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Li Q, Zhang L, Fang F, Xu P, Zhang C. Research progress of indocyanine green fluorescence technology in gynecological applications. Int J Gynaecol Obstet 2024; 165:936-942. [PMID: 37953657 DOI: 10.1002/ijgo.15249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/22/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023]
Abstract
Indocyanine green is a near-infrared fluorescent dye which is widely used in various fields of surgery and gynecology. It is currently mainly used to detect various malignant tumors, sentinel lymph nodes, endometriosis lesions, ureter or intestinal occlusion, vaginal perfusion, uterine arterial blood perfusion, pelvic nerve, uterine niche, lymphatic edema, metastatic lesion shadow, and so on, providing new methods for decision-making during surgery. This article elaborates the application progress of indocyanine green fluorescence technology in gynecology.
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Affiliation(s)
- Qing Li
- Department of Gynecology, Huaian Maternity and Child Clinical College of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Li Zhang
- Department of Gynecology, Huaian Maternity and Child Clinical College of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Fang Fang
- Department of Gynecology, Huaian Maternity and Child Clinical College of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Ping Xu
- Department of Gynecology, Huaian Maternity and Child Clinical College of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Chunhua Zhang
- Department of Gynecology, Huaian Maternity and Child Clinical College of Xuzhou Medical University, Huaian, Jiangsu, China
- Macau University of Science and Technology, Macau, China
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Del Valle D, Ruiz R, Lekuona A, Cobas P, Jaunarena I, Gorostidi M, Cespedes J. Superparamagnetic iron oxide (SPIO) for sentinel lymph node detection in vulvar cancer. Gynecol Oncol 2024; 187:145-150. [PMID: 38776632 DOI: 10.1016/j.ygyno.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Sentinel lymph node (SLN) detection with superparamagnetic iron oxide (SPIO) nanoparticles has been widely studied and standardized for breast and prostate cancer, but there is scarce evidence concerning its use in vulvar cancer. The objective of this study was to compare SLN detection using a SPIO tracer injected at the time of the surgery detected by a magnetometer, with the standard procedure of using a technetium 99 radioisotope (Tc99) detected by a gamma probe, in patients with vulvar cancer. METHODS The SPIO vulvar cancer study was a single-center prospective interventional non-inferiority study of SPIO compared to Tc99, conducted between 2016 and 2021 in patients who met the GROINSS-V study inclusion criteria for selective sentinel lymph node dissection in vulvar cancer. RESULTS We included 18 patients and a total of 41 SLNs. The level of agreement between tracers was 92.7% (80.6%-97.4%), corresponding to 38 out of 41 SLNs, which confirms the non-inferiority of SPIO compared to Tc99. The SLN detection rate per groin was 96.3 (81.7%-99.3) using Tc99 and 100% (87.5%-100%) using SPIO. Both tracers had a detection rate of 100% for positive lymph nodes. CONCLUSIONS The use of SPIO as a tracer for detecting SLNs in patients with vulvar cancer has shown to be non-inferior to that of the standard radiotracer, with the advantages of not requiring nuclear medicine and being able to inject it at the time of surgery after induction of anesthesia.
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Affiliation(s)
| | - Ruben Ruiz
- Hospital Universitario Donostia, San Sebastián, Spain
| | - Arantxa Lekuona
- Hospital Universitario Donostia, San Sebastián, Spain; Biogipuzkoa Health Research Institute, San Sebastián, Spain
| | - Paloma Cobas
- Hospital Universitario Donostia, San Sebastián, Spain
| | - Ibon Jaunarena
- Hospital Universitario Donostia, San Sebastián, Spain; Biogipuzkoa Health Research Institute, San Sebastián, Spain
| | - Mikel Gorostidi
- Hospital Universitario Donostia, San Sebastián, Spain; Biogipuzkoa Health Research Institute, San Sebastián, Spain.
| | - Juan Cespedes
- Hospital Universitario Donostia, San Sebastián, Spain
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Chargari C, Wasserman J, Gabro A, Canlobre G, Spano JP, Uzan C, Maingon P. Vulvar Carcinoma: Standard of Care and Perspectives. J Clin Oncol 2024; 42:961-972. [PMID: 38315939 DOI: 10.1200/jco.23.01187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/24/2023] [Accepted: 11/14/2023] [Indexed: 02/07/2024] Open
Abstract
PURPOSE Treatment of vulvar carcinoma (VC) is challenging. The objectives of this review were to describe for clinicians the epidemiologic and clinical aspects of VC, the standard of care in terms of primary local treatment and systemic therapies, and the recent innovations and perspectives emerging from translational research in immuno-oncology. DESIGN We conducted a comprehensive review outlying the clinical aspects and biologic background of vulvar cancer, highlighting modern treatment strategies on the basis of a personalized approach. RESULTS Epidemiologic data showed a recent rise in incidence of VC, attributed to human papillomavirus. Surgery is the mainstay of primary treatment, but multimodal approaches are frequently required in the presence of adverse prognosis histopathologic factors. Chemoradiation is indicated when organ-sparing surgery is not feasible. However, inability to achieve high locoregional control rates in advanced cases and the morbidity associated with local treatments are still key issues. Recent clinical data showed the benefit of individualized strategies combining organ-sparing surgical strategies, less invasive lymph node staging procedures, and refinement in radiotherapy modalities. Among the most important research area, there is a sound rationale for testing modern systemic approaches such as immune checkpoint inhibitors in selected patients with recurrent and/or metastatic tumors. Although no specific data exist for VC, the role of supportive care and post-treatment rehabilitation strategies is also crucial. CONCLUSION There are still insufficient studies dedicated to patients with VC. Public health programs for prevention, screening, and early diagnosis are required, and clinical research should be strengthened to provide high-quality clinical evidence and improve patients' oncologic and functional outcomes.
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Affiliation(s)
- Cyrus Chargari
- Service d'oncologie radiothérapie, Hôpital Universitaire Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
| | - Johanna Wasserman
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
- Service d'oncologie médicale, Hôpital Universitaire Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
| | - Alexandra Gabro
- Service d'oncologie radiothérapie, Hôpital Universitaire Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
| | - Geoffroy Canlobre
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
- Service de chirurgie et cancérologie gynécologique et mammaire, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
- INSERM UMR S938, Biologie et Thérapeutique des cancers, Paris, France
| | - Jean-Philippe Spano
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
- Service d'oncologie médicale, Hôpital Universitaire Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
| | - Catherine Uzan
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
- Service de chirurgie et cancérologie gynécologique et mammaire, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
- INSERM UMR S938, Biologie et Thérapeutique des cancers, Paris, France
| | - Philippe Maingon
- Service d'oncologie radiothérapie, Hôpital Universitaire Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
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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] [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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Penn CA, Schneiter MK, Watson CH. Sentinel Lymph Node Evaluation in Early-Stage Vulvar Cancer. Curr Treat Options Oncol 2024; 25:20-26. [PMID: 38170388 DOI: 10.1007/s11864-023-01165-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
OPINION STATEMENT Sentinel lymph node mapping (SLNM) and dissection (SLND) should be used as an alternative to full inguinofemoral lymph node dissection (IFLND) in select patients with early-stage vulvar cancer. IFLND is associated with high postoperative complications such as wound breakdown, lymphedema, lymphocyst formation, and infection. SLND in select patients offers a safe, effective, and less morbid alternative. Candidates for SLND include patients with a unifocal vulvar tumor less than four centimeters, clinically negative lymph nodes, and no prior inguinofemoral surgeries. SLND should ideally be performed by a high-volume SLN surgeon. Most commonly, SLND is performed using both radiocolloid lymphoscintigraphy (e.g., Technetium-99) and a visual tracer such as blue dye; however, near infrared imaging with indocyanine green injection is becoming more widely adopted. Further prospective studies are needed to examine the safety and efficacy of various techniques for SLND. SLND has been demonstrated to be cost-effective, especially when including perioperative complications. Further studies are needed to demonstrate quality of life differences between IFLND and SLND.
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Affiliation(s)
- Courtney A Penn
- Vanderbilt University Medical Center, Vanderbilt Ingram Cancer Center, 1211 21 St Ave Suite B-1126, Nashville, TN, 37232, USA
| | - Mali K Schneiter
- Vanderbilt University Medical Center, Vanderbilt Ingram Cancer Center, 1211 21 St Ave Suite B-1126, Nashville, TN, 37232, USA.
| | - Catherine H Watson
- Vanderbilt University Medical Center, Vanderbilt Ingram Cancer Center, 1211 21 St Ave Suite B-1126, Nashville, TN, 37232, USA
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Kuan I, Tian K, Grabosch S, Sehn J, Hoff J. HPV-associated vulvar carcinoma with sebaceous differentiation. Gynecol Oncol Rep 2023; 50:101298. [PMID: 37965381 PMCID: PMC10641161 DOI: 10.1016/j.gore.2023.101298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023] Open
Abstract
•Sebaceous carcinoma is rare on the vulva and uncommonly associated with HPV.•Pregnancy may play a role in onset or exacerbation of HPV-associated vulvar cancers.•Treatment of vulvar sebaceous carcinoma is local excision and sentinel lymph node dissection with close follow-up.
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Affiliation(s)
- Irena Kuan
- Saint Louis University Graduate Medical Education, Saint Louis MO, USA
| | - Katherine Tian
- Saint Louis University Graduate Medical Education, Saint Louis MO, USA
| | - Shannon Grabosch
- SLUCare Department of Obstetrics, Gynecology and Women’s Health, Saint Louis MO, USA
- SSM Health St. Mary’s Hospital, Saint Louis MO, USA
| | - Jennifer Sehn
- SLUCare Department of Pathology, Saint Louis MO, USA
- SSM Health St. Mary’s Hospital, Saint Louis MO, USA
| | - John Hoff
- SLUCare Department of Obstetrics, Gynecology and Women’s Health, Saint Louis MO, USA
- SSM Health St. Mary’s Hospital, Saint Louis MO, USA
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Zachou G, Yongue G, Chandrasekaran D. Feasibility of Sentinel Lymph Node Biopsy in Early-Stage Epithelial Ovarian Cancer: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:3209. [PMID: 37892029 PMCID: PMC10606383 DOI: 10.3390/diagnostics13203209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Sentinel lymph node biopsy (SLNB) has been widely adopted in the management of early-stage gynaecological cancers such as endometrial, vulvar and cervical cancer. Comprehensive surgical staging is crucial for patients with early-stage ovarian cancer and currently, that includes bilateral pelvic and para-aortic lymph node assessment. SLNB allows the identification, excision and pathological assessment of the first draining lymph nodes, thus negating the need for a full lymphadenectomy. We systematically searched the MEDLINE, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases (from inception to 3 November 2022) in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Our search identified 153 articles from which 11 were eligible for inclusion. Patients with clinical stage I-II ovarian cancer undergoing sentinel lymph node biopsy were included. Statistical analysis was performed in RStudio using the meta package, where meta-analysis was performed for the detection. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies C (QUADAS-C) tool. Overall, 11 observational studies met the predetermined criteria and these included 194 women. The meta-analysis showed that the detection rate of sentinel lymph nodes in early-stage ovarian cancer was 94% (95% CI of 86% to 1.00%). Significant heterogeneity was noted among the studies with Q = 47.6, p < 0.0001, I2 = 79% and τ2 = 0.02. Sentinel lymph nodes in early-stage ovarian cancer have a high detection rate and can potentially have applicability in clinical practice. However, considering the small number of participants in the studies, the heterogeneity among them and the low quality of evidence, the results should be interpreted with caution. Larger trials are needed before a change in clinical practice is recommended.
