Omitting Preoperative Lymphoscintigraphy Does Not Decrease Sentinel Lymph Node Detection Rate in Vulvar Cancer
International Journal of Clinical Oncology and Cancer Research
Volume 3, Issue 3, June 2018, Pages: 30-34
Received: Jun. 19, 2018;
Accepted: Jul. 16, 2018;
Published: Aug. 9, 2018
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Kasey Marie Roberts, Department of Obstetrics and Gynecology, Riverside Methodist Hospital, Columbus, USA
Aine Emma Clements, Department of Obstetrics and Gynecology, Riverside Methodist Hospital, Columbus, USA
John Ottis Elliott, Department of Obstetrics and Gynecology, Riverside Methodist Hospital, Columbus, USA
Kellie Susan Rath, Department of Obstetrics and Gynecology, Riverside Methodist Hospital, Columbus, USA
Gary Craig Reid, Department of Obstetrics and Gynecology, Riverside Methodist Hospital, Columbus, USA
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Sentinel lymph nodes in vulvar cancer can be detected in a variety of ways. A method described in GOG-173 involves injection of technetium-99m and isosulfan blue intraoperatively. Lymphoscintigraphy, for which the technetium-99m is injected preoperatively, became required two years into the study due to unpublished evidence that lymphoscintigraphy improved intraoperative sentinel lymph node localization. Despite this amendment, the need for preoperative lymphoscintigraphy has been questioned. The primary objective of this study was to determine the detection rate of sentinel lymph nodes in vulvar cancer when preoperative lymphoscintigraphy is omitted. The secondary objective was to compare the sentinel lymph node detection rate when lymphoscintigraphy is omitted to the rate reported in GOG-173, in which preoperative lymphoscintigraphy was performed. The tertiary objective was to determine lymphoscintigraphy cost at one institution. Patients with vulvar cancer who underwent sentinel lymph node dissection at a single institution from 2008 to 2016 were identified. All but one patient had intraoperative peritumoral injection of both technetium-99m and patent blue dye. Patients were excluded if preoperative lymphoscintigraphy was performed. Information on demographics, pathology, and outcomes were collected. Descriptive statistics were used for patient demographics, tumor characteristics, and the detection rate. A 1-sample proportion test was used to compare our detection rate to data available from GOG-173. Percentages were rounded to the nearest whole number. Current procedural terminology codes were used to estimate lymphoscintigraphy cost. Fifty patients were identified and 32 patients were deemed eligible for the study. The sentinel lymph node detection rate was 97% per patient, which was not statistically different from the rate of 92% reported in GOG-173 (p = 0.347). It was determined that lymphoscintigraphy cost $5,288.22 per imaging study. In this study, omitting preoperative lymphoscintigraphy did not decrease sentinel lymph node detection rates when compared to GOG-173. Furthermore, there is a substantial cost associated with lymphoscintigraphy, although this cost may vary between institutions.
Lymphoscintigraphy, Sentinel Lymph Node, Vulvar Cancer
To cite this article
Kasey Marie Roberts,
Aine Emma Clements,
John Ottis Elliott,
Kellie Susan Rath,
Gary Craig Reid,
Omitting Preoperative Lymphoscintigraphy Does Not Decrease Sentinel Lymph Node Detection Rate in Vulvar Cancer, International Journal of Clinical Oncology and Cancer Research.
Vol. 3, No. 3,
2018, pp. 30-34.
Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
American Cancer Society [Internet]. Atlanta (GA): American Cancer Society, 2017. Cancer Facts & Figures [updated 2017; cited 2017 Jun 08]. Available from: https://www.cancer.org/cancer/vulvar-cancer/about/key-statistics.html.
Oonk MH, van Hemel BM, Hollema H, de Hullu JA, Ansink AC, Vergote I, et al. Size of sentinel-node involvement and survival in early stage vulvar cancer: results from GROINSS-V, a multicenter observational study. Lancet Oncol. 2010 Jul; 11 (7):646-52.
Giammarile F, Bozkurt MF, Cibula D, Pahisa J, Oyen WJ, Paredes P, et al. The EANM clinical and technical guidelines for lymphoscintigraphy and sentinel node localization in gynaecological cancers. Eur J Nucl Med Mol Imaging. 2014 Jul; 41 (7):1463-77.
Gonzale Bosquet J, Kinney W, Russell A, Gaffey T, Magrina J, Podratz K. Risk of Occult Inguinofemoral Lymph Node Metastasis From Squamous Carcinoma of the Vulva. Int J Radiat Oncol Biol Phys. 2003 Oct 1; 57 (2):419-24.
Hacker H, Eifel P, van der Velden J. Cancer of the vulva. Int J Gynaecol Obstet. 2015 Sept 2; 131:S76-S83.
Levenback CF, Ali S, Coleman RL, Gold MA, Fowler JM, Judson PL. Lymphatic Mapping and Sentinel Lymph Node Biopsy in Women With Squamous Cell Carcinoma of the Vulva: A Gynecologic Oncology Group Study. J Clin Oncol. 2012 Nov 1; 30 (31):3786-91.
Covens A, Vella E, Kennedy E, Reade CJ, Jimenez W, Le T. Sentinel lymph node biopsy in vulvar cancer: Systematic review, meta-analysis, and guideline recommendations. Gynecol Oncol. 2015 May; 137 (2):351-61.
Hassanzade M, Attaran M, Treglia G, Yousefi Z, Sadeghi R. Lymphatic mapping and sentinel node biopsy in SCC of the vulva: Systematic review and meta-analysis of the literature. Gynecol Oncol. 2013 Jul; 130 (1):237-45.
Hubalewska-Dydejczk A, Sowa-Staszczak A, Huszno B. Current application of sentinel lymph node lymphoscintigraphy to detect various cancer metastases. Hell J Nucl Med. 2006 Jan-Apr; 9 (1):5-9.
Lindell G, Jonsson C, Ehrsson RJ, Jacobsson H, Danielsson KG, Källström BN et al. Evaluation of preoperative lymphoscintigraphy and sentinel node procedure in vulvar cancer. Eur J Obstet Gynecol Reprod Biol. 2010 Sep; 152 (1):91-5.
McCann G, Cohn D, Jewell E, Havrilesky, LJ. Lymphatic mapping and sentinel lymph node dissection compared to complete lymphadenectomy in the management of early-stage vulvar cancer: A cost-utility analysis. Gynecol Oncol. 2015 Feb; 136 (2):300-4.
Slomovitz B, Coleman R, Oonk M, van der Zee A, Levenback C. Update on sentinel lymph node biopsy for early-stage vulvar cancer. Gynecol Oncol. 2015 Aug; 138 (2):472-7.
Meads C, Sutton A, Małysiak S, Kowalska M, Zapalska A, Rogozinska E, et al. Sentinel lymph node status in vulval cancer: systematic review of test accuracy and decision-analytic model-based economic evaluation. Health Technol Assess. 2013 Dec; 17 (60):1-216.