Page 29 - ESGO - Vulvar cancer - Complete report_fxd2

10.3 Development group comments

In tumours involving the midline, absence of bilateral drainage should be considered as a false negative
procedure at the site of no drainage.
Multiple sectioning and immunohistochemistry allow more accurate evaluation of the SLN.

10.4 Guidelines

c

B The sentinel lymph node procedure is recommended in patients with unifocal cancers of < 4 cm,
without suspicious groin nodes.

B Use of radioactive tracer is mandatory, use of blue dye is optional.
C Lymphoscintigram is advised to enable the preoperative identification, location and number of sentinel

lymph nodes.
C Intraoperative evaluation and/or frozen sectioning of the sentinel lymph node can be performed in an

attempt to prevent a second surgical procedure. Caution is warranted because of an increased risk of
missing micrometastases on final pathology due to the loss of tissue arising from processing for frozen
section assessment.
 When a sentinel lymph node is not found (method failure), inguinofemoral lymphadenectomy should
be performed.

c

C Where metastatic disease is identified in the sentinel lymph node (any size): inguinofemoral
lymphadenectomy in the groin with the metastatic sentinel lymph node.

 For tumours involving the midline: bilateral sentinel lymph node detection is mandatory. Where only
unilateral sentinel lymph node detection is achieved, an inguinofemoral lymphadenectomy in the
contralateral groin should be performed.

c

C Pathological evaluation of sentinel lymph nodes should include serial sectioning at levels of at least
every 200 µm. If the H&E sections are negative, immunohistochemistry should be performed.

 VULVAR CANCER - GUIDELINES 
29