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Affiliation(s)
- Georgia Zachou
- Department of Surgical Gynaecological Oncology, University College London Hospital, London NW1 2BU, UK
- Department of Obstetrics and Gynaecology, Barnet Hospital, Royal Free London NHS Foundation Trust, London EN5 3DJ, UK
| | - Gabriella Yongue
- Department of Surgical Gynaecological Oncology, University College London Hospital, London NW1 2BU, UK
| | - Dhivya Chandrasekaran
- Department of Surgical Gynaecological Oncology, University College London Hospital, London NW1 2BU, UK
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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. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 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] [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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Jankowski P, Findeklee S, Georgescu MT, Sima RM, Nigdelis MP, Solomayer EF, Klamminger GG, Hamoud BH. The Therapy of Vulvar Carcinoma-Evaluation of Surgical Options in a Retrospective Monocentric Study. Life (Basel) 2023; 13:1973. [PMID: 37895358 PMCID: PMC10608767 DOI: 10.3390/life13101973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/21/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Surgical-oncological treatment methods are continuously put to the test in times of evidence-based medicine-notably, a constant reevaluation remains key, especially for tumor entities with increasing incidence such as vulvar carcinoma. (2) Methods: In order to determine the postoperative clinical course of different methods of vulvar excision (vulvectomy, hemivulvectomy) as well as inguinal lymph node removal (lymphadenectomy, sentinel lymph node biopsy) with regard to postoperative wound-healingprocess, perioperative hemorrhage, and re-resection rates, we retrospectively analyzed surgical, morphological and laboratory data of 76 patients with a pathological diagnosed vulvar cancer. (3) Results: Analysis of our data from a single center revealed a comparable perioperative clinical course regardless of the chosen method of vulvar excision and inguinal lymph node removal. (4) Conclusions: Thus, our results emphasize the current multimodality in surgical therapy of vulvar carcinoma, in which consideration of known prognostic factors together with the individual patient's clinical situation allow guideline-based therapy aimed at maximizing surgical safety.
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Affiliation(s)
- Peter Jankowski
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, 66421 Homburg, Germany
| | - Sebastian Findeklee
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, 66421 Homburg, Germany
| | - Mihai-Teodor Georgescu
- Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- “Prof. Dr. Alexandru Trestioreanu” Oncology Institute, 022328 Bucharest, Romania
| | - Romina Marina Sima
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- The “Bucur” Maternity, ‘Saint John’ Hospital, 040294 Bucharest, Romania
| | - Meletios P. Nigdelis
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, 66421 Homburg, Germany
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece
| | - Erich-Franz Solomayer
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, 66421 Homburg, Germany
| | - Gilbert Georg Klamminger
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, 66421 Homburg, Germany
| | - Bashar Haj Hamoud
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, 66421 Homburg, Germany
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10
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Garrett AA, Ricciuti J, Lang SM, Burriss ME, Flanigan M, O'Brien E, Hay C, Lesnock J, Berger JL, Taylor SE. Feasibility of intraoperative injection of radioactive tracer and blue dye for sentinel lymph node biopsy in vulvar cancer. Gynecol Oncol 2023; 175:41-44. [PMID: 37321154 DOI: 10.1016/j.ygyno.2023.05.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The objective of this study was to examine the feasibility and success rate of intraoperative injection of radiotracer and blue dye performed by the surgeon without the use of preoperative lymphoscintigraphy for the detection of sentinel lymph nodes in clinically early stage vulvar cancer. METHODS All patients with clinically early stage vulvar cancer who underwent attempted sentinel lymph node biopsy using intraoperative injection of Technetium-99 m (99mTc) tracer and blue dye performed by the surgeon after induction of anesthesia at single academic institution from 12/2009 to 5/2022 were identified. Demographic and clinicopathologic variables were collected. Data were compared using descriptive statistics. RESULTS One hundred sixty-four patients (median age 66.4 years) underwent intraoperative injection of radioactive tracer and dye for sentinel lymph node biopsy. Most patients (n = 156, 95.1%) were white. Squamous cell carcinoma accounted for 138 cases (84.1%), melanoma for 10 (6.1%), extra-mammary invasive Paget's disease for 11 (6.7%), and other histologies for 5 (3%). A majority of cases were stage I disease on final pathology (n = 119, 72.6%). Most patients (n = 117, 71%) had tumors located within 2 cm of the midline and underwent planned bilateral groin assessment, while 47 (29%) had well lateralized lesions and underwent unilateral groin assessment. For the patients undergoing unilateral groin assessment, 44 of 47 (93.6%) had successful unilateral mapping. Of the patients who underwent bilateral groin assessment, 87 of 117 (74.4%) had successful bilateral mapping, and 26 of 117 (22.2%) had successful unilateral mapping. Of the 26 patients who underwent bilateral assessment but only had unilateral mapping, 19 had unilateral mapping to ipsilateral groin but failed contralateral mapping, six had midline lesions with successful mapping to one groin but failed mapping to the other groin, and one had unilateral mapping to the contralateral groin but not ipsilateral groin. The total successful sentinel lymph node mapping rate in this cohort was 86.5% (243/281 total sentinel lymph node attempts). CONCLUSION In this cohort, the overall success rate of sentinel lymph node mapping and biopsy was 86.5%. The high rate of successful sentinel lymph node mapping supports the use of intraoperative radiotracer and blue dye injection by trained providers.
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Affiliation(s)
- Alison A Garrett
- Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, United States of America.
| | - Jason Ricciuti
- Division of Gynecologic Oncology, SLUCare Physician Group, St Louis, MO, United States of America
| | - Susan M Lang
- Division of Gynecologic Oncology, Stanford University, Palo Alto, CA, United States of America
| | - Mary E Burriss
- East Suburban OB/GYN Associates, Allegheny Health Network, Pittsburgh, PA, United States of America
| | - Margaret Flanigan
- Department of Obstetrics, Gynecology and Reproductive Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Emily O'Brien
- Department of Obstetrics, Gynecology and Reproductive Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Casey Hay
- Providence Gynecologic Oncology, Providence Sacred Heart Medical Center, Spokane, WA, United States of America
| | - Jamie Lesnock
- Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Jessica L Berger
- Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Sarah E Taylor
- Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, United States of America
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11
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Pascoal E, Alyafi M, Pokoradi A, Eiriksson L, Helpman L. Inguinofemoral sentinel lymph node biopsy by scar injection in vulvar cancer: an assessment of feasibility and long-term outcomes. Int J Gynecol Cancer 2022; 32:1512-1518. [PMID: 36332935 DOI: 10.1136/ijgc-2022-003836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Performing inguinofemoral sentinel lymph node biopsy for vulvar cancer following a previous vulvar excision, often referred to as 'scar injection', is debated. OBJECTIVE To assess the feasibility of sentinel lymph node biopsy following scar injection and the long-term outcomes in patients undergoing this procedure. METHODS We conducted a retrospective observational cohort study of patients with vulvar cancer. We assessed detection rates and outcomes in patients who underwent sentinel lymph node biopsy by scar injection and compared them with patients who had injection around a visible tumor and with patients who had an inguinofemoral lymphadenectomy following previous vulvar excision. Sentinel node detection rates are described per patient and per groin and are compared using Χ2 analysis. Cox regression analysis was used to assess the association of recurrence and survival with surgical technique and recognized pathological variables. RESULTS Data were analyzed for 173 groins in 97 patients. At least one sentinel lymph node was detected in 162 (94%) groins examined, and detection rate did not differ whether the groin was assessed following tumor injection (n=122, 94%) or scar injection (n=40, 93%; p=0.85). Patients in the scar-injection group had less frequent lymph node metastases (p<0.02), smaller tumors (p<0.001), and more superficial invasion (p<0.02). Median follow-up was 34.7 months (range 0-108). Scar injection was not independently associated with recurrence or death on multivariable analysis, and depth of invasion was the only independent predictor of disease recurrence (hazards ratio (HR)=1.14, p=0.03). Recurrence and survival were also comparable for patients who had a sentinel lymph node biopsy or inguinofemoral lymphadenectomy following previous vulvar excision (log rank p=0.30; p=0.67). CONCLUSIONS Sentinel lymph node biopsy by scar injection is feasible and demonstrates similar long-term outcomes in patients having scar or tumor injections, and in patients following previous tumor excision undergoing sentinel lymph node biopsy or lymphadenectomy.
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Affiliation(s)
- Erica Pascoal
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Mohammad Alyafi
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, McMaster University, Hamilton, Ontario, Canada.,Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Alida Pokoradi
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Lua Eiriksson
- Department of Gynecologic Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Limor Helpman
- Department of Gynecologic Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada.,Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel
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12
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The Prognostic Value of the Fibrinogen-Albumin-Ratio Index (FARI) in Patients with Advanced Vulvar Cancer. J Pers Med 2022; 12:jpm12111882. [PMID: 36579608 PMCID: PMC9694316 DOI: 10.3390/jpm12111882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/18/2022] [Accepted: 11/06/2022] [Indexed: 11/12/2022] Open
Abstract
The present study aims to evaluate the pretherapeutic Fibrinogen-Albumin-Ratio Index (FARI), as currently reliable biomarkers to predict therapy response and prognosis of patients with advanced vulvar cancer are missing. Data of 124 consecutive patients, who underwent primary resection for vulvar cancer ≥ pT1b, were retrospectively analyzed. Associations between the FARI and disease recurrence were assessed fitting receiver operating characteristics (ROC) and binary logistic regression models; univariate and multivariable Cox regression models for disease-specific survival (DSS) and progression-free survival (PFS) were performed. A pretherapeutic low FARI cut at its median (<9.67) is significantly associated with younger age (65.5 vs. 74.0 years) and higher risk of recurrence (52.4% vs. 26.2%). The ROC analysis calculates the area under the curve (AUC) of the FARI for a PFS < 6 months of 0.700 and for a DSS < 12 months of 0.706, outperforming fibrinogen and albumin alone. The FARI remained independently predictive for PFS (HR 0.84, 95% CI [0.99−1.03], p = 0.009) and DSS (HR 0.82, 95% CI [0.70−0.99], p = 0.019), also in multivariable survival analysis. Despite the FARI’s promising predictive and prognostic value, however, further elucidation of its precise mode of action is warranted before clinical application as it appears to rely only on subtle changes of fibrinogen levels.
