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Guijarro-Campillo AR, Padilla-Iserte P, Couso B, Erasun D, Utrilla-Layna J, Arencibia O, Boldo-Roda A, Gilabert-Estellés J, Veiga N, Lago V, Cárdenas-Rebollo JM, Domingo S. Accuracy of ICG compared with technetium-99 m for sentinel lymph node biopsy in vulvar cancer. Eur J Obstet Gynecol Reprod Biol 2024; 294:11-19. [PMID: 38183845 DOI: 10.1016/j.ejogrb.2023.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/08/2023] [Accepted: 12/27/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE Sentinel lymph node biopsy with radioactive tracer is the standard-of-care in lymph node status assessment in vulvar cancer. Indocyanine green fluorescence-ICG is a promising detection method, due to its advantages over technetium-99 m. In vulvar cancer, the procedure is controversial due to study heterogeneity and the small sample size in previous studies. This study evaluates ICG sentinel lymph node detection compared with the criterion-standard with technetium (dual modality method). METHODS Preoperative technetium and intraoperative ICG for sentinel lymph node have been prospectively evaluated in early-stage vulvar cancer. The primary endpoint was to determine accuracy in the detection rate for ICG compared with technetium. Secondary objectives included tracer modality relationship with obesity, tumor size and location. RESULTS In total, 75 patients participated at 8 centers; 38 had lateral and 37 had midline vulvar tumors. The overall sentinel lymph node detection rate was 85.3 % for technetium and 82.7 % for ICG. For lateral tumors, the detection rate was 84.2 % vs. 89.5 %, while it was 86.5 % vs. 75.7 % for middle tumors, using technetium and ICG, respectively. The median sentinel node harvest was 1.7 (range 1-4), with 24 % metastatic involvement. The sensitivity and positive predictive value for ICG based on the standard technique with technetium was 91.08 % (95 % CI, 83.76-95.84) and 94.8 % (95 % CI, 84.84-96.48), respectively. No significant differences were found comparing the two tracers in patients with midline lesions, obesity (body mass index ≥ 30) and tumor size ≥ 2-4 cm. CONCLUSION(S) ICG shows comparable performance parameters to the gold-standard of radioisotope localization.
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Affiliation(s)
| | - Pablo Padilla-Iserte
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Bárbara Couso
- Department of Obstetrics and Gynecology, University Hospital of Ourense, Spain
| | - Diego Erasun
- Department of Obstetrics and Gynecology, Hospital Marqués de Valdecilla, Santander, Spain
| | | | - Octavio Arencibia
- Department of Gynecologic Oncology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Ana Boldo-Roda
- Department of Obstetrics and Gynecology, University Hospital La Plana, Villareal, Spain
| | - Juan Gilabert-Estellés
- Department of Obstetrics and Gynecology, University General Hospital of Valencia, University of Valencia, Spain
| | - Nadia Veiga
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, Spain
| | - Víctor Lago
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
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2
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Warmerdam DHM, van Geloven N, Beltman JJ, De Kroon CD, Rietbergen DDD, van Poelgeest MIE, Gaarenstroom KN. Sentinel lymph node procedure in early-stage vulvar cancer: Correlation of lymphoscintigraphy with surgical outcome and groin recurrence. Eur J Surg Oncol 2023; 49:107006. [PMID: 37572588 DOI: 10.1016/j.ejso.2023.107006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/26/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION In early-stage vulvar squamous cell carcinoma (VSCC) a sentinel lymph node (SLN) procedure is regarded successful if at least one SLN is removed with minimal residual radioactivity. An inguinofemoral lymphadenectomy is considered if not all SLNs visualized on lymphoscintigraphy can be found, with subsequent increased morbidity. We correlated lymphoscintigraphy findings with surgical outcome and groin recurrence with focus on number of SLNs found. METHODS This study concerns a retrospective cohort of 171 women treated for early-stage VSCC who underwent a SLN procedure between 2000 and 2020. The risk of groin recurrence was compared after either a successful or complete SLN procedure, i.e. removal of all SLNs that were visualized on lymphoscintigraphy. RESULTS In 13 (7.6%) groins of 171 patients SLN visualization on lymphoscintigraphy failed. In 230 of the 246 (93.5%) groins in which a SLN was visualized, at least one SLN was found during surgery. In 224 of the 246 (91.1%) groins the SLN procedure was regarded either successful (n = 14) or complete (n = 210). An isolated groin recurrence was documented in 5 out of 192 (2.6%, 95%-CI; 0.34 to 4.9) SLN-negative groins after a median follow-up of 47.0 months. All recurrences were noted in the complete SLN group (5/180 groins). The difference with the successful SLN group (0/12 groins) was not significant. CONCLUSION Risk of groin recurrence was 2.6% after SLN negative biopsy in early-stage VSCC. The risk appeared not increased if at least one SLN was found with minimal residual radioactivity, in case more SLNs were visualized on lymphoscintigraphy.
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Affiliation(s)
- Daniëlle H M Warmerdam
- Department of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Nan van Geloven
- Department of Biomedical Data Sciences (section Medical Statistics), Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Jogchum J Beltman
- Department of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Cor D De Kroon
- Department of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Daphne D D Rietbergen
- Daphne D.D. Rietbergen: Department of Radiology, Section Nuclear Medicine, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Mariette I E van Poelgeest
- Department of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Katja N Gaarenstroom
- Department of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
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Huisman BW, Pagan L, Ulrich M, Rissmann R, Damman J, Piek JMJ, Niemeyer-van der Kolk T, van Poelgeest MIE. Reflectance confocal microscopy as a non-invasive imaging tool in vulvar high-grade squamous intraepithelial lesions and lichen sclerosus: A descriptive morphological study in patients and healthy volunteers. Exp Dermatol 2023; 32:1734-1743. [PMID: 37486173 DOI: 10.1111/exd.14888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023]
Abstract
Incorrect and delayed diagnosis of vulvar high-grade squamous intraepithelial neoplasia (vHSIL) and lichen sclerosus (LS) increases malignant progression risks and negatively impacts prognosis and quality of life. There is a need to improve diagnosis and monitoring. Reflectance confocal microscopy is a non-invasive imaging tool that visualizes skin structures at cellular resolution. The objectives were to explore feasibility and patient acceptability of vulvar RCM imaging and to identify RCM characteristics that are discriminative for vulvar HSIL and LS. This was a prospective, cross-sectional, observational clinical trial in patients with vHSIL and LS compared to healthy volunteers. RCM images and vulvar tissue samples were obtained. Five (5) patients with vHSIL, 10 patients with LS and 10 healthy volunteers were enrolled. In total, 100 image series of vulvar skin were obtained, including lesional and nonlesional sites. The RCM technique was considered acceptable for application by patients and healthy controls. Healthy vulvar skin was characterized by a homogenous, normal honeycomb patterned epidermis and a clear epidermal-dermal junctions. Vulvar HSIL and LS displayed an atypical honeycomb pattern of the epidermis and lymphocytic influx with presence of melanophages. Distinct features specifically observed in LS included the presence of hyalinised vessels and sclerotic areas in the dermis. RCM is a non-invasive imaging technique that is feasible and clinically acceptable to apply on vulvar skin, both in patients with premalignant lesions and healthy controls. Recognition and validation of disease-specific characteristics could make reflectance confocal microscopy a clinical tool to non-invasively aid identification of vulvar premalignancies.
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Affiliation(s)
- Bertine W Huisman
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisa Pagan
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Martina Ulrich
- CMB Collegium Medicum Berlin GmbH/Dermatology Office, Berlin, Germany
| | - Robert Rissmann
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Jeffrey Damman
- Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jurgen M J Piek
- Department of Obstetrics and Gynaecology and Catharina Cancer Institute, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | | | - Mariette I E van Poelgeest
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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4
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Iwai Y, Fujiwara H. Fluorescence imaging of lymphangioma circumscriptum of the vulva with aminolevulinic acid and target-type narrow band ultraviolet light. Photodiagnosis Photodyn Ther 2023; 43:103671. [PMID: 37356698 DOI: 10.1016/j.pdpdt.2023.103671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/22/2023] [Indexed: 06/27/2023]
Abstract
Lymphangioma circumscriptum of the vulva is a rare lymphatic disorder. Defining the precise location of the lesion is required to select an appropriate treatment. Herein we present photodynamic diagnosis of lymphangioma circumscriptum of the vulva with aminolevulinic acid and target-type narrow band ultraviolet light device.
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Affiliation(s)
- Yuki Iwai
- Department of Dermatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minamiuonuma, Niigata 949-7302, Japan.
| | - Hiroshi Fujiwara
- Department of Dermatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minamiuonuma, Niigata 949-7302, Japan
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Aminimoghaddam S, Sarchami N, Mahboub SS. Second recurrence of aggressive vulvar angiomyxoma: a case report. J Int Med Res 2023; 51:3000605231189366. [PMID: 37551697 PMCID: PMC10411273 DOI: 10.1177/03000605231189366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/05/2023] [Indexed: 08/09/2023] Open
Abstract
Aggressive angiomyxoma is a rare benign tumor with diverse clinical and radiologic presentations, making its differential diagnosis challenging. Here we report the second recurrence of an aggressive angiomyxoma of the vulva in a 33-year-old woman who presented with pain and swelling. Clinical examination revealed a well-circumscribed large palpable mass extending from the inferior part of the right labia major into the right side of the gluteus. A second recurrence of aggressive angiomyxoma was suspected based on the patient's history, clinical examination, and magnetic resonance imaging report, and the patient underwent surgical resection with a negative margin. Histological evaluation of the extracted lesion confirmed the diagnosis of aggressive angiomyxoma. At the 1-year follow-up, the patient was recurrence-free. The present report urges more awareness regarding the aggressiveness of angiomyxoma of the vulva. Closer attention should be given to margin-free removal of such tumors, and patients should be routinely followed up for at least 2 years postoperatively for early diagnosis of recurrence, thereby reducing the risk of morbidity.
