Reply to Sentinel Lymph Node in Vulvar Cancer

✍ Scribed by Jan Hauspy; Allan Covens; Marlo Beiner; Ian Harley; Lisa Erlich; Golnar Rasty; Jan Hauspy

• Publisher: John Wiley and Sons
• Year: 2008
• Tongue: English
• Weight: 32 KB
• Volume: 112
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/cncr.23380

✦ Synopsis

Hauspy and colleagues, 1 and I agree that the sentinel lymph node (SLN) procedure is safe for patients with vulvar cancer and should reduce morbidity compared with full inguinofemoral dissection. Now, with those authors' results, we can perform the selective removal of SLNs in patients with clinical stage T1 and T2 vulvar cancer (International Federation of Gynecology and Obstetrics staging) if they have a positive SLN by using a combination of technetium sulfur colloid and/or lymphazurin instead of complete inguinofemoral lymphadenectomy, thereby reducing resultant complications.

However, this procedure is possible only in centers that have facilities available for detecting SLNs. In developing countries like India, most hospitals do not have such facilities, and the majority of patients cannot afford the procedure. Frozen-section facilities also are not available. In this situation, it becomes very difficult to manage patients with vulvar cancer: Hauspy et al. rightly reported that clinical examination is an unreliable predictor of lymph node status and is considered inaccurate in 25% to 30% of patients. In addition, it has not been demonstrated that computed tomography scanning or magnetic resonance imaging add improved accuracy over and above clinical examination. I would like to know what the authors believe would be the most cost-effective policy in places where the facilities for detecting SLNs are not available. It appears that complete inguinofemoral lymphadenectomy, either ipsilateral or bilateral, based on the location of vulvar cancer, probably is a better policy in patients with clinical stage T1 and T2 vulvar cancer.