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13
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Collaborative centralization of gynaecological cancer care. Curr Opin Oncol 2022; 34:518-523. [PMID: 35900753 DOI: 10.1097/cco.0000000000000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To discuss the benefits of centralization of gynaecological cancer care on patients and the healthcare system and how to overcome its barriers. RECENT FINDINGS Evidence demonstrates that adherence to clinical practice management guidelines is more likely; the risk of adverse events is lower; survival is improved; in young women fertility preservation is higher; and cost effectiveness is higher; in systems that employ centralized care for women with gynaecological cancer. Barriers to the uptake of centralized models include knowledge, attitude as well as deficient systems and processes, including a lack of governance and leadership. Collaborative centralization refers to a model that sees both elements (centralization and treatment closer to home) utilized at the patient level that addresses some of the barriers of centralized gynaecological cancer care. SUMMARY Evidence supports centralized gynaecological cancer care, as it results in reduced risks of adverse events, improved survival and higher fertility rates at lower cost to funders. Collaborative centralization is a process that considers both the value of centralization and collaboration amongst healthcare professionals at primary, secondary and tertiary levels of healthcare to benefit patient outcomes.
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14
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Mattson J, Emerson J, Underwood A, Sun G, Mott SL, Kulkarni A, Robison K, Hill EK. Superficial versus deep inguinal nodal dissection for vulvar cancer staging. Gynecol Oncol 2022; 166:465-470. [PMID: 35781163 DOI: 10.1016/j.ygyno.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The objective of this study was to compare the rate of groin recurrence among women undergoing superficial or deep inguinal lymph node dissections in suspected early-stage vulvar carcinoma. Secondary objectives included comparison of overall survival and post-operative morbidity between the study groups. METHODS A retrospective cohort of 233 patients with squamous cell carcinoma (SCC) of the vulva who underwent an inguinal lymph node dissection at two major academic institutions from 1999 to 2017 were analyzed. Demographic, surgical, recurrence, survival, and post-operative morbidity data were collected for 233 patients, resulting in a total of 400 groin node dissections analyzed. RESULTS Rates of overall primary recurrence of disease between superficial and deep inguinal LND (42.5 vs. 39.8%, p = 0.70) and rates of inguinal recurrence (3.4 vs. 8.3%, p = 0.16) were similar. Overall rates of postoperative morbidity were significantly higher in the cohort undergoing deep LND (70.3% vs 44.3%, p < 0.01). Rates of lymphedema (42.4 vs 15.9%, p < 0.01), readmission (26.3 vs 6.8%, p < 0.01), and infection (40.7 vs 14.8%, p < 0.01) were all significantly higher among patients undergoing deep LND. There was no significant difference noted in overall survival between the study groups when adjusting for stage and age (HR 1.08, p = 0.84). CONCLUSION Superficial inguinal LND had no significant difference in rate of recurrence or overall survival when compared to deep inguinal LND in patients with vulvar SCC. Those who received a deep LND had a significant increase in overall morbidity, including lymphedema, readmission, and infection. For patients who cannot undergo or fail sentinel lymph node mapping, a superficial inguinal lymph node dissection may have similar outcomes in recurrence and overall survival with a reduction in overall morbidity as compared to a complete, or deep, lymph node dissection.
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Affiliation(s)
- Jordan Mattson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Minnesota, 515 Mayo Memorial Building, Moos Tower 12th Floor, Minneapolis, MN, United States of America.
| | - Jenna Emerson
- Department of Gynecologic Oncology, Oregon Health and Science University, Portland, OR, United States of America
| | - Amelia Underwood
- United Family Physicians, Allina Health, St. Paul, MN, United States of America
| | - Grace Sun
- Department of Obstetrics and Gynecology, Program in Women's Oncology, Warren Alpert Medical School of Brown University, Women and Infants Hospital, 101 Dudley Street, Providence, RI, United States of America
| | - Sarah L Mott
- Holden Clinical Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA, United States of America
| | - Amita Kulkarni
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Columbia University, New York, NY, United States of America
| | - Katina Robison
- Department of Obstetrics and Gynecology, Program in Women's Oncology, Warren Alpert Medical School of Brown University, Women and Infants Hospital, 101 Dudley Street, Providence, RI, United States of America
| | - Emily K Hill
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Iowa City, IA, United States of America
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15
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Abstract
PURPOSE OF REVIEW To provide an overview of the current knowledge and recent advances of sentinel lymph node (SLN) assessment in uterine, cervical, vulvar, and ovarian cancers. RECENT FINDINGS In endometrial cancer, SLN evaluation has become increasingly utilized as part of the treatment of early-stage disease, with data showing improved detection of pelvic lymph node metastasis. In cervical cancer, SLN biopsy has also gained increasing traction with studies demonstrating the feasibility and accuracy of SLN detection. Evaluation with frozen section, however, remains limited in the detection of metastases. The prognostic significance of positive SLN in vulvar cancer is currently being investigated, with preliminary data showing lower recurrence rates in patients receiving adjuvant radiation. SUMMARY SLN evaluation remains standard of care to detect lymph node metastasis in early-staged endometrial cancer. In cervical cancer, SLN biopsy has been shown to be reliable, while decreasing morbidity without impacting disease-free survival in select patients. The technique and high sensitivity of SLN biopsy in vulvar cancer has been demonstrated in large prospective trials. There are no randomized controlled trials in ovarian cancer that evaluate the role of SLN biopsy on treatment and outcome; current SLN evaluation remains investigational.
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16
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Gaunt E, Pounds R, Yap J. Vulval cancer in pregnancy: Two case reports. Case Rep Womens Health 2022; 33:e00374. [PMID: 34993054 PMCID: PMC8713052 DOI: 10.1016/j.crwh.2021.e00374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022] Open
Abstract
Vulval cancer is rare in women of reproductive age. We report two cases of vulval squamous cell carcinoma (VSCC) in pregnancy. They presented with a solitary labial mass, at 20 and 21 weeks of gestation, diagnosed as stage 1B VSCC based on clinical examination and cross-sectional imaging. In the first case, the patient underwent close clinical surveillance whilst pregnant and had an elective caesarean section at 39 weeks of gestation. Two months post-partum she underwent a radical anterior vulvectomy and bilateral groin sentinel lymph node biopsy. In the second case, the patient underwent an anterior vulvectomy at 33 weeks of gestation followed by a vaginal delivery at 37 weeks of gestation. Six weeks post-natally she had bilateral groin sentinel lymph node biopsies. We conclude that surgical resection is safe during pregnancy under spinal anaesthesia but it can be deferred until the post-partum period if the cancer presents at early stage. Vulval cancer is rare in pregnancy and management is tailored according to gestation age. Surgical resection of a local tumour for symptom control is feasible antenatally and the decision should be made on a case-by-case basis with antenatal surveillance of the tumour. Staging surgery for inguinal lymphatics should be deferred until the post-natal period if there is no suspicion of clinical or radiology metastasis. Sentinel inguinal lymph node biopsy is absolutely contraindicated during the antenatal period due to risks of radiation exposure of the foetus. Vaginal birth is possible after vulvectomy and reconstructive surgery may be considered in the future.
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Affiliation(s)
- Ellen Gaunt
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, England, United Kingdom
| | - Rachel Pounds
- University of Birmingham, Birmingham, England, United Kingdom
| | - Jason Yap
- Institute of Genomic Cancer Sciences, College of Dental and Medical School, University of Birmingham, Birmingham, England, , United Kingdom
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17
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Giannini A, D'Oria O, Chiofalo B, Bruno V, Baiocco E, Mancini E, Mancari R, Vincenzoni C, Cutillo G, Vizza E. The giant steps in surgical downsizing toward a personalized treatment of vulvar cancer. J Obstet Gynaecol Res 2021; 48:533-540. [PMID: 34962334 PMCID: PMC9302990 DOI: 10.1111/jog.15103] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/15/2021] [Accepted: 11/07/2021] [Indexed: 12/01/2022]
Abstract
The present article aims to highlight the importance of changes of personalized surgical treatment for vulvar cancer. Current international literature regarding surgical treatment of vulvar cancer was evaluated. This included several studies and systematic reviews. Radical surgery approach, such as en bloc resection, was the first therapeutic option and the standard care for many years, even if burdened with a high complication rate and frequently disfiguring. Taussing and Way introduced radical vulvectomy approach with en bloc bilateral inguinal-femoral lymphadenectomy; modified radical vulvectomy was developed, with a wide radical excision of the primary tumor. The role of inguinofemoral lymphadenectomy (mono or bilateral) changed in the years too, particularly with the advent of SLN biopsy as minimally invasive surgical approach for lymph node staging, in patients with unifocal cancer <4 cm, without suspicious groin nodes. More personalized and conservative surgical approach, consisting of wide local or wide radical excisions, is necessary to reduce complications as lymphedema or sexual disfunction. The optimal surgical management of vulvar cancer needs to consider dimensions, staging, depth of invasion, presence of carcinoma at the surgical margins of resection and grading, with the goal of making the treatment as individualized as possible.
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Affiliation(s)
- Andrea Giannini
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy.,Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in "Translational Medicine and Oncology", Sapienza University, Rome, Italy
| | - Ottavia D'Oria
- Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in "Translational Medicine and Oncology", Sapienza University, Rome, Italy
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
| | - Valentina Bruno
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
| | - Ermelinda Baiocco
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
| | - Emanuela Mancini
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
| | - Rosanna Mancari
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
| | - Cristina Vincenzoni
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
| | - Giuseppe Cutillo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
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18
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Malandrone F, Bevilacqua F, Merola M, Gallio N, Ostacoli L, Carletto S, Benedetto C. The Impact of Vulvar Cancer on Psychosocial and Sexual Functioning: A Literature Review. Cancers (Basel) 2021; 14:cancers14010063. [PMID: 35008225 PMCID: PMC8750175 DOI: 10.3390/cancers14010063] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The diagnostic and therapeutic pathway of vulvar cancer impacts severely on the psychosocial and psychosexual equilibrium of women affected by it. The current literature shows the presence of depressive and anxious symptoms in association with physical, psychological and behavioural alterations in sexuality as well as deterioration of partner relationship. The aim of this article is to highlight the difficulties and challenges faced by women diagnosed and treated for vulvar cancer to provide early recognition and appropriate assistance. By implementing an integrated care model, it should be possible to detect unmet needs and improve the quality of life of these women. Abstract Women who are diagnosed and treated for vulvar cancer are at higher risk of psychological distress, sexual dysfunction and dissatisfaction with partner relationships. The aim of this article is to provide a review of the psychological, relational and sexual issues experienced by women with vulvar cancer in order to highlight the importance of this issue and improve the quality of care offered to these patients. A review of the literature was performed using PubMed, CINAHL, PsycINFO, and the Cochrane Library. The results are presented as a narrative synthesis and highlight the massive impact of vulvar cancer: depressive and anxiety symptoms were more frequent in these women, and vulvar cancer may have a negative effect on sexuality from a physical, psychological and behavioural point of view. Factors that may negatively affect these women’s lives are shame, insecurity or difficulties in self-care and daily activities. This review highlights the psychosocial and psychosexual issues faced by women diagnosed and treated for vulvar cancer, although more studies are needed to better investigate this field of interest and to identify strategies to relieve their psychological distress. Care providers should implement an integrated care model to help women with vulvar cancer recognise and address their unmet needs.
