Nodal Metastasis Is Highly Consistent in Squamous Cell Carcinoma of the Vulva

Abstract

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2001.19.10.2767 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 11352972 Nodal Metastasis Is Highly Consistent in Squamous Cell Carcinoma of the Vulva Richard T. PensonxRichard T. PensonSearch for articles by this author , Arlan F. Fuller JrxArlan F. Fuller JrSearch for articles by this author Joanne A. de HulluxJoanne A. de HulluSearch for articles by this author , Ate G.J. van der ZeexAte G.J. van der ZeeSearch for articles by this author Show More Massachusetts General Hospital, Boston, MAUniversity Hospital Groningen, Groningen, the Netherlands https://doi.org/10.1200/JCO.2001.19.10.2767 First Page Full Text PDF Figures and Tables © 2001 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse15052001In Reply:Drs Penson and Fuller suggest that sentinel lymph node biopsy is not necessary in vulvar cancer because of the consistent localization of the sentinel lymph node. Instead of sentinel lymph node identification, they therefore suggest standard removal of a limited number of superficial inguinofemoral lymph nodes (so-called DiSaia’s nodes). We would like to make some remarks on their suggestion.(1) Although there is consistency in the localization of the sentinel lymph nodes, the radioactivity and blue dye are very helpful in identification of these sentinel lymph nodes, especially in obese patients. (2) DiSaia’s nodes comprise 8 to 10 lymph nodes, whereas we only remove one to two sentinel lymph nodes in our procedure, which at least makes a difference in the size of the incision, frequency of postoperative lymphocysts, and probably also in the risk of lymph edema. (3) The recurrence rate, especially in the groin, is another important issue. It is generally accepted that the majority of local recurrences are curable, whereas most patients with a groin recurrence will die of disease. (4) Preoperative lymposcintigram shows uni- or bilateral lymph flow and is, therefore, helpful in making the decision to perform either unilateral or bilateral sentinel lymph node biopsy (and in case of positive sentinel lymph nodes subsequent inguinofemoral lymphadenectomy). Penson and Fuller suggest that it is possible to define a group of patients who are at low risk of developing lymph node metastases based on tumor characteristics. However, until now, omission of inguinofemoral lymphadenectomy was only possible in patients with vulvar cancer with depth of invasion ≤ 1 mm because of the negligible risk of lymph node metastases.In conclusion, although we agree with Penson and Fuller that removal of DiSaia’s nodes is an appropriate technique in some patients, we are convinced that our sentinel lymph node biopsy technique is superior, especially for obese patients, and is the most accurate minimally invasive procedure for nodal staging with the lowest risk of complications.