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Affiliation(s)
- Soheila Aminimoghaddam
- Department of Obstetrics and Gynecology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Sarchami
- Department of Obstetrics and Gynecology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sarah Sadat Mahboub
- Department of Obstetrics and Gynecology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Huisman BW, Pagan L, Naafs RG, ten Voorde W, Rissmann R, Piek JM, Damman J, Juachon MJ, Osse M, Niemeyer-van der Kolk T, van Hees CL, van Poelgeest MI. Dermatoscopy and Optical Coherence Tomography in Vulvar High-Grade Squamous Intraepithelial Lesions and Lichen Sclerosus: A Prospective Observational Trial. J Low Genit Tract Dis 2023; 27:255-261. [PMID: 36924426 PMCID: PMC10309090 DOI: 10.1097/lgt.0000000000000731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
OBJECTIVE This study aimed to examine potential discriminatory characteristics of dermatoscopy and dynamic optical coherence tomography (D-OCT) on vulvar high-grade squamous intraepithelial lesions (vHSIL) and lichen sclerosus (LS) compared with healthy vulvar skin. METHODS A prospective observational clinical trial was performed in 10 healthy volunteers, 5 vHSIL and 10 LS patients. Noninvasive imaging measurements using dermatoscopy and D-OCT were obtained at several time points, including lesional and nonlesional vulvar skin. Morphologic features of vHSIL and LS were compared with healthy controls. Epidermal thickness and blood flow were determined using D-OCT. Patients reported tolerability of each study procedure, including reference vulvar biopsies. The main outcome measures were feasibility and tolerability of imaging modalities, dermatoscopy and OCT characteristics, OCT epidermal thickness and D-OCT dermal blood flow. RESULTS The application of dermatoscopy and D-OCT is feasible and tolerable. In vHSIL, dermatoscopic warty structures were present. In LS, sclerotic areas and arborizing vessels were observed. Structural OCT in the vulvar area aligned with histology for hyperkeratosis and dermal-epidermal junction visualization. Currently, the OCT algorithm is unable to calculate the epidermal thickness of the uneven vulvar area. Dynamic optical coherence tomography showed statistically significant increased blood flow in LS patients (mean ± SD, 0.053 ± 0.029) to healthy controls (0.040 ± 0.012; p = .0024). CONCLUSIONS The application of dermatoscopy and D-OCT is feasible and tolerable in vHSIL and LS patients. Using dermatoscopy and D-OCT, the authors describe potential characteristics to aid differentiation of diseased from healthy vulvar skin, which could complement clinical assessments.
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Affiliation(s)
- Bertine W. Huisman
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisa Pagan
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Robert Rissmann
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Jurgen M.J. Piek
- Department of Obstetrics and Gynaecology and Catharina Cancer Institute, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Jeffrey Damman
- Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Michelle Osse
- Centre for Human Drug Research, Leiden, The Netherlands
| | | | | | - Mariette I.E. van Poelgeest
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
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7
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Lin GY, Liu Y, Ye T, Lu XY, Gao J, Wang YZ. Granular cell tumor of the vulva: Case report and systematic review of the literature. Medicine (Baltimore) 2022; 101:e32568. [PMID: 36595970 PMCID: PMC9803509 DOI: 10.1097/md.0000000000032568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Granular cell tumor (GCT) of the vulva is an exceptionally rare female genital tract tumor. The majority of these are benign and there are no standardized surgical techniques for the special site to reduce tension of the wound. PATIENT CONCERNS A 47-years-old Chinese woman experienced a nodule on her right vulva with itch sometimes in late 2018. DIAGNOSES Magnetic resonance imaging showed a high possibility of vulvar cancer. While Chest X-ray, abdominal sonography, and cystoscopy examination were unremarkable. INTERVENTIONS The patient underwent local complete resection of vulvar tumor under general anesthesia on March 24, 2022. The resection scope was approximately 4 cm × 3 cm × 3 cm. Due to the large surgical incision, Z-plasty was performed to achieve the primary closure for decreasing wound tension and improving aesthetic reduction. OUTCOMES The final pathological diagnosis was benign GCT of the vulva and surgical margins were uninvolved. At 8 months follow-up, no new lesions were detected. LESSONS Surgery with negative resection margins is the mainstay for benign GCT of the vulva, while Z-plasty is appropriate for decreasing the tension of the wound and improving aesthetic reduction.
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Affiliation(s)
- Guang-Yao Lin
- Department of Gynecology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Liu
- Department of Gynecology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Tao Ye
- Department of Gynecology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Xin-Yu Lu
- Department of Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Jie Gao
- Department of Pathology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Yong-Zhou Wang
- Department of Gynecology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
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Srivastava V, Jha PK, Verma AK, Ansari MA. Vulvar aggressive angiomyxoma: a surgical challenge. BMJ Case Rep 2021; 14:e240687. [PMID: 34404643 PMCID: PMC8372801 DOI: 10.1136/bcr-2020-240687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 11/03/2022] Open
Abstract
Aggressive angiomyxoma is a rare and locally aggressive mesenchymal tumour, predominantly occurring in women of reproductive age group. The term aggressive is attributed to the infiltrative nature and frequent local recurrences. They arise commonly from the vulvovaginal region, perineum or pelvis and are usually misdiagnosed as other common entities in these regions. Radiological investigations aid in the diagnosis and planning of surgery. However, the final diagnosis in most of the cases is established by histopathological examination. We herein report a case of a middle-aged woman presenting with recurrent large right vulvar mass highlighting the surgical challenges posed by its intrapelvic extension.
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Affiliation(s)
- Vivek Srivastava
- General Surgery, Banaras Hindu University Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Pratik K Jha
- General Surgery, Banaras Hindu University Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Awgesh Kumar Verma
- General Surgery, Banaras Hindu University Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Mumtaz Ahmad Ansari
- General Surgery, Banaras Hindu University Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
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Fischerova D, Garganese G, Reina H, Fragomeni SM, Cibula D, Nanka O, Rettenbacher T, Testa AC, Epstein E, Guiggi I, Frühauf F, Manegold G, Scambia G, Valentin L. Terms, definitions and measurements to describe sonographic features of lymph nodes: consensus opinion from the Vulvar International Tumor Analysis (VITA) group. Ultrasound Obstet Gynecol 2021; 57:861-879. [PMID: 34077608 DOI: 10.1002/uog.23617] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/29/2020] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
In centers with access to high-end ultrasound machines and expert sonologists, ultrasound is used to detect metastases in regional lymph nodes from melanoma, breast cancer and vulvar cancer. There is, as yet, no international consensus on ultrasound assessment of lymph nodes in any disease or medical condition. The lack of standardized ultrasound nomenclature to describe lymph nodes makes it difficult to compare results from different ultrasound studies and to find reliable ultrasound features for distinguishing non-infiltrated lymph nodes from lymph nodes infiltrated by cancer or lymphoma cells. The Vulvar International Tumor Analysis (VITA) collaborative group consists of gynecologists, gynecologic oncologists and radiologists with expertise in gynecologic cancer, particularly in the ultrasound staging and treatment of vulvar cancer. The work herein is a consensus opinion on terms, definitions and measurements which may be used to describe inguinal lymph nodes on grayscale and color/power Doppler ultrasound. The proposed nomenclature need not be limited to the description of inguinal lymph nodes as part of vulvar cancer staging; it can be used to describe peripheral lymph nodes in general, as well as non-peripheral (i.e. parietal or visceral) lymph nodes if these can be visualized clearly. The association between the ultrasound features described here and histopathological diagnosis has not yet been established. VITA terms and definitions lay the foundations for prospective studies aiming to identify ultrasound features typical of metastases and other pathology in lymph nodes and studies to elucidate the role of ultrasound in staging of vulvar and other malignancies. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D Fischerova
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - G Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - H Reina
- Department of Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University Hospital of Basel, Basel, Switzerland
| | - S M Fragomeni
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - D Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - O Nanka
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - T Rettenbacher
- Department Radiologie, Universitäts Klinik für Radiologie II, Innsbruck, Austria
| | - A C Testa
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - E Epstein
- Department of Clinical Science and Education, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Sodersjukhuset, Stockholm, Sweden
| | - I Guiggi
- Department of Obstetrics and Gynecology, North West Tuscany Hospital, Livorno, Italy
| | - F Frühauf
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - G Manegold
- Department of Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University Hospital of Basel, Basel, Switzerland
| | - G Scambia
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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10
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Mokoala KMG, Lawal IO, Lengana T, Popoola GO, Boshomane TMG, Mokgoro NP, Vorster M, Sathekge MM. The Association of Tumor Burden by 18F-FDG PET/CT and Survival in Vulvar Carcinoma. Clin Nucl Med 2021; 46:375-381. [PMID: 33630802 DOI: 10.1097/rlu.0000000000003549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to assess the impact of 18F-FDG PET/CT metabolic parameters obtained at initial staging of vulva carcinoma on survival in women with and without HIV infection. PATIENTS AND METHODS 18F-FDG PET/CT images of women with vulva cancer who are planned for definitive therapy were analyzed. SUVmax, SUVmean, MTV, and total lesion glycolysis (TLG) as well as whole-body MTV and whole-body TLG were computed. RESULTS Twenty-five women were included with a mean age of 43.44 ± 10.32. The majority of the patients were HIV infected with a median CD4 count of 444.00 cells/mm3. The HIV-infected women are younger at diagnosis than their HIV-uninfected counterparts. All patients presented with inguinofemoral lymph node involvement, whereas half the patients had pelvic nodal metastasis. All the patients with distant visceral or skeletal metastasis were HIV infected. The lungs were the most common site of distant metastasis. When comparing the SUVmax, SUVmean, MTV, TLG, wbMTV, and wbTLG between HIV-infected and HIV-uninfected patients, we did not find statistical differences. Twelve patients (48%) were upstaged to metastatic disease. Seven patients had died at the time of analysis. The wbMTV and wbTLG were significantly higher in nonsurvivors than survivors. CONCLUSIONS 18F-FDG PET/CT improves initial staging of squamous cell carcinoma among women with and without HIV infection. The whole-body tumor burden assessed by 18F-FDG PET metabolic metrics did not differ between HIV-infected and HIV-uninfected women. A higher whole-burden tumor burden is associated with a higher risk of mortality among women with vulva cancer.
