Sentinel Nodes for Vulva Cancer

Sentinel Nodes for Vulva Cancer
Kenneth D. Hatch
GENERAL PRINCIPLES
The major morbidity from complete inguinal-femoral node dissection is lower-extremity lymphedema. This may be accompanied by recurrent lymphangitis. This has heightened the interest in developing the concept of sentinel lymph node detection.
Anatomic Considerations
  • The ideal candidate is a squamous cell cancer less than 4 cm in size that is 2 cm or more from the midline and unifocal.
  • The inguinal lymph nodes should not be clinically suspicious for metastasis.
  • If the tumor is in the midline then sentinel nodes must be identified on both sides. In the absence of a sentinel node then an inguinofemoral node dissection should be performed.
  • Patients with vulva melanomas are also good candidates for sentinel node removal.
IMAGING AND OTHER DIAGNOSTICS
  • Standard imaging has not been successful in identifying metastases in groin lymph nodes. PET/CT, MRI, and CT have not been accurate.
PREOPERATIVE PLANNING
  • The radioactive injections are placed in the nuclear medicine department 2 hours before the procedure and a lymphoscintigram or SPECT-CT scan is performed. An image of the sentinel node is obtained for the surgeon. A handheld gamma probe must be available for intraoperative assessment of the gamma count.
  • Frozen section for the sentinel node should be available.
SURGICAL MANAGEMENT
Positioning
  • Low lithotomy position with leg support stirrups.
May 7, 2019 | Posted by in GYNECOLOGY | Comments Off on Sentinel Nodes for Vulva Cancer

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