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Affiliation(s)
- Francesca Malandrone
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy
| | - Federica Bevilacqua
- Gynaecology and Obstetrics 1, Department of Surgical Sciences, University of Torino, City of Health and Science, 10126 Torino, Italy
| | - Mariagrazia Merola
- Clinical Psychology Service, City of Health and Science, 10126 Torino, Italy
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, 10126 Torino, Italy
| | - Niccolò Gallio
- Gynaecology and Obstetrics 1, Department of Surgical Sciences, University of Torino, City of Health and Science, 10126 Torino, Italy
| | - Luca Ostacoli
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy
- Clinical Psychology Service, City of Health and Science, 10126 Torino, Italy
| | - Sara Carletto
- Clinical Psychology Service, City of Health and Science, 10126 Torino, Italy
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, 10126 Torino, Italy
| | - Chiara Benedetto
- Gynaecology and Obstetrics 1, Department of Surgical Sciences, University of Torino, City of Health and Science, 10126 Torino, Italy
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19
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Indocyanine green fluorescent image-guided inguinal sentinel lymph node biopsy in vulvar cancer. Obstet Gynecol Sci 2021; 65:223-225. [PMID: 34911177 PMCID: PMC8942746 DOI: 10.5468/ogs.21335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 12/03/2022] Open
Abstract
Objective To demonstrate near-infrared fluorescence image-guided inguinal sentinel lymph node (SLN) biopsy in patients with vulvar cancer. Methods A 40-year-old woman with a 3-cm-sized palpable left vulvar mass was diagnosed with vulvar cancer on biopsy with protrusion into the vaginal cavity. Pelvic contrast-enhanced magnetic resonance imaging and F-18 fluorodeoxyglucose positron-emission tomography-computed tomography showed a small ulcerative enhancing lesion confined to the left vulva without distant metastasis. The patient was scheduled for radical vulvectomy with a left inguinal SLN biopsy. Indocyanine green was injected directly into the vulvar mass to map lymphatic drainage. A 4-cm-sized linear incision was made on the left inguinal crease, and the lymphatic channels of the left inguinal area were dissected under fluorescent image guidance using a 1588 Advanced Imaging Modalities Platform laparoscopic camera (Stryker, Kalamazoo, MI, USA). Results Fluorescence image-guided left inguinal SLN biopsy and radical vulvectomy were performed. The pathologic diagnosis confirmed vulvar adenoid cystic carcinoma with metastasis to the left inguinal lymph node (International Federation of Gynecology and Obstetrics stage IIIA). The patient was discharged without complications and received adjuvant radiotherapy. Conclusion This video demonstrates a successful ICG fluorescence image-guided left inguinal SLN biopsy in a vulvar cancer patient using a laparoscopic camera. Mapping of inguinal SLNs in patients with vulvar cancer may help in retaining surgical radicality while minimizing operative complications.
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20
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The accuracy of intraoperative frozen section examination of sentinel lymph nodes in squamous cell cancer of the vulva. Gynecol Oncol 2021; 164:393-397. [PMID: 34893347 DOI: 10.1016/j.ygyno.2021.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the diagnostic accuracy of intraoperative pathologic examination of sentinel lymph nodes (SLNs) and patient outcomes in vulva cancer. METHODS This retrospective study included patients with unifocal, <4 cm, invasive vulvar squamous cell carcinoma and clinically negative groin nodes treated with SLN biopsy from January 2008-March 2020. Intraoperative SLN frozen section and final pathology were compared. If the SLN was negative, inguinal femoral lymphadenectomy (IFLD) was omitted. Recurrence location and groin recurrence free survival (RFS) were assessed. RESULTS The SLN cohort included 173 patients, with 258 groins. On frozen section, there were 36/258 positive and 222 negative groins. On final pathology, there were 39/258 positive: 31 macrometastases, 6 micrometastases, 2 isolated tumor cells (ITCs) and 219 negative groins. The sensitivity, specificity, PPV and NPV for intraoperative detection of metastatic disease, was 89.7% and 99.5%, 97.2% and 98.2%, respectively. There was 1 false positive and 4 false negative frozen section results where final pathology revealed 2 ITCs, 1 micrometastasis and 1 macrometastasis. Based on intraoperative results, thirty patients (17.3%) underwent immediate IFLD. Median follow up was 38.0 (1-137.8) months. The 3-year groin RFS was 91.6% (95% CI 86.2-97.4%) for negative SLNs and 64.6% (95% CI 46.5-89.7%) for positive SLNs on frozen section. Similarly, the 3-year groin RFS was 91.7% (95% CI 86.3-97.4%) for negative, 58.4% (95% CI 38.5-87.7%) for macrometastases and 100% for micrometastases/ITCs on final pathology. CONCLUSIONS Intraoperative assessment of SLNs is accurate to determine need for IFLD and does not compromise patient outcomes in vulvar cancer.
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21
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Abstract
Vulvar cancer is an uncommon gynecological malignancy primarily affecting postmenopausal women. There is no specific screening and the most effective strategy to reduce vulvar cancer incidence is the opportune treatment of predisposing and preneoplastic lesions associated with its development. While vulvar cancer may be asymptomatic, most women present with vulvar pruritus or pain, or have noticed a lump or ulcer. Therefore, any suspicious vulvar lesion should be biopsied to exclude invasion. Once established, the most common subtype is squamous cell carcinoma. Treatment of vulvar cancer depends primarily on histology and surgical staging. Treatment is predominantly surgical, particularly for squamous cell carcinoma, although concurrent chemoradiation is an effective alternative, particularly for advanced tumors. Management should be individualized and carried out by a multidisciplinary team in a cancer center experienced in the treatment of these tumors. A useful update for trainees and specialists regarding the diagnosis, staging, treatment, and some controversies in the management of vulvar neoplasms.
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Affiliation(s)
- Alexander B Olawaiye
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mauricio A Cuello
- Department of Gynecology, Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Linda J Rogers
- Division of Gynecological Oncology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council University of Cape Town Gynecological Cancer Research Centre (SA MRC UCT GCRC, Cape Town, South Africa
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22
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Nikolić O, Sousa FAE, Cunha TM, Nikolić MB, Otero-García MM, Gui B, Nougaret S, Leonhardt H. Vulvar cancer staging: guidelines of the European Society of Urogenital Radiology (ESUR). Insights Imaging 2021; 12:131. [PMID: 34550489 PMCID: PMC8458511 DOI: 10.1186/s13244-021-01075-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 08/11/2021] [Indexed: 12/02/2022] Open
Abstract
Objective The aim of the Female Pelvic Imaging Working Group of the European Society of Urogenital Radiology (ESUR) was to develop imaging staging guidelines for vulvar cancer and to propose standardised MRI protocols and reporting. Methods The guidelines recommended from the ESUR in this article resulted from a questionnaire analysis regarding imaging staging of vulvar cancer that was answered by all members of the Female Pelvic Imaging Working Group. Only the answers with an agreement equal to or more than 80% were considered. Additionally, the literature was reviewed to complement and further support our conclusions. Results The critical review of the literature and consensus obtained among experts allows for recommendations regarding imaging staging guidelines, patient preparation, MRI protocol, and a structured MRI report. Conclusions Standardising image acquisition techniques and MRI interpretation reduces ambiguity and ultimately improves the contribution of radiology to the staging and management of patients with vulvar cancer. Moreover, structured reporting assists with the communication of clinically relevant information to the referring physician.
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Affiliation(s)
- Olivera Nikolić
- Center of Radiology, Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 1-9, 21000, Novi Sad, Serbia
| | - Filipa Alves E Sousa
- Department of Radiology, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António Dos Capuchos, 1169-050, Lisboa, Portugal.
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023, Lisbon, Portugal
| | - Marijana Basta Nikolić
- Center of Radiology, Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 1-9, 21000, Novi Sad, Serbia
| | | | - Benedetta Gui
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiologia Generale Ed Interventistica Generale, Area Diagnostica Per Immagini, Dipartimento Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Stephanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, 15 INSERM, Montpellier Cancer Research Institute, U1194, University of Montpellier, 208 Avenue des Apothicaires, 34295, Montpellier, France
| | - Henrik Leonhardt
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska University Hospital, Bruna straket 11B, 413 45, Gothenburg, Sweden
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23
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Wohlmuth C, Wohlmuth-Wieser I. Vulvar Melanoma: Molecular Characteristics, Diagnosis, Surgical Management, and Medical Treatment. Am J Clin Dermatol 2021; 22:639-651. [PMID: 34125416 PMCID: PMC8421300 DOI: 10.1007/s40257-021-00614-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Abstract
Ten percent of all women have pigmented vulvar lesions. Fortunately, most of these are benign but 1% of all melanomas in women affect the vulva. While the mortality rate of cutaneous melanoma has dropped by 7% annually during the last 5 years, the prognosis of vulvar melanoma remains dismal: the 5-year overall survival rate is 47% compared with 92% for cutaneous melanoma. The current evidence suggests that this likely results from a combination of delayed diagnosis and different tumor biology, treatment strategies, and treatment response. Although many landmark trials on checkpoint inhibitors included mucosal and vulvar melanomas, the results were often not reported separately. Post-hoc analyses indicate overall response rates between 19 and 37% for checkpoint inhibitors. A recently published retrospective study on vulvar melanomas suggests an objective response in 33.3% with a similar safety profile to cutaneous melanoma. Tyrosine kinase inhibitors may be considered in recurrent disease if a c-KIT mutation is present.
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Affiliation(s)
- Christoph Wohlmuth
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.
| | - Iris Wohlmuth-Wieser
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Altın D, Taşkın S, Ortaç F. short review of current implementations of sentinel lymph node mapping in gynecologic cancers. J Turk Ger Gynecol Assoc 2021; 22:242-248. [PMID: 34109643 PMCID: PMC8420745 DOI: 10.4274/jtgga.galenos.2021.2021.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Lymph node metastasis both increases disease stage and alters adjuvant treatment plans in gynecologic cancers. Since a minority of the patients have nodal metastasis, many patients unnecessarily undergo complete lymphadenectomy and are exposed to the subsequent morbidities. Sentinel lymph node (SLN) mapping is an alternative for evaluation of lymph nodes with lesser side effects. Although it is yet an experimental approach in ovarian cancer, it has been incorporated into guidelines for endometrial, cervical and vulvar cancers. We aimed to summarize the current situation of SLN mapping in gynecologic cancers.