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Affiliation(s)
| | | | | | - Gbenga O Popoola
- Department of Epidemiology and Community Health, University of Ilorin, Ilorin, Nigeria
| | | | - Neo P Mokgoro
- From the Department of Nuclear Medicine, University of Pretoria
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Lakhman Y, Vargas HA, Reinhold C, Akin EA, Bhosale PR, Huang C, Kang SK, Khanna N, Kilcoyne A, Nicola R, Paspulati R, Rauch GM, Shinagare AB, Small W, Glanc P. ACR Appropriateness Criteria® Staging and Follow-up of Vulvar Cancer. J Am Coll Radiol 2021; 18:S212-S228. [PMID: 33958115 DOI: 10.1016/j.jacr.2021.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/21/2022]
Abstract
Vulvar cancer is an uncommon gynecologic tumor and one of several human papillomavirus-associated malignancies. Squamous cell carcinoma is the most prevalent histologic subtype of vulvar cancer, accounting for the majority of cases. Imaging plays an important role in managing vulvar cancer. At initial diagnosis, imaging is useful to assess the size and extent of primary tumor and to evaluate the status of inguinofemoral lymph nodes. If recurrent disease is suspected, imaging is essential to demonstrate local extent of tumor and to identify lymph node and distant metastases. In this publication, we summarize the recent literature and describe the panel's recommendations about the appropriate use of imaging for various phases of patient management including initial staging, surveillance, and restaging of vulvar cancer. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Yulia Lakhman
- Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Hebert Alberto Vargas
- Memorial Sloan Kettering Cancer Center, New York, New York, Chief, Body Imaging Service, Memorial Sloan Kettering Cancer Center
| | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | | | - Chenchan Huang
- New York University Langone Medical Center, New York, New York
| | - Stella K Kang
- New York University Medical Center, New York, New York
| | - Namita Khanna
- Emory University, Atlanta, Georgia, Society of Gynecologic Oncology
| | | | - Refky Nicola
- Roswell Park Cancer Institute, Jacobs School of Medicine and Biomedical Science, Buffalo, New York
| | | | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Atul B Shinagare
- Brigham & Women's Hospital Dana-Farber Cancer Institute, Boston, Massachusetts
| | - William Small
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, Illinois, Professor and Chairman, Department of Radiation Oncology, Loyola University, Director, Cardinal Bernardin Cancer Center
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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12
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Rufini V, Garganese G, Ieria FP, Pasciuto T, Fragomeni SM, Gui B, Florit A, Inzani F, Zannoni GF, Scambia G, Giordano A, Collarino A. Diagnostic performance of preoperative [ 18F]FDG-PET/CT for lymph node staging in vulvar cancer: a large single-centre study. Eur J Nucl Med Mol Imaging 2021; 48:3303-3314. [PMID: 33619601 PMCID: PMC8426310 DOI: 10.1007/s00259-021-05257-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/11/2021] [Indexed: 12/19/2022]
Abstract
Purpose This retrospective study aimed to assess the diagnostic performance of preoperative [18F]FDG-PET/CT in predicting the groin and pelvic lymph node (LN) status in a large single-centre series of vulvar cancer patients. Methods Between January 2013 and October 2018, among all consecutive women with proven vulvar cancer submitted to [18F]FDG-PET/CT, 160 patients were included. LNs were analysed by two qualitative methods assessing PET information (defined as visual assessment) and a combination of PET and low-dose CT information (defined as overall assessment), respectively, as well as semi-quantitative analysis (LN-SUVmax). Sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV) in predicting the groin and pelvic LN status were calculated in the overall study population; a subset analysis of groin parameters in clinically/ultrasonography negative patients was also performed. Histopathology was the reference standard. Results All patients underwent vulvar and inguinofemoral LN surgery, and 35 pelvic LN surgery. Overall, 338 LN sites (296 groins and 42 pelvic sites) were histologically examined with 30.4% prevalence of metastatic groins and 28.6% for metastatic pelvic sites. In the overall study population, sensitivity (95% confidence interval, CI), specificity (95% CI), accuracy (95% CI), PPV (95% CI) and NPV (95% CI) at the groin level were 85.6% (78.3–92.8), 65.5% (59.0–72.0), 71.6% (66.5–76.8), 52.0% (44.0–60.1) and 91.2% (86.7–95.8) for visual assessment; 78.9% (70.5–87.3), 78.2% (72.5–83.8), 78.4% (73.7–83.1), 61.2% (52.3–70.1) and 89.4% (85.0–93.9) for overall assessment; and 73.3% (64.2–82.5), 85.0% (80.1–89.8), 81.4% (77.0–85.8), 68.0% (58.8–77.3) and 87.9% (83.4–92.5) for semi-quantitative analysis (SUVmax cut-off value 1.89 achieved by ROC analysis). Similar results were observed in the pelvis-based analysis. Conclusion In this large single-centre series of vulvar cancer patients, [18F]FDG-PET/CT showed good values of sensitivity and NPV in discriminating metastatic from non-metastatic LNs. In routine clinical practice, qualitative analysis is a reliable interpretative criterion making unnecessary commonly used semi-quantitative methods such as SUVmax. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05257-8.
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Affiliation(s)
- Vittoria Rufini
- Section of Nuclear Medicine, University Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
- Unit of Nuclear Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Giorgia Garganese
- Department of Woman and Child Health and Public Health, Vul.Can MDT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Francesco P Ieria
- Section of Nuclear Medicine, University Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Tina Pasciuto
- Department of Woman and Child Health and Public Health, Vul.Can MDT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simona M Fragomeni
- Department of Woman and Child Health and Public Health, Vul.Can MDT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Benedetta Gui
- Unit of Radiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anita Florit
- Section of Nuclear Medicine, University Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Frediano Inzani
- Unit of Gynecopathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gian Franco Zannoni
- Unit of Gynecopathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Section of Pathology, Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Vul.Can MDT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Section of Obstetrics and Gynecology, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Giordano
- Section of Nuclear Medicine, University Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
- Unit of Nuclear Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angela Collarino
- Unit of Nuclear Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Koual M, Benoit L, Nguyen-Xuan HT, Bentivegna E, Azaïs H, Bats AS. Diagnostic value of indocyanine green fluorescence guided sentinel lymph node biopsy in vulvar cancer: A systematic review. Gynecol Oncol 2021; 161:436-441. [PMID: 33551201 DOI: 10.1016/j.ygyno.2021.01.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/24/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Sentinel lymph node biopsy (SLN) helps define lymph node status, a major prognostic factor in vulvar cancer. The aim of the current systematic review was to assess the use of indocyanine green (ICG) coupled with near-infrared (NIR) fluorescence imaging in SLN mapping in vulvar cancer in terms of technique used, feasibility and accuracy. DATA SOURCES We performed a systematic review using bibliographic citations from PubMed, Clinical Trials.gov, Embase, Cochrane Library, and Web of Science databases. MeSH terms for SLN, ICG and vulvar cancer were combined and restricted to the English language. The final search was performed on May 28, 2020. The primary outcome was to determine if the use of ICG alone in detecting SLN in women with vulvar cancer is as accurate as the gold standard dual labeling technique. RESULTS Of the 34 studies initially identified, 13 were included for analysis. The SLN detection rate with ICG and NIR fluorescence ranged from 89.7 to 100%. No studies demonstrated the superiority of other detection techniques compared to ICG and NIR imaging. Lower SLN detection rates were found in studies with the most metastatic lymph nodes. No consensus was reached concerning the optimal use of ICG in terms of: injection timing or site; concentrations or volume of ICG; or use of human serum albumin or hybrid tracer. No adverse events were reported. CONCLUSION ICG for SLN mapping appears to be safe in women with vulvar cancer with a detection rate similar to the current techniques. A large prospective randomized controlled study with optimization of the technique is necessary to homogenize current practice and determine the true value of ICG in vulvar cancer. PROSPERO ID CRD42020178261.
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Affiliation(s)
- Meriem Koual
- Department of Gynecologic and Breast Oncological Surgery, European Georges-Pompidou Hospital, APHP. Centre, France; Paris University, Faculty of Medicine, Paris, France; INSERM UMR-S 1124, Université de Paris, Centre Universitaire des Saints-Pères, Paris, France.
| | - Louise Benoit
- Department of Gynecologic and Breast Oncological Surgery, European Georges-Pompidou Hospital, APHP. Centre, France; INSERM UMR-S 1124, Université de Paris, Centre Universitaire des Saints-Pères, Paris, France
| | - Huyen-Thu Nguyen-Xuan
- Department of Gynecologic and Breast Oncological Surgery, European Georges-Pompidou Hospital, APHP. Centre, France
| | - Enrica Bentivegna
- Department of Gynecologic and Breast Oncological Surgery, European Georges-Pompidou Hospital, APHP. Centre, France
| | - Henri Azaïs
- Department of Gynecologic and Breast Oncological Surgery, European Georges-Pompidou Hospital, APHP. Centre, France
| | - Anne-Sophie Bats
- Department of Gynecologic and Breast Oncological Surgery, European Georges-Pompidou Hospital, APHP. Centre, France; Paris University, Faculty of Medicine, Paris, France; INSERM UMR-S 1147, Université de Paris, Centre Universitaire des Saints-Pères, Paris, France
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Triumbari EKA, de Koster EJ, Rufini V, Fragomeni SM, Garganese G, Collarino A. 18F-FDG PET and 18F-FDG PET/CT in Vulvar Cancer: A Systematic Review and Meta-analysis. Clin Nucl Med 2021; 46:125-132. [PMID: 33234921 DOI: 10.1097/rlu.0000000000003411] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM The aims of this study were to determine the role of 18F-FDG PET/CT in vulvar cancer patients and to extract summary estimates of its diagnostic performance for preoperative lymph node staging. PATIENTS AND METHODS PubMed/Medline and Embase databases were searched to identify studies evaluating 18F-FDG PET/CT in vulvar cancer patients. The assessment of methodological quality of the included articles was performed. Per-patient and per-groin pooled estimates, with 95% confidence intervals (CIs), of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratio (DOR) were calculated. RESULTS Ten articles were included in the systematic review, 7 among which evaluated the diagnostic performance of preoperative 18F-FDG PET/CT for lymph node staging. Qualitative per-patient analysis (72 patients from 4 studies) resulted in estimated pooled sensitivity, specificity, PPV, NPV, and DOR of 0.70 (95% CI, 0.44-0.95), 0.90 (95% CI, 0.76-1.04), 0.86 (95% CI, 0.66-1.06), 0.77 (95% CI, 0.56-0.97), and 10.49 (95% CI, 1.68-65.50), respectively. Qualitative per-groin analysis (245 groins from 5 studies) resulted in estimated pooled sensitivity, specificity, PPV, NPV, and DOR of 0.76 (95% CI, 0.57-0.94), 0.88 (95% CI, 0.82-0.94), 0.70 (95% CI, 0.55-0.85), 0.92 (95% CI, 0.86-0.97), and 19.43 (95% CI, 6.40-58.95), respectively. CONCLUSIONS Despite limited literature data, this systematic review and meta-analysis revealed that a negative preoperative PET/CT scan may exclude groin metastases in at least early-stage vulvar cancer patients currently unfit for sentinel node biopsy and select those eligible for a less invasive surgical treatment. A positive PET/CT result should otherwise be interpreted with caution. Larger prospective studies are needed to confirm these results and to evaluate the diagnostic value of standardized semiquantitative analysis compared with the qualitative one.
