Sentinel Lymph Node Biopsy in Vulvar Cancer: What is the Standard of Care?

Purpose: The surgical treatment of most vulvar cancers includes a lymph node evaluation. Historically, inguinofemoral lymphadenectomy was performed with significant associated morbidity. Sentinel lymph node biopsy has been studied as an alternative in order to decrease postoperative morbidity. This review summarizes the evidence supporting the use of sentinel lymph node biopsy as standard of care in vulvar cancer. Findings: Sentinel lymph node biopsy has a sensitivity of 92% with a negative predictive value of 97-98%. Combining both radiotracer and dye methods improves the sentinel lymph node detection rate and sensitivity. The rate of groin recurrence and 5-year overall survival are comparable to inguinofemoral lymphadenectomy. Postoperative complications including lymphedema, wound infection and wound separation are significantly lower after sentinel lymph node biopsy. Summary: Sentinel lymph node biopsy for the surgical evaluation of vulvar cancer is feasible, cost-effective, associated with less short- and long-term morbidity when compared to inguinofemoral lymphadenectomy and has comparable rates of survival and groin recurrence. Sentinel lymph node biopsy should be performed as the standard of care for appropriate patients in high-volume centers.