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Year : 2017  |  Volume : 3  |  Issue : 1  |  Page : 5-11

Sentinel node biopsy in vulvar cancer: A critical appraisal

1 Gynaecological Cancer Centre, Royal Hospital for Women; Department of Gynaecological Oncology, School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
2 Gynaecological Cancer Centre, Royal Hospital for Women, Randwick, NSW, Australia

Correspondence Address:
Neville F Hacker
Gynaecological Cancer Centre, Royal Hospital for Women, Locked Bag 1000, Barker Street, Randwick 2031, NSW
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2454-6798.209328

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Since the incorporation of inguinal-femoral lymphadenectomy into the management of patients with vulvar cancer in the mid-20th century, there have been attempts to modify or eliminate the groin dissection to decrease the risk of lower limb lymphedema. Early attempts were significantly flawed and resulted in much unnecessary loss of life because recurrence in an undissected groin is usually fatal. The best compromise yet to decrease the risk of lymphedema is sentinel node biopsy, but accumulated evidence now suggests that the false-negative rate for this procedure, if used for lesions up to 4 cm in diameter, is between 5% and 10%. Most women, properly informed of risks and benefits, are not prepared to take a 1% risk of dying from recurrent vulvar cancer to avoid lymphedema. This is the risk involved, assuming a false-negative rate of 5% and an incidence of positive nodes of 20%. For this reason, sentinel node biopsy should not be considered to be standard practice for patients with early vulvar cancer.

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