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Affiliation(s)
- Elizabeth K A Triumbari
- From the Section of Nuclear Medicine, University Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Simona M Fragomeni
- Department of Woman and Child Health and Public Health, Vul.Can MDT, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
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15
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Garganese G, Fragomeni SM, Pasciuto T, Leombroni M, Moro F, Evangelista MT, Bove S, Gentileschi S, Tagliaferri L, Paris I, Inzani F, Fanfani F, Scambia G, Testa AC. Ultrasound morphometric and cytologic preoperative assessment of inguinal lymph-node status in women with vulvar cancer: MorphoNode study. Ultrasound Obstet Gynecol 2020; 55:401-410. [PMID: 31237047 DOI: 10.1002/uog.20378] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/11/2019] [Accepted: 06/17/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess the accuracy of preoperative ultrasound examination for predicting lymph-node (LN) status in patients with vulvar cancer. METHODS This was a single-institution retrospective observational study of all women with a histological diagnosis of vulvar cancer triaged to inguinal surgery within 30 days following ultrasound evaluation between December 2010 and January 2016. For each groin examined, 15 morphological and dimensional sonographic parameters associated with suspicion for LN involvement were examined. A morphometric ultrasound pattern (MUP) was expressed for each groin, classifying the inguinal LN status into five groups (normal; reactive-but-negative; minimally suspicious/probably negative; moderately suspicious; and highly suspicious/positive) according to subjective judgment, followed by stratification as positive or negative for metastasis according to morphometric binomial assessment (MBA). In cases of positive MBA, fine-needle aspiration cytology was performed. Combining the information obtained from MUP and cytologic results, a binomial final overall assessment (FOA) was assigned for each groin. The final histology was considered as the reference standard. Comparison was performed between patients with negative and those with positive LNs on histology, and receiver-operating-characteristics curves were generated for statistically significant variables on univariate analysis, to evaluate their diagnostic ability to predict negative LN status. RESULTS Of 144 patients included in the analysis, 87 had negative inguinal LNs and 57 had positive LNs on histology. A total of 256 groins were analyzed, of which 171 were negative and 85 showed at least one metastatic LN on histology. The following parameters showed the greatest accuracy, with the best balance between specificity and sensitivity, in predicting negative LN status: cortical (C) thickness of the dominant LN (cut-off, 2.5 mm; sensitivity, 90.0%; specificity, 77.9%); short-axis (S) length of the dominant LN (cut-off, 8.4 mm; sensitivity, 63.9%; specificity, 90.6%); C/medulla (M) thickness ratio of the dominant LN (cut-off, 1.2 mm; sensitivity, 70.4%; specificity, 91.5%), the combination of S length and C/M thickness ratio (sensitivity, 88.9%; specificity, 82.4%); and the FOA analysis (sensitivity, 85.9%; specificity, 84.2%). CONCLUSIONS Preoperative ultrasound assessment, with or without the addition of cytology, has a high accuracy in assessing inguinal LN status in patients with vulvar cancer. In particular, the combination of two ultrasound parameters (S length and C/M thickness ratio) provided the greatest accuracy in discriminating between negative and positive LNs. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G Garganese
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - S M Fragomeni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Rome, Italy
| | - T Pasciuto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, STAR Center (Statistics Technology Archiving Research Center), Rome, Italy
| | - M Leombroni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Rome, Italy
| | - F Moro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Rome, Italy
| | - M T Evangelista
- Ginecologia Oncologica, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - S Bove
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - S Gentileschi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Chirurgia Plastica, Rome, Italy
- Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Rome, Italy
| | - I Paris
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Rome, Italy
| | - F Inzani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Gineco-patologia e Patologia Mammaria, Rome, Italy
| | - F Fanfani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A C Testa
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
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Huisman BW, Burggraaf J, Vahrmeijer AL, Schoones JW, Rissmann RA, Sier CFM, van Poelgeest MIE. Potential targets for tumor-specific imaging of vulvar squamous cell carcinoma: A systematic review of candidate biomarkers. Gynecol Oncol 2020; 156:734-743. [PMID: 31928804 DOI: 10.1016/j.ygyno.2019.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Vulvar squamous cell carcinoma (VSCC) is a rare malignancy with an increasing incidence, especially in young women. Surgical treatment of VSCC is associated with significant morbidity and high recurrence rates, which is related to the limited ability to distinguish (pre)malignant from healthy tissue. There is a need for new tools for specific real-time detection of occult tumor lesions and localization of cancer margins in patients with VSCC. Several tumor-specific imaging techniques are developed to recognize malignant tissue by targeting tumor markers. We present a systematic review to identify, evaluate, and summarize potential markers for tumor-specific imaging of VSCC. METHODS Relevant papers were identified by a systematic cross-database literature search developed with assistance of an experienced librarian. Data were extracted from eligible papers and reported based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. VSCC-specific tumor markers were valued based on a weighted scoring system, in which each biomarker was granted points based on ranked eligibility criteria: I) percentage expression, II) sample size, and III) in vivo application. RESULTS In total 627 papers were included of which 22 articles met the eligibility criteria. Twelve VSCC-specific tumor markers were identified and of these 7 biomarkers were considered most promising: EGFR, CD44v6, GLUT1, MRP1, MUC1, CXCR-4 and VEGF-A. DISCUSSION This overview identified 7 potential biomarkers that can be used in the development of VSCC-specific tracers for real-time and precise localization of tumor tissue before, during, and after treatment. These biomarkers were identified in a small number of samples, without discriminating for VSCC-specific hallmarks such as HPV-status. Before clinical development, experimental studies should first aim at validation of these biomarkers using immunohistochemistry and cell line-based examination, discriminating for HPV-status and the expression rate in lymph nodes and precursor lesions.
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Affiliation(s)
- B W Huisman
- Centre for Human Drug Research, Zernikedreef 8, 2333CL Leiden, the Netherlands; Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - J Burggraaf
- Centre for Human Drug Research, Zernikedreef 8, 2333CL Leiden, the Netherlands; Leiden Academic Center for Drug Research, Leiden University, Einstein weg 55, 2333 CC Leiden, the Netherlands; Department of Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - A L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - J W Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, PO Box 9600, 2300 RC, the Netherlands.
| | - R A Rissmann
- Centre for Human Drug Research, Zernikedreef 8, 2333CL Leiden, the Netherlands; Leiden Academic Center for Drug Research, Leiden University, Einstein weg 55, 2333 CC Leiden, the Netherlands.
| | - C F M Sier
- Department of Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - M I E van Poelgeest
- Centre for Human Drug Research, Zernikedreef 8, 2333CL Leiden, the Netherlands; Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
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Yoshida H. Surgical Treatment for Locally Advanced Adenoid Cystic Carcinoma of the Bartholin's Gland: A Case Report. Tokai J Exp Clin Med 2019; 44:68-72. [PMID: 31768993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/27/2019] [Indexed: 06/10/2023]
Abstract
Adenoid cystic carcinoma (ACC) of the Bartholin's gland (BACC) is an extremely rare malignancy of the vulva. The characteristics of BACC include slow tumor growth and aggressive invasion, especially with perineural involvement. A 64-year-old Japanese woman complained of a mass and pain in the perineum. A 3 cm-sized mass was palpated inside of the labia majora. Diagnostic imaging demonstrated the tumor invading the anus and urethra. The patient underwent total pelvic exenteration with radical vulvectomy. Pathological findings revealed that the tumor was BACC. The surgical margin was positive for tumor cells, which necessitated adjuvant radiotherapy. No serious complications were associated with the surgery and radiotherapy. There is no clear consensus on to the proper surgical intervention in BACC. Achieving tumor-free surgical margins is desired to avoid recurrence. However, such attempts have often failed in reported BACC cases with extended surgical resection. Nevertheless, given the aggressive nature of BACC, extensive surgery including total pelvic exenteration is justified, particularly with promising reported efficacy of adjuvant radiotherapy on BACC prognosis.
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Affiliation(s)
- Hiroshi Yoshida
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama 240-8555, Japan.
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Heidkamp J, Zusterzeel PL, van Engen‐van Grunsven AC, Overduin CG, Veltien A, Maat A, Rovers MM, Fütterer JJ. MRI evaluation of vulvar squamous-cell carcinoma in fresh radical local excision specimens for cancer localization and prediction of surgical tumor-free margins. NMR Biomed 2019; 32:e4025. [PMID: 30431192 PMCID: PMC6587990 DOI: 10.1002/nbm.4025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/30/2018] [Accepted: 09/19/2018] [Indexed: 06/09/2023]
Abstract
In the surgical treatment of vulvar squamous-cell carcinoma (VSCC), tumor-free margins of 8 mm or more are considered adequate. However, limited perioperative information on the tumor-free margins other than the surgeon's own estimation is available. The purpose of this study was therefore to investigate the feasibility of ex vivo MRI in localizing VSCC and to assess the surgical tumor-free margins in fresh radical local excision (RLE) specimens to guide the surgeon during resections. Nine patients with biopsy-proven VSCC scheduled for RLE were prospectively included. Intact fresh specimens were scanned using a 7 T preclinical MR-scanner. Whole mount H&E-stained slides were obtained every 3 mm and correlated with ex vivo MRI. A pathologist annotated VSCC and minimal tumor-free margins (3 o'clock, 9 o'clock, basal) on the digitalized histological slides. An observer with knowledge of histology (the non-blinded annotation) and a radiologist blinded to histology (the blinded annotation) separately performed annotation of the same features on ex vivo MRI. Linear correlation and agreement of the ex vivo MRI measurements with histology were assessed. Diagnostic performance for VSCC localization and identification of margins less than 8 mm was expressed as positive and negative predictive values (PPV, NPV). In 153 matched ex vivo MRI slices, the observer correctly identified 79/91 margins as less than 8 mm (PPV 87%) and 110/124 margins as 8 mm or greater (NPV 89%). The radiologist correctly annotated absence of VSCC in 73/81 (NPV 90%) and presence in 65/72 (PPV 90%) slices. Sixty-four of 90 margins were correctly identified as less than 8 mm (PPV 71%) and 83/102 margins as 8 mm or greater (NPV 81%). Both non-blinded and blinded annotations were linearly correlated and demonstrated good agreement with histology. Accurate localization of VSCC and measurements of the surgical tumor-free margins in fresh RLE specimens using ex vivo MRI seems feasible. High diagnostic performance in VSCC localization and identification of margins less than 8 mm suggest ex vivo MRI to be clinically applicable.