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Affiliation(s)
- Duygu Altın
- Clinic of Gynecology and Obstetrics, Ordu University Training and Research Hospital, Ordu, Turkey
| | - Salih Taşkın
- Department of Gynecology and Obstetrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fırat Ortaç
- Department of Gynecology and Obstetrics, Ankara University Faculty of Medicine, Ankara, Turkey
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25
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Predictive Value of an Alternative Strategy for Measuring Depth and Size of Stage 1 Vulvar Squamous Cell Carcinoma. J Low Genit Tract Dis 2021; 24:265-271. [PMID: 32366757 DOI: 10.1097/lgt.0000000000000544] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Despite poor reproducibility for measuring vulvar cancer depth, 1-mm or greater invasion triggers lymphadenectomy for small tumors. Previous literature suggests that measuring depth from the nearest dysplastic rete peg (alternative method) rather than highest dermal papilla (conventional method) may be acceptable. METHODS Pathologic staging and follow-up information were recorded for 100 pT1 vulvar squamous cell carcinoma (SCC) resected from 1990 to 2019. Conventional depth, alternative depth, gross/clinical size, and size of the invasive component were measured for each tumor. In this retrospective study, we evaluated which clinicopathologic factors were most predictive of lymph node involvement and recurrence. RESULTS Depending on the measurements used (conventional vs alternative depth, clinical lesion size vs cumulative extent of invasive component), between 1 and 18 cases were downstaged to pT1a. All such cases were pN0, without lymphovascular or perineural invasion. Infiltrative cords (hazard ratio [HR] = 5.15; 95% CI = 1.63-16.2; p = .005) and perineural invasion (HR = 3.16; 1.18-8.45; p = .022) were most strongly associated with groin recurrence. Of staging criteria evaluated, only cumulative extent of the invasive component 2 cm or greater was significantly associated with groin recurrence (HR = 2.87; 1.01-8.17; p = .048). The Kaplan-Meier curves for local recurrence-free survival by stage did not show significant separation regardless of method. CONCLUSIONS Patients downstaged using alternative measurement techniques lacked nodal disease/recurrence; one-third of those with nodal sampling experienced postoperative morbidity. Our data suggest that the use of alternative depth and cumulative extent of invasion could safely allow some conventional stage IB vulvar SCC patients to avoid groin surgery, thereby reducing treatment-related morbidity.
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26
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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] [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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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] [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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Winarno AS, Mondal A, Martignoni FC, Fehm TN, Hampl M. The potential risk of contralateral non-sentinel groin node metastasis in women with early primary vulvar cancer following unilateral sentinel node metastasis: a single center evaluation in University Hospital of Düsseldorf. BMC WOMENS HEALTH 2021; 21:23. [PMID: 33435958 PMCID: PMC7802357 DOI: 10.1186/s12905-020-01165-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022]
Abstract
Background Since the introduction of sentinel node biopsy (SLNB) in unifocal vulvar cancer (diameter of < 4 cm) and unsuspicious groin lymph nodes, the morbidity rate of patients has significantly decreased globally. In contrast to SLNB, bilateral inguinofemoral lymphadenectomy (IFL) has been associated with increased risk of common morbidities. Current guidelines (NCCN, ESGO, RCOG, and German) recommend that in cases of unilaterally positive sentinel lymph node (SLN), bilateral IFL should be performed. However, two recent publications by Woelber et al. and Nica et al. contradict the current guideline, since a significant rate of positive non sentinel lymph nodes in IFL contralaterally was not observed [Woelber et al. 0% (p = 0/28) and Nica et al. 5.3% (p = 1/19)].
Methods A retrospective single-center analysis conducted in the University Hospital of Dusseldorf, evaluating vulvar cancer patients treated with SLNB from 2002 to 2018. Results 22.2% of women (n = 4/18) were found to have contralateral IFL groin metastasis after an initial diagnosis of unilateral SLN metastasis. The depth of tumor infiltrating cells correlated significantly and positively with the rate of incidence of groin metastasis (p = 0.0038). Conclusion Current guideline for bilateral IFL should remain as the standard management. Therefore, this depth may be taken into account as an indication for bilateral IFL. The management of VC and SLNB should be performed in a high volume center with an experienced team in marking SLN and performing the adequate surgical procedure. Well conducted counseling of the patients outlining advantages but also potential oncological risks of this technique especially concerning rate of groin recurrence is critical.
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Affiliation(s)
- Andreas Suhartoyo Winarno
- Department of Obstetrics and Gynecology, University Hospital of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany. .,Department of Obstetrics and Gynecology, Franziskus Hospital Bielefeld, Kiskerstraße 26, 33615, Bielefeld, Nordrhein-Westfalen, Germany.
| | - Anne Mondal
- Women's Clinic on Schwanenmarkt, Düsseldorf, Germany
| | - Franca Christina Martignoni
- Department of Obstetrics and Gynecology, University Hospital of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Tanja Natascha Fehm
- Department of Obstetrics and Gynecology, University Hospital of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Monika Hampl
- Department of Obstetrics and Gynecology, University Hospital of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
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Gu H, Liu G, Li J, Chen J, Zhang X, Liu Z, Tu H. Long-term outcomes of individualized management after sentinel lymph-node biopsy for vulvar cancer. Int J Clin Oncol 2021; 26:784-793. [PMID: 33386557 DOI: 10.1007/s10147-020-01838-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The management for patients with vulvar cancer after sentinel lymph-node biopsy (SLNB) remains controversial. The aim of this study was to investigate the long-term outcomes of individualized management after SLNB for early stage vulvar cancer. METHODS The medical records of patients with vulvar cancer treated by surgery involving SLNB between 2004 and 2019 were retrospectively reviewed. During this period, the inguinofemoral lymphadenectomy (IL) were performed with individualized strategy, while the postoperative intensity-modulated radiotherapy was planned with a consistent policy. RESULTS We identified 138 patients with at least one sentinel node detected, of whom 64 underwent further IL while 74 had SLNB only. Nodal metastases (pN+) were confirmed in 22 patients with IL and 16 without. Radiotherapy was scheduled with the dose of 60-70 Gy for all pN+ patients and finally completed in 15 with IL and 15 without. The median follow-up time was 56 months (6-156 months). Recurrence was observed in 24 patients, of whom 10 were pN- at primary treatment. The 3-year overall survival (OS) was 97.2, 95.2, 68.3, and 71.8%; 3-year disease-free survival (DFS) was 94.5, 91.4, 60.2, and 59.2%, respectively, for patients with pN- and IL, pN- and SLNB, pN+ and IL, and pN+ and SLNB. Neither OS nor DFS showed significant difference between SLNB and IL in pN- (P = 0.564 for OS, P = 0.423 for DFS), or pN + patients (P = 0.920 for OS, P = 0.862 for DFS). CONCLUSIONS With appropriate adjuvant radiotherapy, SLNB alone provided similar long-term survival compared with IL for both patients with and without sentinel node metastasis.
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Affiliation(s)
- Haifeng Gu
- Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 East Dongfeng Road, Guangzhou, China
| | - Guochen Liu
- Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 East Dongfeng Road, Guangzhou, China
| | - Junyun Li
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jieping Chen
- Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 East Dongfeng Road, Guangzhou, China
| | - Xinke Zhang
- Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zhimin Liu
- Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 East Dongfeng Road, Guangzhou, China.
| | - Hua Tu
- Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 East Dongfeng Road, Guangzhou, China.
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30
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Pelligra S, Scaletta G, Cianci S, Gueli Alletti S, Restaino S, Fagotti A, Scambia G, Fanfani F. Update on new imaging technologies in sentinel node detection. ACTA ACUST UNITED AC 2020; 72:404-412. [PMID: 33306284 DOI: 10.23736/s0026-4784.20.04707-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In most cancers, lymph node status is the most critical factor impacting the evolution of the disease and the overall survival. Identifying potential nodal metastasis allows the oncologist to adjust the stage and, consequently, the patient's treatment. For this reason, a precise evaluation of the regional nodes is mandatory. In gynecological cancers, pelvic, paraaortic, and inguinal nodes are the region most frequently interested by metastasis. In the past years, comprehensive lymphadenectomy was the standard of care for endometrial, cervical, ovarian, and vulvar cancers. However, after introducing the sentinel lymph node (SNL) biopsy in breast cancers, this technique has gained much more interest in gynecology oncology. Several studies have shown that SLN allows an evaluation of the node status without the complications related to the lymphadenectomy that impacts the patient's quality of life. In this review, we discuss the role of SNL biopsy in gynecological cancers and the technique's evolution over the years. Moreover, we debate the OSNA method for SLN analysis that is recently introduced for uterine cancer.
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Affiliation(s)
- Silvia Pelligra
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Giuseppe Scaletta
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
| | - Stefano Cianci
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Salvatore Gueli Alletti
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Stefano Restaino
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Anna Fagotti
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Department of Women's and Children's Health Sciences and Public Health, Sacred Heart Catholic University, Rome, Italy
| | - Giovanni Scambia
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Department of Women's and Children's Health Sciences and Public Health, Sacred Heart Catholic University, Rome, Italy
| | - Francesco Fanfani
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Department of Women's and Children's Health Sciences and Public Health, Sacred Heart Catholic University, Rome, Italy
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31
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Waldschmidt J, Jung L, Juhasz-Böss I. Status of Sentinel Lymph Node Biopsy in Vulvar and Cervical Cancer. Geburtshilfe Frauenheilkd 2020; 80:1212-1220. [PMID: 33293729 PMCID: PMC7714557 DOI: 10.1055/a-1128-0168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/26/2020] [Indexed: 02/01/2023] Open
Abstract
Assessment of lymphatic metastasis is an essential component of solid tumour staging. Sentinel lymph node (SLN) biopsy is a minimally invasive procedure that allows regional lymph node involvement by tumour to be estimated by selectively examining the sentinel lymph node while minimising the morbidity of systematic lymph node dissection. Within the group of genital cancers, the diagnostic value of SLN biopsy is rated differently. For selected patients with early-stage vulvar cancer (unifocal primary tumour < 4 cm, clinically negative inguinal lymph nodes) the SLN technique is already an established procedure in the guidelines of the German Society for Gynaecology and Obstetrics (DGGG)/German Cancer Society (DKG) and the recommendations of the European Society of Gynaecological Oncology (ESGO). For cervical cancer, SLN biopsy has not yet been sufficiently standardised but can be considered for patients without risk factors with a primary tumour size < 2 cm. The SLN
is identified by combined use of radioactive
99m
technetium nanocolloid and patent blue. The use of indocyanine green offers an alternative for SLN identification with few side effects. Recent studies aim to increase the diagnostic reliability of intraoperative frozen section analysis as this continues to show limited sensitivity in both vulvar and cervical cancer. The rate of detection of micrometastases can be increased by additional ultrastaging, the prognostic significance of which for both diseases is still unclear. The prognostic value of SLN biopsy compared with systematic lymph node dissection is being investigated in current studies (GROINSS-V-II for vulvar cancer and SENTIX-, SENTICOL-3 for cervical cancer). For this review article, a guideline-based literature search was performed in the National Library of Medicine (PubMed/MEDLINE) database with a particular focus on recent cohort studies and conference contributions.
