Identification of sentinel lymph nodes in vulvar carcinoma patients with the aid of a patent blue V injection - A multicenter study

BACKGROUND, The aim of this multicenter study was to investigate the feasib ility and negative predictive value of sentinel lymph node detection with b lue dye in Vulvar carcinoma patients. METHODS, In patients with squamous cell carcinoma of the vulva without susp icious groin lymph nodes, patent blue V was injected intradermally shortly before surgery. Routine groin lymph node dissection and radical vulvectomy were performed. During the surgery, blue lymph vessels and lymph nodes were identified, and the blue lymph nodes were sent separately for histologic e xamination. The negative predictive value of the blue lymph nodes for the a bsence of metastases was assessed by histologic examination of the groin ly mph node specimens. RESULTS. Fifty-one patients in whom 93 groin lymph node dissections were pe rformed were entered. One or more blue lymph nodes were detected in only 52 groins (56%). Nine (17%) of these were tumor positive, and 6 blue lymph no des were the only tumor positive lymph nodes in the specimen in which they were found. There were two false-negative blue lymph nodes. The negative pr edictive value was 0.953. CONCLUSIONS. It was shown in this multicenter study that sentinel lymph nod e detection in vulvar carcinoma patients with blue dye only is not feasible because its negative predictive value is too low. Further studies involvin g the use of a combination of radioactive labeled technetium and blue dye a re warranted. Cancer 1999;86:652-6. (C) 1999 American Cancer Society.