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Affiliation(s)
- Jan Heidkamp
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Petra L.M. Zusterzeel
- Department of Obstetrics and GynaecologyRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Christiaan G. Overduin
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Andor Veltien
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Arie Maat
- Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Maroeska M. Rovers
- Department of Operating RoomsRadboud University Medical CenterNijmegenThe Netherlands
| | - Jurgen J. Fütterer
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
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19
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Abstract
Sentinel node biopsy has become a standard diagnostic procedure to assess lymph node status of various tumors. The combination of blue dye and a radioactive tracer offers the best chances of identifying the sentinel lymph node. Most progress in the technique of the sentinel node procedure has been made in melanoma and breast cancer. In melanoma, sentinel node biopsy has been introduced as a fundamental procedure for staging. Information on the lymphatic drainage from a melanoma can have a direct impact on the surgery. More recently, the technique has been successfully introduced in the management of breast cancer, in which a large number of unnecessary axillary dissections could be avoided. However, there are many other potential fields of application of the sentinel node biopsy (e.g. endometrial, vulvar, head and neck cancers) that are worthy of investigation. In any case, multicenter trials are required to standardize the procedures, taking into account several variables such as particle size and mode of delivery of the radiotracer, amount of radioactivity administered, number and location of injections, and choice of the hand-held probe. We briefly describe the technical and historical aspects of the sentinel node biopsy and summarize the main clinical trials proposed and/or performed in the field.
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Affiliation(s)
- L Maffioli
- Nuclear Medicine, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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20
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Abstract
152 cases of squamous cell carcinoma of the vulva, operated at the National Cancer Institute of Milan have been analyzed for the purpose of assessing: the frequency of metastases in relation to the. local extent, site of the growth, and clinical and lymphography diagnosis. We reached the following conclusions: a) in T1N0 cancers, the incidence of inguinal metastases is less than 2.7 %. Therefore in unilateral T1N0 tumors a simple vulvectomy may be considered; b) in median tumors, metastases are always bilateral, and in the mixed ones (lateral and median) bilateral metastases are more frequent than unilateral metastases (31.4% vs. 12.9%); c) in unilateral tumors, inguinal metastases are homolateral or bilateral: we have never observed inguinal metastases contralateral to the primary growth. We think that inguinal lymphadenectomy should be bilateral in median or mixed tumors, while in unilateral cases it should be bilateral only in cases where at least homolateral metastases are present. We have never observed pelvic metastases in patients with negative pelvic lymphangiography and/or without inguinal metastatic nodes. Pelvic lymphadenectomy should be planned only in cases of metastases of ipsilateral inguinal nodes or if there are lymphographically positive nodes. We think that the surgical approach to cancer of the vulva should be planned taking into account the T, the N, and the Iymphographic or histologic peroperative diagnosis. In this way, radicality and, at the same time, saving of non-metastatic nodes, which can play an important role in preventing recurrences, could be achieved.
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Sideri M, De Cicco C, Maggioni A, Colombo N, Bocciolone L, Trifirò G, De Nuzzo M, Mangioni C, Paganelli G. Detection of Sentinel Nodes by Lymphoscintigraphy and Gamma Probe Guided Surgery in Vulvar Neoplasia. Tumori 2018; 86:359-63. [PMID: 11016730 DOI: 10.1177/030089160008600431] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Pathologic lymph node status is the most important prognostic factor in vulvar cancer; however, complete inguinofemoral node dissection is associated with significant morbidity. Intraoperative lymphoscintigraphy associated with gamma detecting probe-guided surgery has proved to be reliable in the detection of sentinel node (SN) involvement in melanoma and breast cancer patients. The present study evaluates the feasibility of the surgical identification of inguinal sentinel nodes using lymphoscintigraphy and a gamma detecting probe in patients with early vulvar cancer. Methods Technetium-99-labeled colloid human albumin was administered perilesionally in 44 patients. Twenty patients had T1 and 23 had T2 invasive epidermoid vulvar cancer; one patient had a lower-third vaginal cancer. An intraoperative gamma detecting probe was used to identify SNs during surgery. Complete inguinofemoral node dissection was subsequently performed. SNs underwent separate pathologic evaluation. Results A total of 77 groins were dissected in 44 patients. SNs were identified in all the studied groins. Thirteen cases had positive nodes: the SN was positive in all of them; in 10 cases the SN was the only positive node. Thirty-one patients showed negative SNs: all of them were negative for lymph node metastasis. Conclusions Lymphoscintigraphy and SN biopsy under gamma detecting probe guidance proved to be an easy and reliable method for detection of SNs in early vulvar cancer. If these preliminary data will be confirmed, the technique would represent a real progress towards less aggressive treatment in patients with vulvar cancer.
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Affiliation(s)
- M Sideri
- Division of Gynecology, European Institute of Oncology, Milan, Italy.
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22
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Herghelegiu CG, Neacşu A, Oprescu ND, Cărbunaru AE, Brăila AD, Curea FG, Marcu ML, Ioan RG, Bohîlţea RE. Difficulties of clinical and histopathological diagnosis in advanced vulvar clear cell carcinoma. Rom J Morphol Embryol 2018; 59:1233-1237. [PMID: 30845306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Clear cell carcinoma (CCC) of the female genital tract usually arises in the ovary, endometrium, cervix and vagina. A rare site for CCC is the vulva, and moreover even rarer are the cases involving the Bartholin gland. A 54-year-old female was admitted for a 1.5×2 cm tumor at the level of the right Bartholin gland. The magnetic resonance imaging (MRI) exam revealed enlarged inguinal, pelvic and para-aortic lymph nodes but no other primary tumor. Microscopic examination revealed CCC. The tumor was positive for cytokeratin 7 (CK7), paired-box 8 (Pax8), napsin A and vimentin, negative for estrogen receptor (ER), progesterone receptor (PR), calretinin, cluster of differentiation 10 (CD10), carcinoembryonic antigen (CEA), p16 and p63. Also, p53 was expressed in 30-40% and Ki67 in 70% of the malignant cells. Given the clinical, imagistic, histological and immunohistochemical features of the tumor, we concluded that the tumor is a CCC of the Bartholin gland. Aim of the study is to signal a rare case of CCC of Bartholin gland. Since there are only two other cases reported in literature, the natural history and prognosis of the disease is not known, also there are no therapeutic guidelines regarding this rare tumor so appropriate treatment is uncertain. Therefore, it is important that new cases are reported for a better understanding of this rare condition. Bartholin gland carcinoma is a pathology quite rarely encountered in practice. The positive diagnosis is eminently histological and immunohistochemistry. Bartholin gland CCC is an extremely rare diagnosis with, to our knowledge, only two other cases reported in literature, but with a potential aggressive clinical behavior and poor outcome.
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Affiliation(s)
- Cătălin Gabriel Herghelegiu
- Department of Obstetrics and Gynecology, "Polizu" Clinical Hospital, "Alessandrescu-Rusescu" National Institute for Healthcare of Mother and Child, Bucharest, Romania;
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23
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Crivellaro C, Guglielmo P, De Ponti E, Elisei F, Guerra L, Magni S, La Manna M, Di Martino G, Landoni C, Buda A. 18F-FDG PET/CT in preoperative staging of vulvar cancer patients: is it really effective? Medicine (Baltimore) 2017; 96:e7943. [PMID: 28930828 PMCID: PMC5617695 DOI: 10.1097/md.0000000000007943] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to assess the role of 18F-FDG PET/CT in preoperative staging of vulvar cancer patients.29 pts (69 years, range 51-88) with vulvar cancer (clinical apparent stage I-II), underwent preoperative FDG-PET/CT scan followed by radical vulvectomy and bilateral (or monolateral in case of tumor >2 cm from midline) inguinal lymphadenectomy ± sentinel node biopsy. PET/CT images were analyzed in consensus and correlated to histological findings according to a pt-based and a groin-based analyses. SUVmax of the nodal uptake of each inguinal area (if present) was calculated and correlated to histological findings. The presence of distant metastases was also considered and confirmed.PET/CT analysis in consensus resulted negative at the inguinal LN level in 17 pts (10 true negative, 7 false negative) and positive in 12 pts (7 true positive, 5 false positive). Incidence of LN metastases resulted 48%. On pt-based analysis, sensitivity, specificity, accuracy, and negative and positive predictive value of PET/CT in detecting LN metastases were 50%, 67%, 59%, 59%, and 58%, respectively. On a groin-based analysis, considering overall 50 LN-sites, sensitivity, specificity, accuracy, and negative and positive predictive value of PET/CT were 53%, 85%, 73%, 67%, and 76%, respectively. The mean value of SUVmax was 6.1 (range 0.7-16.2) for metastatic nodes, whereas 1.6 (range 0.7 - 5.4) for negative lymph-nodes (P = .007). PET/CT detected pelvic (n = 1) and both pelvic/paraortic (n = 1) nodal metastases.In clinical early stage vulvar cancer FDG PET/CT showed low sensitivity and moderate specificity for N-staging; therefore, it is not an accurate tool for the nodal status assessment. PET/CT may not be cost-effective in detecting the rare event of distant metastases, but further studies are needed.
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Affiliation(s)
- Cinzia Crivellaro
- Department of Nuclear Medicine, ASST Monza, Monza
- University Milan-Bicocca, Milan
| | | | | | | | - Luca Guerra
- Department of Nuclear Medicine, ASST Monza, Monza
| | - Sonia Magni
- Department of Obstetrics and Gynecology, ASST Monza, Monza, Italy
| | - Maria La Manna
- Department of Obstetrics and Gynecology, ASST Monza, Monza, Italy
| | | | - Claudio Landoni
- Department of Nuclear Medicine, ASST Monza, Monza
- University Milan-Bicocca, Milan
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, ASST Monza, Monza, Italy
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24
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Sherer DM, Moron A, Peirera L, Ward K, Benton L, Abulafia O. Transperineal sonographic findings of vulvar neurofibromatosis Type 1. Ultrasound Obstet Gynecol 2017; 49:543-544. [PMID: 27484041 DOI: 10.1002/uog.17213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 07/15/2016] [Indexed: 06/06/2023]
Affiliation(s)
- D M Sherer
- Divisions of Gynecologic Oncology and Obstetrics and Gynecology Ultrasound, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, 450 Clarkson Avenue, Box 24, Brooklyn, NY, USA
| | - A Moron
- Divisions of Gynecologic Oncology and Obstetrics and Gynecology Ultrasound, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, 450 Clarkson Avenue, Box 24, Brooklyn, NY, USA
| | - L Peirera
- Divisions of Gynecologic Oncology and Obstetrics and Gynecology Ultrasound, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, 450 Clarkson Avenue, Box 24, Brooklyn, NY, USA
| | - K Ward
- Divisions of Gynecologic Oncology and Obstetrics and Gynecology Ultrasound, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, 450 Clarkson Avenue, Box 24, Brooklyn, NY, USA
| | - L Benton
- Divisions of Gynecologic Oncology and Obstetrics and Gynecology Ultrasound, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, 450 Clarkson Avenue, Box 24, Brooklyn, NY, USA
| | - O Abulafia
- Divisions of Gynecologic Oncology and Obstetrics and Gynecology Ultrasound, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, 450 Clarkson Avenue, Box 24, Brooklyn, NY, USA
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25
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Abstract
Liposarcoma (LPS) of vulva is a rare entity. We present the ultrasonographic (US) and color Doppler ultrasonographic (CDUS) findings of a vulvar myxoid LPS. Although LPS cases have been reported in the extremities and trunk, the US or CDUS findings of LPS in vulva have not been described previously. On US the mass appeared as a well-defined, homogeneous hypoechoic structure and on CDUS it was quite hypervascular.
