. METHODS: A systematic data search using PubMed/MEDLINE database was performed up to May 29, 2019. Only original studies focused on SLN biopsy in vulvar cancer, published in the English language and with a minimum of nine patients were selected. RESULTS: Among 280 citations, 65 studies fulfilled the inclusion criteria. On the basis of the published evidences and consensus of European experts, this study provides an updated overview on clinical applications and technical procedures of SLN biopsy in vulvar cancer. CONCLUSIONS: SLN biopsy is nowadays the standard treatment for well-selected women with clinically negative lymph nodes. Negative SLN is associated with a low groin recurrence rate and a good 5-year disease-specific survival rate. SLN biopsy is the most cost-effective approach than lymphadenectomy in early-stage vulvar cancer. However, future trials should focus on the safe extension of the indication of SLN biopsy in vulvar cancer. Although radiotracers and optical agents are widely used in the clinical routine, there is an increasing interest for hybrid tracers like indocyanine-99mTc-nanocolloid. Finally, it is essential to standardise the acquisition protocol including SPECT/CT images, and due to the low incidence of this type of malignancy to centralise this procedure in experienced centres for personalised approach.
PURPOSE: This study aimed to update the clinical practice applications and technical procedures of sentinel lymph node (SLN) biopsy in vulvar cancer from European experts. METHODS: A systematic data search using PubMed/MEDLINE database was performed up to May 29, 2019. Only original studies focused on SLN biopsy in vulvar cancer, published in the English language and with a minimum of nine patients were selected. RESULTS: Among 280 citations, 65 studies fulfilled the inclusion criteria. On the basis of the published evidences and consensus of European experts, this study provides an updated overview on clinical applications and technical procedures of SLN biopsy in vulvar cancer. CONCLUSIONS: SLN biopsy is nowadays the standard treatment for well-selected women with clinically negative lymph nodes. Negative SLN is associated with a low groin recurrence rate and a good 5-year disease-specific survival rate. SLN biopsy is the most cost-effective approach than lymphadenectomy in early-stage vulvar cancer. However, future trials should focus on the safe extension of the indication of SLN biopsy in vulvar cancer. Although radiotracers and optical agents are widely used in the clinical routine, there is an increasing interest for hybrid tracers like indocyanine-99mTc-nanocolloid. Finally, it is essential to standardise the acquisition protocol including SPECT/CT images, and due to the low incidence of this type of malignancy to centralise this procedure in experienced centres for personalised approach.
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