Sentinel Lymph Node Biopsy in Vulvar Cancerenglish
- To determine whether sentinel lymph node biopsy (SLNB) can safely and effectively identify women with node-negative, early-stage vulvar cancer and can be used as an alternative to inguinofemoral lymph node dissection (IFLD).
- To provide guidance with respect to the appropriate techniques and procedures in SLNB for women with early-stage vulvar cancer. These include:
- Selecting appropriate patients
- Determining the appropriate technique
- learning curve and maintenance
- which tracer to inject
- whether lymphoscintigraphy should be used
- where and when to inject
- role of intraoperative frozen-section analysis
- role of ultrastaging and the use of immunohistochemistry
- Management of patients with positive sentinel lymph nodes
Women in Ontario with early-stage (T1 or T2, <4 cm) squamous cell cancer of the vulva
Intended Guideline Users
Gynecologic oncologists and other clinicians involved in the surgical management of early-stage vulvar cancer
For patients with stage I or II vulvar cancer and using IFLD as the reference standard:
- What are the detection and false-negative rates of SLNB?
- What is the recurrence rate after a negative SLNB test compared with the recurrence rate after a negative IFLD test?
- What are the complication rates after SLNB compared with the complication rates after IFLD?
- Which patient characteristics affect detection or false-negative rates of SLNB or recurrence or complication rates after SLNB?
- What is the impact of the learning curve on detection or false-negative rates of SLNB or recurrence or complication rates after SLNB?
- What is the diagnostic accuracy of frozen-section analysis of SLNB?
- What is the diagnostic accuracy of SLNB using ultrastaging?
- What social and ethical issues are associated with SLNB?