Background: Sentinel lymph node biopsy (SLNB) has been proven to be safe in patients with early stage vulval cancer with no clinically or radiologically concerning nodes1 and is associated with a significant reduction in treatment associated morbidity when compared with total lymphadenectomy2. In most centres sentinel node biopsy is the preferred surgical approach, but certain groups of patients are ineligible to undertake sentinel node assessment. There is paucity of information available on the proportion of patients eligible and ineligible for SLNB and associated indications for each chosen approach.
Objectives: The aims of the study were to provide an overview of patterns of care for early stage vulval cancer, focusing on eligibility and method of inguinofemoral lymph node assessment, complications associated with each approach and any patterns of short-term recurrence.
Materials and methods: Retrospective data analysis on patients with early primary vulval squamous cell carcinoma from 2014 to 2017 undergoing primary surgical management (including nodal surgery) at all gynaecology oncology cancer centres in Queensland. Patient data was extracted from the Queensland Centre for Gynaecological Cancer (QCGC) database. SPSS was used for statistical analysis.
Results (Preliminary results only, final results to be presented at conference): 193 patients were included for analysis. Of the 193 patients, 96 were eligible for SLNB (49.8%) and 97 ineligible (50.2%) and therefore underwent regional lymph node dissection. Reasons for ineligibility for SLNB included: failed sentinel lymph node mapping, suspicious lymph nodes on imaging/histopathology, tumour >4cm in size, multifocal disease or other reasons (such as allergies, co-morbidities). Complications occurred in 19/96 patients in the SLNB group (19.8%) and 27/97 in the dissection group (27.8%).
Conclusions: While SLNB has been proven to be a safe and sensitive approach, evidence in this area is still limited due to the rarity of vulval cancer which ultimately limits overall application. This study shows that only approximately 50% of patients with vulval cancer were eligible for SLNB. Consistent with previous evidence SLNB also proved to be a faster and less morbid procedure in comparison to complete inguino-femoral lymph node dissection.
Outcomes such as complications, recurrence rates, cancer-related survival and overall survival to be presented at conference, along with final statistical analysis (including significance of above numbers)