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Affiliation(s)
- Julia Waldschmidt
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Lisa Jung
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Ingolf Juhasz-Böss
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
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Hermann CE, Nasioudis D, Mastroyannis SA, Latif NA, Haggerty AF, Giuntoli Ii RL, Cory L, Kim SH, Morgan MA, Ko EM. Utilization and outcomes of sentinel lymph node biopsy in patients with early stage vulvar cancer. Int J Gynecol Cancer 2020; 31:40-44. [PMID: 33243778 DOI: 10.1136/ijgc-2020-001934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE A retrospective cohort study comparing survival and perioperative outcomes of patients with early vulvar cancer who underwent sentinel lymph node biopsy versus standard lymphadenectomy METHODS: Patients diagnosed between January 2012 and December 2015 with vulvar squamous cell carcinoma of less than 4 cm in size, with invasion of at least 1 mm, who underwent sentinel lymph node biopsy, lymphadenectomy, or both were identified from the National Cancer Database. Overall survival was evaluated following generation of Kaplan-Meier curves and compared with the log-rank test for patients who had at least 1 month of follow-up. A Cox model was constructed to control for confounders. RESULTS A total of 1583 patients were identified; 304 patients (19.2%) underwent sentinel lymph node biopsy alone. Sentinel lymph node biopsy utilization increased 13.9% between 2012 and 2015. Patients who underwent sentinel node biopsy alone were less likely to have comorbidities compared with those undergoing lymphadenectomy only or sentinel node biopsy with lymphadenectomy (25.3% vs 32.9% vs 31.9%, p=0.042), had smaller tumors (median 1.6 vs 2.0 vs 2.0 cm, p<0.001), and were less likely to have positive lymph nodes (11% vs 19.6% vs 28.1%, p<0.001). There was no difference in 3 year overall survival between the three groups (86.3% vs 82.1% vs 77.9%, p=0.26). After controlling for age, race, insurance, comorbidities, lymph node metastases, and tumor size, sentinel lymph node biopsy alone was not associated with worse overall survival compared with lymphadenectomy (HR 0.86, 95% CI 0.57 to 1.32). The sentinel node only group had shorter inpatient stays compared with lymphadenectomy only (median 1 vs 2 days, p<0.001) and a lower rate of unplanned readmission (1.7% vs 5.0%, p=0.010). CONCLUSIONS The utilization of sentinel lymph node biopsy is increasing in the management of vulvar cancer and is associated with superior perioperative outcomes without impacting overall survival.
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Affiliation(s)
| | - Dimitrios Nasioudis
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | | | - Nawar A Latif
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Ashley F Haggerty
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Robert L Giuntoli Ii
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Lori Cory
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Sarah H Kim
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Mark A Morgan
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Emily M Ko
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
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33
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Orta N, Sampol C, Reyes A, Martín A, Torrent A, Amengual J, Rioja J, Repetto A, Luna B, Peña C. Selective sentinel lymph node biopsy in squamous vulvar cancer. Ten-year follow-up analysis. Rev Esp Med Nucl Imagen Mol 2020. [DOI: 10.1016/j.remnie.2020.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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34
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Bartl T, Bekos C, Postl M, Alexander R, Polterauer S, Stefanie A, Richard S. The systemic immune-inflammation index (SII) is an independent prognostic parameter of survival in patients with invasive vulvar cancer. J Gynecol Oncol 2020; 32:e1. [PMID: 33185042 PMCID: PMC7767659 DOI: 10.3802/jgo.2021.32.e1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/15/2020] [Accepted: 08/29/2020] [Indexed: 01/08/2023] Open
Abstract
Objective To assess the prognostic value of the systemic immune-inflammation index (SII) in patients with vulvar cancer. Methods Data of 130 consecutive patients who underwent primary surgical resection for vulvar cancer at the Medical University of Vienna between 1999 and 2018 was retrospectively analyzed. The SII was defined as platelets × neutrophils/lymphocytes as previously described. Its prognostic value on disease-specific survival (DSS) and overall survival (OS) was evaluated by univariate log-rank tests and multivariable cox regression models. Prediction accuracy was assessed by receiver operating characteristics curves and Youden's J statistics. A Hosmer-Lemeshow test was performed to confirm the model's goodness of fit. Results A pre-therapeutic high serum SII (>866.4) was associated with advanced International Federation of Gynecology and Obstetrics (FIGO)-stage. In univariate survival analysis, a high SII was associated with both DSS (p<0.001) and OS (p=0.001). A multivariate cox regression model confirmed the prognostic value of SII regarding DSS (p<0.001) and OS (p=0.014) independently from patients' age and FIGO stage. Conclusions Pretherapeutic SII may serve as a promising predictor for survival in patients with vulvar cancer. After clinical validation, the SII may be used to improve both pre-treatment patient risk stratification and patient counseling.
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Affiliation(s)
- Thomas Bartl
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christine Bekos
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Magdalena Postl
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Reinthaller Alexander
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Stephan Polterauer
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria.
| | - Aust Stefanie
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Schwameis Richard
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria
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Deken MM, van Doorn HC, Verver D, Boogerd LSF, de Valk KS, Rietbergen DDD, van Poelgeest MIE, de Kroon CD, Beltman JJ, van Leeuwen FWB, Putter H, Braak JPBM, de Geus-Oei LF, van de Velde CJH, Burggraaf J, Vahrmeijer AL, Gaarenstroom KN. Near-infrared fluorescence imaging compared to standard sentinel lymph node detection with blue dye in patients with vulvar cancer - a randomized controlled trial. Gynecol Oncol 2020; 159:672-680. [PMID: 33041071 DOI: 10.1016/j.ygyno.2020.09.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/27/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to assess the superiority of ICG-99mTc-nanocolloid for the intraoperative visual detection of sentinel lymph nodes (SLNs) in vulvar squamous cell carcinoma (VSCC) patients compared to standard SLN detection using 99mTc-nanocolloid with blue dye. METHODS In this multicenter, randomized controlled trial, VSCC patients underwent either the standard SLN procedure or with the hybrid tracer ICG-99mTc-nanocolloid. The primary endpoint was the percentage of fluorescent SLNs compared to blue SLNs. Secondary endpoints were successful SLN procedures, surgical outcomes and postoperative complications. RESULTS Forty-eight patients were randomized to the standard (n = 24) or fluorescence imaging group (n = 24) using ICG-99mTc-nanocolloid. The percentage of blue SLNs was 65.3% compared to 92.5% fluorescent SLNs (p < 0.001). A successful SLN procedure was obtained in 92.1% of the groins in the standard group and 97.2% of the groins in the fluorescence imaging group (p = 0.33). Groups did not differ in surgical outcome, although more short-term postoperative complications were documented in the standard group (p = 0.041). CONCLUSIONS Intraoperative visual detection of SLNs in patients with VSCC using ICG-99mTc-nanocolloid was superior compared to 99mTc-nanocolloid and blue dye. The rate of successful SLN procedures between both groups was not significantly different. Fluorescence imaging has potential to be used routinely in the SLN procedure in VSCC patients to facilitate the search by direct visualization. CLINICAL TRIAL REGISTRATION Netherlands Trial Register (Trial ID NL7443).
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Affiliation(s)
- Marion M Deken
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Helena C van Doorn
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Danielle Verver
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Leonora S F Boogerd
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Kim S de Valk
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Daphne D D Rietbergen
- Department of Radiology, Section Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Cor D de Kroon
- Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jogchum J Beltman
- Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeffrey P B M Braak
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | - Katja N Gaarenstroom
- Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands.
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Francis JA, Eiriksson L, Dean E, Sebastianelli A, Bahoric B, Salvador S. No. 370-Management of Squamous Cell Cancer of the Vulva. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 41:89-101. [PMID: 30580832 DOI: 10.1016/j.jogc.2018.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This guideline reviews the clinical evaluation and management of squamous cell cancer (SCC) of the vulva with respect to diagnosis, primary surgical, radiation, or chemotherapy management and need for adjuvant treatment with chemotherapy and/or radiation therapy. Other vulvar cancer pathologic diagnoses are not included in the guideline. INTENDED USERS The first part of this document which includes recommendations 1 through 3 is for general gynaecologists, obstetricians, family doctors, registered nurses, nurse practitioners, residents, and health care providers with a focus on the presentation, diagnosis, and updated information about surgical procedures performed by subspecialists. The surgical management and treatment of advanced vulvar cancer are intended for gynaecologic oncologists, radiation oncologists, and medical oncologists who treat these complex patients. This guideline is intended to provide information for interested parties who may follow these patients once treatment is complete. TARGET POPULATION Adult women (18 years and older) with SCC of the vulva. Excluded from these guidelines are women with preinvasive disease. OPTIONS Women diagnosed with SCC of the vulva should be referred to a gynaecologic oncologist for initial evaluation, consideration for primary surgery and inguinal lymph node assessment, and potentially adjuvant radiation and/or chemotherapy. All cases of vulvar cancer should have access to discussion at a multidisciplinary cancer case conference. Women who would otherwise require radical surgery such as abdominal-perineal resection or exenterative procedures may be considered for primary treatment with radiation and/or chemotherapy. EVIDENCE For this guideline, relevant studies were searched in PubMed, Medline, and the Cochrane Systematic Reviews using the following terms, either alone or in combination, with the search limited to English language materials: vulva, vulvar cancer, inguinofemoral lymph node dissection, sentinel nodes, systemic chemotherapy, radiotherapy, neoadjuvant, adjuvant, primary, exenteration, survival, follow up. The initial search was performed in September 2016 with a final literature search in May 2017. Relevant evidence was selected for inclusion in the following order: meta-analyses, systematic reviews, guidelines, randomized controlled trials, prospective cohort studies, observational studies, non-systematic reviews, case series, and reports. Additional significant articles were identified through cross-referencing the identified reviews. The total number of studies identified was 286, and 78 studies were included in this review. VALIDATION METHODS The content and recommendations were drafted and agreed upon by the principal authors. The Executive and Board of the Society of Gynecologic Oncology of Canada reviewed the content and submitted comments for consideration, and the Board of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology framework (Table 1). The interpretation of strong and weak recommendations is described in Table 2. The Summary of Findings is available upon request. BENEFITS, HARMS, AND/OR COSTS These guidelines are to encourage physicians in the appropriate use of sentinel inguinal lymph node assessment for SCC of the vulva. The committee also promotes the centralization of treatment of vulvar cancer in specialized treatment centres. GUIDELINE UPDATE Evidence will be reviewed 5 years after publication to decide whether all or part of the guideline should be updated. However, if important new evidence is published prior to the 5-year cycle, the review process may be accelerated for a more rapid update of some recommendations. SPONSORS This guideline was developed with resources funded by the Society of Gynecologic Oncology of Canada and the Society of Obstetricians and Gynaecologists of Canada. SUMMARY STATEMENTS RECOMMENDATIONS.
