Sentinel Lymph Node Evaluation in Vulvar Cancer: The New Standard of Care

Purpose: The treatment of vulvar cancer remains surgical; however, as surgical treatment has evolved the surgical morbidity has decreased with the use of minimally invasive technology. Sentinel lymph node biopsy, which has been validated in breast cancer and melanoma, has been similarly investigated in vulvar cancer. This review summarizes the current evidence supporting sentinel lymph node biopsy in vulvar cancer. Findings: Compared to inguinofemoral lymphadenectomy sentinel lymph node biopsy has a sensitivity of 87-92% for the detection of vulvar cancer and a false negative predictive value of 2.0% in tumors ≤ 4 cm. Nodal recurrences following sentinel lymph node biopsies are comparable to recurrence rates following inguinofemoral lymphadenectomy. However complications after sentinel lymph node biopsy, including lymphedema, cellulitis and wound breakdown, are much lower. Conclusions: Sentinel lymph node dissection is safe and feasible in select patients with vulvar cancers measuring ≤ 4 cm with bilateral SLN dissection for midline lesions. Procedures should be performed at centers with sufficient volume and with radiologists, surgeons and pathologists trained in a sentinel lymph node protocol.