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Affiliation(s)
- Bahar Yanik
- Department of Radiology, Balikesir University Faculty of Medicine, Balikesir, Turkey
| | - Umit Inceboz
- Department of Obstetrics&Gynecology, Balikesir University Faculty of Medicine, Balikesir, Turkey
| | - Erdogan Bulbul
- Department of Radiology, Balikesir University Faculty of Medicine, Balikesir, Turkey.
| | - Gulen Demirpolat
- Department of Radiology, Balikesir University Faculty of Medicine, Balikesir, Turkey
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26
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Klapdor R, Länger F, Gratz KF, Hillemanns P, Hertel H. SPECT/CT for SLN dissection in vulvar cancer: Improved SLN detection and dissection by preoperative three-dimensional anatomical localisation. Gynecol Oncol 2015; 138:590-6. [PMID: 26067332 DOI: 10.1016/j.ygyno.2015.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/01/2015] [Accepted: 06/06/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In this study, we assessed the feasibility and clinical advantages of single photon emission computed tomography with CT (SPECT/CT) for sentinel lymph node (SLN) detection in vulvar cancer. METHODS This is a unicentric prospective trial. Vulvar cancer patients underwent preoperative SLN marking (10MBq Technetium (TC)-99m-nanocolloid) and subsequent planar lymphoscintigraphy (LSG) and SPECT/CT for SLN visualization. Directly before surgery, a patent blue dye was injected. We assessed detection rates of SPECT/CT and those of planar LSG and intraoperative detection. We analyzed the sensitivity, negative predictive value and false negative rate. RESULTS At Hannover Medical School, 40 vulvar cancer patients underwent SLN dissection after preoperative LSG and SPECT/CT. The mean diameter of all tumors in final histology was 2.23 (0.1-10.5) cm with a mean tissue infiltration of 3.93 (0.25-11) mm. In preoperative imaging, SPECT/CT identified significantly more SLNs (mean 8.7 (1-35) LNs per patient) compared to LSG (mean 5.9 (0-22) LNs, p<0.01). In addition, SPECT/CT led to a high spatial resolution and anatomical localization of SLNs. Thus, SPECT/CT identified aberrant lymphatic drainage in 7/40 (17.5%) patients. There were no significant differences, but significant correlation was found between SPECT/CT and intraoperative SLN identification. Regarding inguino-femoral LNs, for all patients who underwent complete groin dissection, sensitivity was 100%, NPV was 100% and false negative rate was 0%. CONCLUSION SPECT/CT leads to higher SLN identification compared to LSG in vulvar cancer. Due to its higher spatial resolution and three-dimensional anatomical localisation of SLNs, SPECT/CT provides the surgeon with important additional information, facilitates intraoperative SLN detection and predicts aberrant lymphatic drainage.
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Affiliation(s)
- R Klapdor
- Department of Obstetrics and Gynaecology, Hannover Medical School, Germany
| | - F Länger
- Institute of Pathology, Hannover Medical School, Germany
| | - K F Gratz
- Department of Nuclear Medicine, Hannover Medical School, Germany
| | - P Hillemanns
- Department of Obstetrics and Gynaecology, Hannover Medical School, Germany
| | - H Hertel
- Department of Obstetrics and Gynaecology, Hannover Medical School, Germany.
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27
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Kamran MW, O'Toole F, Meghen K, Wahab AN, Saadeh FA, Gleeson N. Whole-body [18F]fluoro-2-deoxyglucose positron emission tomography scan as combined PET-CT staging prior to planned radical vulvectomy and inguinofemoral lymphadenectomy for squamous vulvar cancer: a correlation with groin node metastasis. EUR J GYNAECOL ONCOL 2014; 35:230-235. [PMID: 24984533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Surgery is the mainstay of treatment for vulvar cancer. FIGO staging requires histopathological detail of the primary tumor and inguinofemoral lymph nodes but groin node dissection carries a substantial risk of short and long-term morbidity. The trend in current practice is towards sentinel lymphadenectomy for cancers with a low risk of metastases. Full lymphadenectomy is undertaken if the sentinel lymph node contains metastasis. The predictive value of 18F-FDG-PET in preoperative assessment of the groin in vulvar squamous cancer was assessed in retrospect at a single institution. A period of three years prior to the introduction of sentinel lymph node mapping was chosen in order to have full histopathological assessment of inguinal and femoral lymph nodes available as the gold standard for correlation with positron emission tomography-computerized tomography (PET-CT) to determine the accuracy of the enhanced radiological technique. In patients with histologically proven metastases to groin nodes, comparisons between PET-CT positive (True-positive/TP) and negative (False-negative/FN) groups vis-à-vis histology showed a tendency towards higher FDG avidity in the vulvar lesions, more bilateral nodes, multiple metastases, larger metastases and more extra-capsular extension in the TP group. Calculations per patient for PET-CT yielded a sensitivity of 50% and specificity at 100%. The positive predictive value (PPV) was 100% and the negative predictive value (NPV) was 57.1%. The test accuracy was 70% per patient. The high positive predictive value of PET-CT can be used to advance treatment planning prior to surgical staging of patients identified with Stage III disease. The poor sensitivity makes it unsuitable as a substitute for staging lymphadenectomy.
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28
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Velemínský M. Extremely large vulvar fibroma in a 15-year-old girl. Neuro Endocrinol Lett 2012; 33:600-602. [PMID: 23160223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 08/20/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Fibromas and fibromyomas belong to the most common solid vulvar tumors. Their cause remains unknown. CASE A 15-year-old girl arrived at our department for extirpation of a large pendulous vulval fibroma. For three years she had observed a gradually enlarging structure protruding from her external genitals. After a preoperative CT examination the tumor was extirpated with a histological diagnosis of benign soft fibroma. CONCLUSION Our report describes a therapeutic management of a large vulval fibroma in a young girl. The extended time from first symptoms to final treatment deserves reflection.
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Affiliation(s)
- Milos Velemínský
- Department of Clinical Branches, Faculty of Health and Social Studies, University of South Bohemia in České Budějovice, České Budějovice, Czech Republic.
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29
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Abstract
Cutaneous abscesses are typically incised and drained on the basis of clinical assessment. In most cases this procedure is a safe practice. We report 6 cases in which point-of-care ultrasound interrogation of obvious abscesses revealed potential serious complications with planned incision and drainage. Management was altered in 5 of 6 cases, and potential vascular disasters were avoided. In 1 case, the ultrasound results were ignored, and incision and drainage was completed, confirming the suspected abscess was indeed a solid mass later diagnosed as a carcinoma. In this case series, point-of-care ultrasound interrogation provided rapid assessment and discovery of potentially catastrophic anatomic relationships, avoiding serious complications.
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Affiliation(s)
- Michael Blaivas
- Department of Emergency Medicine, North-side Hospital Forsyth, Cumming, GA 30041 USA.
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30
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Lindell G, Jonsson C, Ehrsson RJ, Jacobsson H, Danielsson KG, Källström BN, Larson B. Evaluation of preoperative lymphoscintigraphy and sentinel node procedure in vulvar cancer. Eur J Obstet Gynecol Reprod Biol 2010; 152:91-5. [PMID: 20579801 DOI: 10.1016/j.ejogrb.2010.05.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 04/19/2010] [Accepted: 05/23/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the value of preoperative lymphoscintigraphy, and to evaluate the validity and feasibility of the sentinel node (SN) procedure in vulvar carcinoma. STUDY DESIGN Retrospective clinical and histopathological review of 77 patients with invasive squamous cell carcinoma in vulva who were treated at Karolinska University Hospital Stockholm, Sweden, from 2000 to 2007. The patients underwent SN mapping preoperatively with radioactive tracer and blue dye (n=60) or only blue dye (n=17). The SN was removed separately followed by complete inguinofemoral lymphadenectomy. RESULTS The relation between SNs detected on the scintigram and those found during surgery showed good agreement using weighted kappa. The detection rate of SN was 98% for radioisotope plus blue dye, and 94% for blue dye alone. Two cases of false negative SN (false negative rate 2.7%) were found, both with large midline tumors. CONCLUSION Preoperative scintigram is a valuable help to identify and localize the SNs and gives the best estimate of the accurate number but cannot determine if unilateral or bilateral groins should be explored in cases of midline tumors. Our results are in favor of using radioisotope and blue dye to identify the SNs. This study support previous reports that the method is not recommended for tumors larger than 40 mm to optimize detection of SN and minimize the false negative detection rate.
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Affiliation(s)
- Gunnel Lindell
- Department of Women's and Children's Health, Division for Obstetrics and Gynecology, Karolinska Institutet, 17176 Stockholm, Sweden.
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31
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Lee J, Jang DG, Kwon JY, Chun CS, Shin JC, Park IY. Prenatal sonographic findings associated with fibroepithelial stromal polyp of the vulva. Prenat Diagn 2010; 30:800-2. [PMID: 20575146 DOI: 10.1002/pd.2553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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32
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Radziszewski J, Kowalewska M, Jedrzejczak T, Kozlowicz-Gudzinska I, Nasierowska-Guttmejer A, Bidzinski M, Siedlecki JA. The accuracy of the sentinel lymph node concept in early stage squamous cell vulvar carcinoma. Gynecol Oncol 2009; 116:473-7. [PMID: 19922986 DOI: 10.1016/j.ygyno.2009.10.072] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Revised: 10/20/2009] [Accepted: 10/26/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of the study was to determine the feasibility and accuracy of the sentinel lymph node (SLN) identification in vulvar carcinoma patients. METHODS Sixty-two patients with clinical early stage vulvar cancer underwent SLN detection procedure, followed by a complete inguinofemoral lymphadenectomy. The SLN was identified intraoperatively using lymphoscintigraphy with technetium-99m as well as patent blue V staining. The resected lymph nodes (LN) were submitted for histological examination by hematoxylin-eosin staining (H-E) and cytokeratin immunohistochemistry (IHC) and examined by the reverse transcriptase-polymerase chain reaction (RT-PCR) assay. RESULTS A total of 109 inguinal LN were dissected in 56 patients. SLNs were identified in 76% groins with patent blue V and in 99% with the use of Tc-99m. The accuracy differed significantly (p<0.0001). An H-E examination combined with IHC revealed 7 false-negative SLNs. The sensitivity of this method was 73% (95% CI, 64% to 81%) and the negative predictive value for a negative SLN finding was 92% (95% CI, 87% to 97%). The RT-PCR assay showed 8 false-negative SLNs. The sensitivity of the RT-PCR-based assay was 83% (95% CI, 75% to 90%) and the negative predictive value for a negative SLN was 88% (95% CI, 82% to 94%). The two diagnostic methods were found not to differ significantly. CONCLUSIONS In SLN mapping, the Tc-99m colloid lymphoscintigraphy is superior to the blue dye staining. Our data do not support the concept of the SLN identification as a highly accurate procedure in predicting the inguinofemoral LN status in patients with early stage vulvar cancer.