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Sentinel lymph node biopsy in vulvar cancer: status, level of knowledge, and counseling in outpatient setting. Arch Gynecol Obstet 2020; 302:1001-1007. [PMID: 32683482 PMCID: PMC7471199 DOI: 10.1007/s00404-020-05701-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/11/2020] [Indexed: 11/01/2022]
Abstract
PURPOSE Evaluating the counseling of patients with vulvar cancer in outpatient setting regarding the application of sentinel lymph node dissection (SLND), the selection of hospitals for further treatment, and level of knowledge. METHODS A questionnaire containing 29 questions about SLND in vulvar cancer was sent to gynecologists in Lower Saxony. The questionnaire contained multiple choice questions and open questions. The study was approved by the local ethics committee. RESULTS The median age of the 86 respondents was 54 (26-66) years. Most participants (83.1%) reported to only treat one to five patients with vulvar cancer per year. Interestingly, 70.5% of the gynecologists send their patients to university hospitals and 64.1% to hospitals offering maximum care, respectively. Of all, 32.7% replied that SLND was performed rarely or never in their patients. The gynecologists answered that only 36.7% of the patients are well informed about advantages and possible disadvantages of SLND. Most (84%) felt responsible to counsel patients on treatment decisions independently from or additionally to the hospital. Of all, 72% replied that they are not completely sure about the exact recurrence rates after SLND. Of notice, 66% believe that SLND for vulvar cancer is safe if applied in specialized centers and 92% stated that focusing treatment on specialized centers is required for best results. CONCLUSION SLND for vulvar cancer is widely accepted and regularly recommended among gynecologists. Outpatient doctors report to send most patients to specialized centers. However, it appears that patients remain uninformed after counseling in the clinics and that there is a lack of detailed knowledge about risks and complication rates of groin treatment in the outpatient setting.
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Giannini A, D'''''Oria O, Santangelo G, Allegrini CM, Caruso G, Di Pinto A, Perniola G, Palaia I, Monti M, Muzii L, Benedetti Panici P, Di Donato V. The role of the sentinel lymph node in vulvar cancer. ACTA ACUST UNITED AC 2020; 72:361-366. [PMID: 32677774 DOI: 10.23736/s0026-4784.20.04601-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this study was to update clinical practice applications and technical procedures regarding sentinel lymph node (SLN) biopsy in vulvar cancer considering European experts' opinions from this field. Systematic data search performed using PubMed/medline database up to May 20, 2020. Focus was only for English language publications of original studies on SLN biopsy in vulvar cancer. Given the basis of published evidence and the consensus of European experts, this study provides an updated overview on clinical applications and technical procedures of SLN biopsy in vulvar cancer. In early-stage vulvar cancer patients with a negative sentinel node the groin recurrence rate is low, survival is excellent, and treatment-related morbidity is minimal. We advise that sentinel node dissection, performed by a quality-controlled multidisciplinary team, should be part of the standard treatment in selected patients with early-stage vulvar cancer.
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Affiliation(s)
- Andrea Giannini
- Department of Maternal, Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Ottavia D'''''Oria
- Department of Maternal, Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Giusi Santangelo
- Department of Maternal, Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy -
| | - Carlo M Allegrini
- Department of Maternal, Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Giuseppe Caruso
- Department of Maternal, Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Anna Di Pinto
- Department of Maternal, Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Giorgia Perniola
- Department of Maternal, Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Innocenza Palaia
- Department of Maternal, Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Marco Monti
- Department of Maternal, Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal, Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal, Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Violante Di Donato
- Department of Maternal, Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
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Jedryka MA, Klimczak P, Kryszpin M, Matkowski R. Superparamagnetic iron oxide: a novel tracer for sentinel lymph node detection in vulvar cancer. Int J Gynecol Cancer 2020; 30:1280-1284. [PMID: 32675253 DOI: 10.1136/ijgc-2020-001458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Superparamagnetic techniques for sentinel lymph node (SLNs) biopsy in breast cancer is well recognized but remains novel in the literature in relation to early stage vulvar cancer. The aim of this study was to compare and validate SLN detection using a superparamagnetic iron oxide tracer and a magnetometer probe compared with the standard procedure with a radioisotope (99Tc-technetium 99) and a gamma probe, in patients with vulvar cancer. METHODS Patients were included in the study with squamous vulvar tumors less than 4 cm in diameter and without suspicious groin lymph nodes on preoperative magnetic resonance imaging. Patients must have previously qualified for SLN biopsy with a radiotracer as the standard of care. The primary endpoint was the proportion of successful SLN detection with superparamagnetic iron oxide tracer versus 99Tc. The secondary endpoints were average number of SLNs retrieved per patient, proportion of SLNs detected (nodal detection rate), and proportion of pathologically positive results (malignancy rate) per patient and per node comparing both SLN detection methods. RESULTS A total of 20 patients were included in the study. SLNs were found in all patients with both methods, resulting in similar average distributions (3.1/3.2 SLN per patient). The SLN detection rate per patient was 100% with both techniques. Nodal detection sensitivity was 98.5% for the superparamagnetic technique and 93.8% for the radiotracer. Percentage of metastatic lymph nodes detected was 100% with both tracers. The rate of lymph node positivity was 21.5% (14 lymph nodes with metastases) and for patients 45% (9 patients with nodal metastases). Additionally, SLN tainted brown due to superparamagnetic iron oxide nanoparticles in 19 of 20 patients. CONCLUSIONS The use of superparamagnetic iron oxide tracer in patients with vulvar cancer seems reliable and not inferior to the standard approach with radiotracer.
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Affiliation(s)
- Marcin A Jedryka
- Gynecological Oncology, Wroclaw Medical University, Wroclaw, Dolnoslaskie, Poland .,Oncological Gynecology, Wroclaw Comprehensive Cancer Center, Wroclaw, Dolnoslaskie, Poland
| | - Piotr Klimczak
- Gynecological Oncology, Regional Oncology Centre of Professor Tadeusz Koszarowski in Opole, Opole, Poland
| | - Marcin Kryszpin
- Oncological Gynecology, Wroclaw Comprehensive Cancer Center, Wroclaw, Dolnoslaskie, Poland
| | - Rafal Matkowski
- Oncology, Wroclaw Medical University, Wroclaw, Dolnoslaskie, Poland.,Breast Unit, Wroclaw Comprehensive Cancer Center, Wroclaw, Dolnoslaskie, Poland
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Orta N, Sampol C, Reyes A, Martín A, Torrent A, Amengual J, Rioja J, Repetto A, Luna B, Peña C. Sentinel lymph node biopsy procedure in squamous vulvar cancer. 10 years follow-up analysis. Rev Esp Med Nucl Imagen Mol 2020; 39:360-366. [PMID: 32563714 DOI: 10.1016/j.remn.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 10/24/2022]
Abstract
AIM Application of sentinel lymph node biopsy (SLNB) procedure in early-stage vulvar cancer and analysis of results, recurrences and complications. MATERIAL AND METHODS 40 patients with vulvar cancer and SLNB between 2008 and 2018 were retrospectively reviewed. During the surgical procedure the inguinofemoral lymph nodes were checked with a gamma probe to identify the sentinel nodes that were removed and referred for intraoperative pathological assessment. Subsequently, long-term patient follow-up was performed with analysis of complications, relapse and mortality. RESULTS 40 patients (mean age: 72 years [47-86], the overall detection rate per patient was 95% and a total of 129 Sentinel Lymph Nodes (SLNs) were removed (3.22 SLN/patient). In 3 out of 25 patients with lateral tumour lesions drainage was bilateral and in 2 out of 15 with midline lesions drainage was unilateral. On lymphoscintigraphy, 16 out of 40 had bilateral drainage and 24 unilateral. A total of 119 SLN- and 10 SLN+ were obtained, in 8 out of 10 an inguinofemoral lymphadenectomy was performed. In the SLN- group, one case of lymphatic blockage and one false negative were included. In 12 out of 40 patients there were post-surgical complications, 4 of them lymphoedemas. In the median follow-up (40 months), 6 out of 10 with SLN+ (40% mortality) and 7 out of 30 SLN- (16% mortality) had recurrences. CONCLUSIONS SLNB in vulvar cancer is the technique of choice for correct staging and locoregional therapy. Correct clinical lymph node staging is important before surgery in order to avoid potential blockage drainages which could induce a false negative SLN.
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Affiliation(s)
- N Orta
- Servicio de Medicina Nuclear, Hospital Universitari Son Espases, Palma de Mallorca, España; Institut d'Investigació Sanitària Illes Balears (IdISBa), Islas Baleares, España.
| | - C Sampol
- Servicio de Medicina Nuclear, Hospital Universitari Son Espases, Palma de Mallorca, España; Institut d'Investigació Sanitària Illes Balears (IdISBa), Islas Baleares, España
| | - A Reyes
- Servicio de Ginecología y Obstetrícia (Sección Oncología Ginecológica), Hospital Universitario Son Llàtzer, Palma de Mallorca, España
| | - A Martín
- Servicio de Ginecología y Obstetrícia (Sección Oncología Ginecológica), Hospital Universitario Son Llàtzer, Palma de Mallorca, España
| | - A Torrent
- Servicio de Ginecología y Obstetrícia, Hospital Universitari Son Espases, Islas Baleares, España
| | - J Amengual
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Islas Baleares, España; Servicio de Ginecología y Obstetrícia, Hospital Universitari Son Espases, Islas Baleares, España
| | - J Rioja
- Servicio de Ginecología y Obstetrícia, Hospital Universitari Son Espases, Islas Baleares, España
| | - A Repetto
- Servicio de Medicina Nuclear, Hospital Universitari Son Espases, Palma de Mallorca, España
| | - B Luna
- Servicio de Medicina Nuclear, Hospital Universitari Son Espases, Palma de Mallorca, España
| | - C Peña
- Servicio de Medicina Nuclear, Hospital Universitari Son Espases, Palma de Mallorca, España; Institut d'Investigació Sanitària Illes Balears (IdISBa), Islas Baleares, España
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Moukarzel LA, Feinberg J, Levy EJ, Leitao MM. Current and novel mapping substances in gynecologic cancer care. Int J Gynecol Cancer 2020; 30:387-393. [PMID: 31953349 PMCID: PMC7375198 DOI: 10.1136/ijgc-2019-001078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/02/2020] [Accepted: 01/06/2020] [Indexed: 01/01/2023] Open
Abstract
Many tracers have been introduced into current medical practice with the purpose of improving lymphatic mapping techniques, anatomic visualization, and organ/tissue perfusion assessment. Among them, three tracers have dominated the field: indocyanine green, technetium-99m radiocolloid (Tc99m), and blue dye. Tc99m and blue dye are used individually or in combination; however, given particular challenges with these tracers, such as the need for a preoperative procedure by nuclear medicine and cost, other options have been sought. Indocyanine green has proven to be a promising alternative for certain procedures, as it is easy to use and has quick uptake. Its use in the management of gynecologic cancers was first described for sentinel lymph node mapping in cervical cancer, and later for endometrial and vulvar cancers. This review provides an in-depth look at these mapping substances, their uses, and the potential for new discoveries.
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Affiliation(s)
- Lea A Moukarzel
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jacqueline Feinberg
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Evan J Levy
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, United States
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Lymphoscintigraphy and sentinel lymph node biopsy in vulvar carcinoma: update from a European expert panel. Eur J Nucl Med Mol Imaging 2020; 47:1261-1274. [PMID: 31897584 DOI: 10.1007/s00259-019-04650-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/02/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE This study aimed to update the clinical practice applications and technical procedures of sentinel lymph node (SLN) biopsy in vulvar cancer from European experts. METHODS A systematic data search using PubMed/MEDLINE database was performed up to May 29, 2019. Only original studies focused on SLN biopsy in vulvar cancer, published in the English language and with a minimum of nine patients were selected. RESULTS Among 280 citations, 65 studies fulfilled the inclusion criteria. On the basis of the published evidences and consensus of European experts, this study provides an updated overview on clinical applications and technical procedures of SLN biopsy in vulvar cancer. CONCLUSIONS SLN biopsy is nowadays the standard treatment for well-selected women with clinically negative lymph nodes. Negative SLN is associated with a low groin recurrence rate and a good 5-year disease-specific survival rate. SLN biopsy is the most cost-effective approach than lymphadenectomy in early-stage vulvar cancer. However, future trials should focus on the safe extension of the indication of SLN biopsy in vulvar cancer. Although radiotracers and optical agents are widely used in the clinical routine, there is an increasing interest for hybrid tracers like indocyanine-99mTc-nanocolloid. Finally, it is essential to standardise the acquisition protocol including SPECT/CT images, and due to the low incidence of this type of malignancy to centralise this procedure in experienced centres for personalised approach.
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Recurrence and survival rates in node negative patients after sentinel node biopsy for early-stage vulva cancer – A nationwide study. Gynecol Oncol 2020; 156:124-130. [DOI: 10.1016/j.ygyno.2019.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/03/2019] [Accepted: 10/20/2019] [Indexed: 11/22/2022]
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Zach D, Kannisto P, Stenström Bohlin K, Moberg L, Kjölhede P. Can we extend the indication for sentinel node biopsy in vulvar cancer? A nationwide feasibility study from Sweden. Int J Gynecol Cancer 2019; 30:402-405. [DOI: 10.1136/ijgc-2019-000938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2019] [Indexed: 11/04/2022] Open
Abstract
BackgroundIn squamous cell vulvar cancer, sentinel node biopsy is accepted as standard treatment in well-defined patient groups and has reduced surgical morbidity considerably. Currently, due to the lack of evidence, it cannot be offered to patients with tumors of 4 cm diameter or greater or with multifocal tumors, or in local recurrences.Primary objectiveThis study is primarily a pilot and feasibility trial, aiming to evaluate if the prerequisites concerning detection rate and negative predictive value are satisfactory before the implementation of a multinational trial.Study hypothesisSentinel node biopsy has an acceptable negative predictive value and detection rate in the study cohort.Trial designThis study is planned as a prospective, national, multicenter interventional trial. Participating patients will undergo a sentinel node biopsy in addition to an inguinofemoral lymphadenectomy.Inclusion and exclusion criteriaInclusion criteria: for women in group 1, a primary tumor ≥4 cm in diameter; in group 2, a multifocal primary tumor; in group 3, a local recurrence without previous inguinofemoral lymphadenectomy or radiation to the groins; in group 4, a local recurrence, with previous inguinofemoral lymphadenectomy and/or radiation to the groins.Primary endpointThe primary endpoints are the detection rate and the negative predictive value of the sentinel node procedure.Sample sizeIn each of the four study arms, recruitment of 20–30 patients is planned.Estimated dates for completing recruitment and presenting resultsRecruitment will take place between November 2019 and October 2021. Results will be available in December 2021.Trial registrationThe trial is registered at “ClinicalTrials.gov” (ID: NCT04147780).
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Nasioudis D, Bhadra M, Ko EM. Extramammary Paget disease of the vulva: Management and prognosis. Gynecol Oncol 2019; 157:146-150. [PMID: 31780234 DOI: 10.1016/j.ygyno.2019.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/02/2019] [Accepted: 11/07/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the clinicopathological characteristics, management and prognosis of patients with vulvar extramammary Paget disease of the vulva (EMPD). MATERIALS AND METHODS The U.S National Cancer Database was accessed and patients diagnosed between 2004 and 2015 with microscopically confirmed vulvar EMPD were selected. Overall survival (OS) was calculated for patients diagnosed between 2004 and 2014, who had at least one month of follow-up. Five year OS rates were calculated following generation of Kaplan-Meier curves while comparisons were made with the log-rank test. RESULTS A total of 2602 patients were identified. Median age at diagnosis was 72 years (range 31-90 years) and the majority were of White race (92%), without any co-morbidities (80.9%). Personal history of another tumor was present in 36.9% of patients. In situ EMPD was diagnosed in 994 cases (38.2%) and the majority (95.1%) were managed with local excision or vulvectomy. Five-year OS was 85.8%, while presence of positive margins was not associated with worse OS (p = 0.38). Invasive EMPD was diagnosed in 1608 (61.8%) patients. Staging information was available for 1172 patients, 75.3% had early stage disease. Most patients underwent surgical treatment (91.6%); 53.6% had positive margins. Performance of lymphadenectomy was infrequent (6.8%). Moreover, immunotherapy (4.5%), chemotherapy (1.5%) and radiation therapy (2.2%) were rarely employed in the management of invasive EMPD. Patients with early stage disease (n = 766) had better OS compared to those with advanced stage (n = 278) (5-yr OS rates were 84.3% and 73.6% respectively, p = 0.015) while presence of positive margins was not associated with worse OS (p = 0.35). CONCLUSIONS Extramammary Paget disease is a rare vulvar tumor. Surgical excision is the main treatment option while other modalities are rarely employed. Overall survival rates are encouraging.
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Affiliation(s)
| | - Madhura Bhadra
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, PA, USA
| | - Emily M Ko
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, PA, USA
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Skanjeti A, Dhomps A, Paschetta C, Tordo J, Giammarile F. Sentinel Node Mapping in Gynecologic Cancers: A Comprehensive Review. Semin Nucl Med 2019; 49:521-533. [DOI: 10.1053/j.semnuclmed.2019.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Querleu D, Rychlik A, Guyon F, Floquet A, Planchamp F. [Management of the nodal disease in vulvar cancers. The ESGO guidelines]. Bull Cancer 2019; 107:715-720. [PMID: 31586525 DOI: 10.1016/j.bulcan.2019.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/15/2019] [Indexed: 11/15/2022]
Abstract
The European Society of Gynaecologic Oncology (ESGO) guidelines cover the whole field of common clinical situations in gynecologic oncology. Their elaboration follows a strict process including a systematic review of the literature, the setting up of a group of expert on the basis of scientific production, geographical balance, and multidisciplinarity, and an external review by users and patients. The recommendations for the management of vulvar cancer were elaborated in 2015 and published in 2017. They are available in open access on the ESGO website, and can be incorporated in clinical practice using the free ESGO guidelines smartphone application. This review is a selection of the sections addressing the diagnostic and strategical aspects of the management of lymph nodal disease in vulvar cancer. An additional review of the recent literature published since 2015 has been carried out. The management of nodal disease in vulvar cancer encompasses a diagnostic and a therapeutic component. Clinical and imaging assessment still play a major role, whilst the identification of the sentinel node is currently a mainstay of assessment of the nodal status in early vulvar cancer. The therapeutic component is based on the rational use of full lymph node dissection and (chemo)radiation.
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Affiliation(s)
- Denis Querleu
- Institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France.
| | | | - Frédéric Guyon
- Institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Anne Floquet
- Institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France
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Angelico G, Santoro A, Inzani F, Spadola S, Fiorentino V, Cianfrini F, Carbone C, Garganese G, Rossi ED, Scambia G, Zannoni GF. Ultrasound‐guided FNA cytology of groin lymph nodes improves the management of squamous cell carcinoma of the vulva: Results from a comparative cytohistological study. Cancer Cytopathol 2019; 127:514-520. [DOI: 10.1002/cncy.22154] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/03/2019] [Accepted: 05/03/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Giuseppe Angelico
- Department of Woman and Child Health and Public Health, Pathology Area Agostino Gemelli University Hospital Foundation, Scientific Institute for Research and Healthcare Rome Italy
| | - Angela Santoro
- Department of Woman and Child Health and Public Health, Pathology Area Agostino Gemelli University Hospital Foundation, Scientific Institute for Research and Healthcare Rome Italy
| | - Frediano Inzani
- Department of Woman and Child Health and Public Health, Pathology Area Agostino Gemelli University Hospital Foundation, Scientific Institute for Research and Healthcare Rome Italy
| | - Saveria Spadola
- Department of Woman and Child Health and Public Health, Pathology Area Agostino Gemelli University Hospital Foundation, Scientific Institute for Research and Healthcare Rome Italy
| | - Vincenzo Fiorentino
- Department of Woman and Child Health and Public Health, Pathology Area Agostino Gemelli University Hospital Foundation, Scientific Institute for Research and Healthcare Rome Italy
| | - Federica Cianfrini
- Department of Woman and Child Health and Public Health, Pathology Area Agostino Gemelli University Hospital Foundation, Scientific Institute for Research and Healthcare Rome Italy
| | - Claudia Carbone
- Department of Woman and Child Health and Public Health, Pathology Area Agostino Gemelli University Hospital Foundation, Scientific Institute for Research and Healthcare Rome Italy
| | - Giorgia Garganese
- Department of Woman and Child Health and Public Health, Woman Health Area Agostino Gemelli University Hospital Foundation and Catholic University of the Sacred Heart, Scientific Institute for Research and Healthcare Rome Italy
| | - Esther D. Rossi
- Department of Woman and Child Health and Public Health, Pathology Area Agostino Gemelli University Hospital Foundation, Scientific Institute for Research and Healthcare Rome Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Woman Health Area Agostino Gemelli University Hospital Foundation and Catholic University of the Sacred Heart, Scientific Institute for Research and Healthcare Rome Italy
| | - Gian F. Zannoni
- Department of Woman and Child Health and Public Health, Pathology Area Agostino Gemelli University Hospital Foundation, Scientific Institute for Research and Healthcare Rome Italy
- Department of Woman and Child Health and Public Health, Woman Health Area Agostino Gemelli University Hospital Foundation and Catholic University of the Sacred Heart, Scientific Institute for Research and Healthcare Rome Italy
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Mise à jour concernant la prise en charge du cancer de la vulve : les recommandations de l’Assistance publique–hôpitaux de Paris. Bull Cancer 2019; 106:371-378. [DOI: 10.1016/j.bulcan.2019.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/15/2019] [Accepted: 01/23/2019] [Indexed: 01/09/2023]
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