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Affiliation(s)
- Jakub Radziszewski
- Department of Brachytherapy, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.
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Melese T, G/Hiwot Y, Schneider J. Synovial sarcoma. Ethiop Med J 2008; 46:411-413. [PMID: 19271408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Here we report a rare variety of soft tissue tumor, vulvar synovial sarcoma, arise on 21 years old girl which was managed with local resection.
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Migliano E, Monarca C, Tedesco M, Rizzo MI, Bucher S. [A case of vulvar melanoma: surgical strategy and five years follow-up]. G Chir 2008; 29:162-164. [PMID: 18419981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We report a case of a woman with vulvar melanoma, arisen from a plane melanocytic lesion, extended from clitoris to the left minor labium. After diagnostic biopsy, a preoperative lymphoscintigraphy with 99m-Tc nanocolloid was performed. Surgery consisted in a radical vulvectomy, radio-controlled lymphadenectomy and vulvar reconstruction by two bilateral subgluteus soft-tissue flaps, anastomosing the urethral and vaginal stumps. Five years follow-up was negative for neoplastic recurrence.
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Affiliation(s)
- E Migliano
- Dipartimento di Chirurgia Plastica Riconstruttiva, IRCCS San Gallicano, Istituto IFO, Roma
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Zámbó K, Szabó Z, Schmidt E, Koppán M, Répásy I, Bódis J. Is the clinical staging system a good choice in the staging of vulvar malignancies? Eur J Nucl Med Mol Imaging 2008; 34:1878-9; author reply 1880. [PMID: 17676321 DOI: 10.1007/s00259-007-0511-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- Neil D Ghushe
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, USA.
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Sherer DM, Gorelick C, Wagreich A, Lee YC, Serur E, Zigalo A, Abulafia O. Sonographic findings of a large vulvar lipoma. Ultrasound Obstet Gynecol 2007; 30:786-7. [PMID: 17763338 DOI: 10.1002/uog.5130] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Lipomas of the vulva are rare benign tumors that consist of mature fat cells often interspersed with strands of fibrous connective tissue. They arise from the vulvar fatty pads and present as soft, multilobulated subcutaneous neoplasms. Histological examination reveals a thin capsule surrounding a lobular proliferation of lipocytes. Liposarcomas of the vulva have been described rarely. We present the sonographic findings of a large lipoma of the vulva, and demonstrate the contribution of topical application of a high-frequency transvaginal transducer in depicting lobular structural features, characteristic of this soft tissue tumor.
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Affiliation(s)
- D M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, Brooklyn, New York, NY, USA
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Imperiale A, Heymann S, Clariá M, Cimarelli S, Sellem DB, Goetz C, Onea A, Blondet C, Constantinesco A. F-18 FDG PET-CT in a Rare Case of Bartholin's Gland Undifferentiated Carcinoma Managed With Chemoradiation and Interstitial Brachytherapy. Clin Nucl Med 2007; 32:498-500. [PMID: 17515770 DOI: 10.1097/rlu.0b013e318053783d] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Alessio Imperiale
- Service de Biophysique et de Médecine Nucléaire, Centre Hospitalier et Universitaire de Hautepierre, Strasbourg, France.
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Fulciniti F, Botti G, De Chiara A, Parlato V, Russo S, Vosa L, Nappi MM. Fine needle aspiration cytolog of perineal alveolar rhabdomyosarcoma: cytohistopathologic and immunocytochemical correlations. Acta Cytol 2007; 51:385-9. [PMID: 17536540 DOI: 10.1159/000325752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the cytopathologic findings in a case of alveolar rhabdomyosarcoma (ARMS) of the perineum in a 13-year-old girl and to compare the cytopathologic findings with the histopathologic and immunohistochemical features observed on the corresponding fragments obtained from core biopsy of the mass. STUDY DESIGN The cytopathologic findings observed in fine needle aspiration biopsy of a vulvar mass were analyzed with reference to their predictive diagnostic value in pathologic evaluation of the lesion. RESULTS Following a prospective cytopathologic diagnosis of ARMS, a cutting needle core biopsy was performed. Histopathologic and immunohistochemical study of the tissue fragments confirmed the cytopathologic diagnosis. CONCLUSION Careful cytopathologic evaluation of optimal cell samples from ARMS may elicit a correct diagnosis provided that immunocytochemical staining for markers of myogenic differentiation is performed in a pretherapeutic phase.
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Affiliation(s)
- Franco Fulciniti
- Department of Pathology, National Cancer Institute of Naples G. Pascale Foundation, Naples, Italy.
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40
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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; 17:147-53. [PMID: 17291246 DOI: 10.1111/j.1525-1438.2007.00806.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We studied the distribution of sentinel lymph nodes (SLNs) in vulvar cancer using blue dye and (99m)Tc radiocolloid and evaluated the techniques used, including the optimum timing of preoperative scintigraphy scans and its contribution to (99m)Tc SLN detection over that of the intraoperative handheld gamma probe. Fifty-nine women with squamous cell cancers <4 cm treated at our institution between December 2001 and December 2005 were included in this study. Blue dye alone was used in the first 16 women (group A) and the combination of (99m)Tc and blue dye was used on 43 women (group B). Of the 118 SLN detected in 82 groins, 83.9% (99) were sited in the superficial medial and intermediate inguinal chain, none were in superficial lateral groin, 16.1% (19) were deep femoral. The patient-specific SLN detection and false-negative rate in group B was 100% and 0%, compared to 68.8% (11/16 cases) and 6.3% (1/16) in group A. The optimum timing for preoperative lymphoscintigraphy scans was 45 min postinjection, but intraoperative use of the handheld gamma probe yielded 15% more "hot" nodes and allowed tailored placement of the lymphadenectomy incision. Eighty-four percent of SLNs were in the medial and intermediate region of the superficial inguinal chain, 16.1% were deep femoral. The combined use of (99m)Tc radiocolloid and blue dye was significantly superior at SLN detection than blue dye alone. (99m)Tc SLN detection using the intraoperative handheld probes was not enhanced by preoperative scintigraphy scans.
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Affiliation(s)
- Lukas Rob
- Department of Obstetrics and Gynecology, Motol University Hospital, 2nd Medical Faculty, Charles University, V Uvalu 84, 06 Prague 5, Czech Republic.
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Migliano E, Monarca C, Mariani L, Tedesco M, Bucher S. Vulvar primitive melanoma and sentinel lymph node: case report. EUR J GYNAECOL ONCOL 2007; 28:229-32. [PMID: 17624094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The case of a 54-year-old woman who developed vulvar melanoma arising from a melanocytic lesion, extending from the clitoris to the left labium minor, without clinical involvement of the groin node station bilaterally is presented. The patient first underwent an incisional diagnostic biopsy that revealed a melanoma 4 mm in thickness; subsequently preoperative lymphoscintigraphy with 99m Tc Nanocoll was executed. Surgery consisted of a radio-controlled lymphadenectomy and radical vulvectomy. Two bilateral subgluteus soft-tissue flaps were made to reconstruct the surgical defect, anastomosing the urethral and vaginal stump. At 36 months follow-up the patient was negative for neoplastic recurrence.
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Affiliation(s)
- E Migliano
- Department of Plastic Surgery, IRCCS San Gallicano Institute IFO, Rome, Italy
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Vidal-Sicart S, Puig-Tintoré LM, Lejárcegui JA, Paredes P, Ortega ML, Muñoz A, Ordi J, Fusté P, Ortín J, Duch J, Martín F, Pons F. Validation and application of the sentinel lymph node concept in malignant vulvar tumours. Eur J Nucl Med Mol Imaging 2006; 34:384-91. [PMID: 17006693 DOI: 10.1007/s00259-006-0237-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Accepted: 06/25/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE Inguinal lymphadenectomy, unilateral or bilateral, is widely used in cases of vulvar squamous cell carcinoma and melanoma but has a high morbidity. Sentinel lymph node (SLN) biopsy may be used in the management of these patients. The aims of this study were firstly to determine the reliability of SLN biopsy in predicting regional lymph node status and secondly to apply this technique in the routine clinical setting. METHODS We prospectively studied 70 women with vulvar malignancies. The first 50 cases were of squamous vulvar cancer and were used to validate the SLN technique in this clinical setting (validation group). Once a satisfactory success rate had been achieved in the validation group, the SLN technique was applied to a further 20 patients with vulvar malignancies, i.e. squamous cell carcinoma (n=12) and melanomas (n=8) (application group). Dynamic and static images were acquired after the injection of 74-148 MBq of a colloidal albumin, and continued until SLN identification. Fifteen minutes before surgery, blue dye injection was administered in a similar manner to the radiocolloid. After incision, a hand-held gamma probe was used to find the SLN. In the validation group, dissection of the SLN was always followed by lymphadenectomy. In the application group, this procedure was only performed if the SLN was positive for metastases. For pathological staging, samples were evaluated using haematoxylin and eosin and immunohistochemistry. RESULTS In the validation group, lymphoscintigraphy allowed SLN detection in 49/50 patients (98%). Blue dye detected the SLN in 40/50 patients (80%). In 16 patients (33%), the SLN showed metastases in the pathology study. All 33 patients with negative SLN had regional lymph nodes negative for metastases (negative predictive value 100%). In the application group, lymphoscintigraphy showed drainage to an SLN in 19 out of 20 patients (95%) and blue dye demonstrated a stained SLN in 17/20 patients (85%). Seven of the 19 SLN-identified nodes (37%) were positive for metastases. CONCLUSION SLN identification permits the accurate pathological study of regional nodes and could reduce the high morbidity of current surgical treatment in vulvar tumour patients if the technique were to be adopted on a routine clinical basis.
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Affiliation(s)
- Sergi Vidal-Sicart
- Department of Nuclear Medicine, Hospital Clinic, University of Barcelona, C/ Villarroel 170, Barcelona, Spain.
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Abstract
The aim of this study was to review the literature on currently available non- and minimally-invasive diagnostic methods and analysis of primary tumor characteristics for prediction of inguinofemoral lymph node metastases in patients with primary squamous cell carcinoma of the vulva. We used the English language literature in PubMed and reference lists from selected articles. Search terms included vulvar carcinoma, prognosis, lymph node metastases, ultrasound, computer tomography, magnetic resonance imaging, positron emission tomography, and sentinel lymph node. No study type restrictions were imposed. Currently no noninvasive imaging techniques exist that are able to predict lymph node metastases with a high enough negative predictive value. A depth of invasion < or =1 mm is the only histopathologic parameter that can exclude patients for complete inguinofemoral lymphadenectomy. No other clinicopathologic parameter allows exclusion of lymph node metastases with a high enough negative predictive value. The minimally invasive sentinel node procedure is a promising technique for selecting patients for complete lymphadenectomy, but its safety has not been proven yet.
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Affiliation(s)
- M H M Oonk
- Department of Gynaecologic Oncology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
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Selman TJ, Luesley DM, Acheson N, Khan KS, Mann CH. A systematic review of the accuracy of diagnostic tests for inguinal lymph node status in vulvar cancer. Gynecol Oncol 2005; 99:206-14. [PMID: 16081147 DOI: 10.1016/j.ygyno.2005.05.029] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Revised: 05/15/2005] [Accepted: 05/18/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the accuracy of minimally and non-invasive tests to assess the groin node status in squamous cell vulvar cancer. METHODS A systematic review of published research from 1979 to 2004 that compares the results of tests to determine groin node status with histology at inguinofemoral lymphadenectomy was made. Studies included in the review were those that compared the index test to the standard surgical intervention of inguinofemoral lymphadenectomy and allowed the construction of two-by-two tables. From these tables, sensitivity, specificity, and the likelihood ratios (with 95% confidence intervals) were reported and, where feasible, meta-analysis was used to pool results for each test separately. Sentinel node biopsy using technetium-99m-labelled nanocolloid ((99m)Tc) had a pooled sensitivity and negative LR of 97% (91-100 95% CI) and 0.12 (0.053-0.28 95% CI), respectively, and was the most accurate test reviewed. CONCLUSION Five diagnostic tests were identified in a total of 29 studies (961 groins). Although the studies were small and the design often poor, this represents the best summary of the data to date. Sentinel node identification using (99m)Tc appeared to be the most promising test for accurately excluding lymph node metastases in squamous cell vulvar cancer and potentially reducing the radicality of surgery. Its efficacy as a tool in reducing the need for radical surgery and associated patient morbidity without reducing survival needs further assessment probably in a randomised control trial.
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Affiliation(s)
- T J Selman
- Birmingham Women's Hospital, Metchley Park Road, Edgbaston, Birmingham B15 2TG, UK.
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45
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Carcopino X, Houvenaeghel G, Buttarelli M, Charaffe-Jauffret E, Gonzague L, Rossi I. [Feasibility and morbidity of sentinel lymph node detection in patients with vulvar carcinoma]. Bull Cancer 2005; 92:489-97. [PMID: 15932812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Accepted: 02/11/2005] [Indexed: 05/02/2023]
Abstract
The aim of this study was to investigate the feasibility and the morbidity of sentinel lymph node detection in patients with vulvar carcinoma. In 15 patients with vulvar squamous cell carcinoma, the inguinal sentinel lymph nodes was detected using both peritumoral injection of technetium-99m sulfur colloid and isosuflan blue before the surgical time. The detection of the inguinal sentinel lymph node was never completed by an inguinal lymphadenectomy. In case of metastatic lymph node, patients were treated by complementary inguinal irradiation. A total of 19 inguinal node dissection were performed. The sentinel lymph node was identified in 18/19 (94.7%) groin dissections. A total of 38 sentinel lymph nodes were removed. 4 patients were found to have metastatic lymph node (26.7%) with a total of 6 metastatic lymph nodes. The postoperative morbidity was minimal, with only one patient presenting a permanent edema of the extremity (6.7%) after complementary inguinal irradiation. We confirm the results of previous studies that sentinel node dissection appears to be technically feasible in patients with vulvar carcinoma. This may reduce the morbidity of usual inguinal lymphadenectomy without under-evaluate the nodal status. This procedure could be implemented in future therapy concepts.
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Affiliation(s)
- Xavier Carcopino
- Département de Chirurgie, Institut Paoli-Calmettes, 232 bd Sainte-Marguerite, 13005 Marseilles
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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; 97:151-4. [PMID: 15790451 DOI: 10.1016/j.ygyno.2004.12.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Carcinomas of the vulva situated on the midline or close to it, are supposed to have a bilateral lymphatic drainage. The aim of this study was to evaluate sentinel node identification in these tumors. METHODS Between April 2002 and February 2004, 17 patients with operable vulvar cancer situated on, or close to the midline were entered in a prospective study. All patients underwent sentinel node identification with (99m)Tc-labelled nanocolloid (preoperative lymphoscintigraphy and intraoperative use of a handheld probe). Depending on the surgeon, intraoperative blue dye was associated. Radical excision of the tumor and routine bilateral lymphadenectomy were then performed. Sentinel nodes were sent separately for histologic examination. Negative sentinel nodes on hematoxylin/eosine were further examined with immunohistochemistry. RESULTS One or more sentinel nodes were identified in the 17 patients and in 21 of the 34 groins. In 5 patients, the sentinel nodes were metastatic. There was no false negative (negative sentinel node and metastatic non-sentinel node). In 13 patients, lymphoscintigraphy and then intraoperative identification suggested a unilateral drainage of the tumor with sentinel nodes localized in only one groin. Among these 13 patients, 3 groins with no sentinel node identified contained in fact massively metastatic nodes. CONCLUSION Unilateral finding of a sentinel node in tumors of the midline does not preclude a metastatic node in the other groin. Lymph node assessment should remain bilateral in these lesions.
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Affiliation(s)
- Christine Louis-Sylvestre
- Department of Gynecology, Service de Gynécologie, Centre Hospitalier Intercommunal 40 Avenue de Verdun, 94000 Créteil, France.
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Wydra D, Matuszewski R, Romanowicz G, Bandurski T. Evaluation of surgical gamma probes for sentinel node localization in cervical and vulvar cancer. Nucl Med Rev Cent East Eur 2005; 8:105-10. [PMID: 16437395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Sentinel node (SN) scintigraphy for cervical and vulvar cancer guides the gynaecological oncologist in finding the metastatic lymph nodes during lymphadenectomy. The role of the surgical gamma probe in the sentinel node concept in gynaecological oncology is to localise (SN) both intra-operatively and transcutaneously. Intra-operative hand-held collimated gamma probes are increasingly used for detection of the sentinel lymph node. MATERIAL AND METHODS A comparative evaluation of hand held gamma probes: Neoprobe 1,500, Europrobe, Gamma Finder, Gamma Ray Prospector GRP1 and GPR2 was performed using different detection methods. Laboratory tests were performed in which sensitivity, spatial resolution and angular sensitivity were evaluated. RESULTS The results for each gamma probe were summarised and discussed. CONCLUSION Awareness of a gamma probeís capabilities and limitations should be considered in the appropriate selection of a device.
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Affiliation(s)
- Dariusz Wydra
- Department of Gynaecology, Medical University, Gdańsk, Poland.
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Wydra D, Sawicki S, Emerich J, Romanowicz G. Evaluation of sentinel node detection in vulvar cancer. Nucl Med Rev Cent East Eur 2005; 8:128-30. [PMID: 16437399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND In vulvar cancer, in a large portion of patients with early stages of the disease, the inguinal lymphadenectomy not only does not influence the overall survival and recurrence rate but may increase the incidence of complications. Sentinel lymph node (SN) detection is a promising technique for detecting groin lymph nodes, which may in future lead to less extensive use of surgical treatment. The aim of the study was to evaluate the feasibility of the sentinel node detection technique in patients with vulvar cancer. MATERIAL AND METHODS Between the years 2003 and 2005, we performed intraoperative lymphatic mapping on 10 patients with planoepithelial vulvar cancer. In eight cases, vulvar lesion was localized centrally, around the clitoris. The extent of the surgery included radical vulvectomy with bilateral inguinal lymphadenectomy in nine cases and unilateral inguinal lymphadenectomy in one case. For the lymphatic mapping, we employed two detection methods: (99m)Tc-labelled radiocolloid (activity 35-70 MBq) and blue dye (3-5 ml). Both techniques were used in six cases (60%), blue dye only in three cases and radiocolloid only in one case. RESULTS In each patient, we detected at least one sentinel lymph node. Sentinel nodes were localized in 14 of 19 operated groins (73.7%); a total of 25 SNs in all. The mean number of SNs for one groin was 1.78. Nodal metastases were found in four cases. In three cases, metastases were detected only in the SN. In one patient, two SNs with metastases were found in one groin and in the contralateral groin (without any SN) there was one unchanged node, which transpired to be metastatic. This can be explained by a complete overgrowth of neoplasm in the lymph node resulting in lymph flow stasis and disabling tracer uptake. In five cases, an SN was found only in one groin ó the first case is described above, in the second case the vulvar tumor was localized laterally, opposite to the groin without any SN. In the remaining three cases, we have used only one method of SN detection. CONCLUSIONS Lymphatic mapping in vulvar cancer based on the combined detection technique is a highly accurate method after adequate training of the surgeons.
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Affiliation(s)
- Dariusz Wydra
- Department of Gynaecology, Medical University, Gdansk, Poland.
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Affiliation(s)
- Rashmi Bagga
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
In gynecologic malignancies, regional lymph node status is a major prognostic factor and a decision criterion for adjuvant therapy. This is the basis for lymphadenectomy. The sentinel node (SN) procedure has emerged as an alternative to systematic lymphadenectomy in various cancers, reducing treatment-related morbidity. In melanoma and breast cancer, SN biopsy is the standard procedure for determining nodal stage. Use of the SN procedure is also well established in vulvar cancer. In small series, combined SN detection based on blue dye and radiocolloid was suitable for the evaluation of lymph node status in cervical cancer. Although some investigators have reported the feasibility of the SN procedure in endometrial cancer, further studies and standardization are required before its routine use can be recommended.
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