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Clinical Trial
. 2013 Feb;128(2):155-9.
doi: 10.1016/j.ygyno.2012.11.034. Epub 2012 Nov 29.

Is bilateral lymphadenectomy for midline squamous carcinoma of the vulva always necessary? An analysis from Gynecologic Oncology Group (GOG) 173

Robert L Coleman  1 , Shamshad Ali, Charles F Levenback, Michael A Gold, Jeffrey M Fowler, Patricia L Judson, Maria C Bell, Koen De Geest, Nick M Spirtos, Ronald K Potkul, Mario M Leitao Jr, Jamie N Bakkum-Gamez, Emma C Rossi, Samuel S Lentz, James J Burke 2nd, Linda Van Le, Cornelia L Trimble
Affiliations
Clinical Trial

Is bilateral lymphadenectomy for midline squamous carcinoma of the vulva always necessary? An analysis from Gynecologic Oncology Group (GOG) 173

Robert L Coleman et al. Gynecol Oncol. 2013 Feb.

Abstract

Objective: To determine which patients with near midline lesions may safely undergo unilateral groin dissection based on clinical exam and lymphoscintigraphy (LSG) results.

Methods: Patients participating in GOG-173 underwent sentinel lymph node (SLN) localization with blue dye, and radiocolloid with optional LSG before definitive inguinal-femoral lymphadenectomy (LND). This analysis interrogates the reliability of LSG alone relative to primary tumor location in those patients who had an interpretable LSG and at least one SLN identified. Primary tumor location was categorized as lateral (>2cm from midline), midline, or lateral ambiguous (LA) if located within 2cm, but not involving the midline.

Results: Two-hundred-thirty-four patients met eligibility criteria. Sixty-four had lateral lesions, and underwent unilateral LND. All patients with LA (N=65) and midline (N=105) tumors underwent bilateral LND. Bilateral drainage by LSG was identified in 14/64 (22%) patients with lateral tumors, 38/65 (58%) with LA tumors and in 73/105 (70%) with midline tumors. At mapping, no SLNs were found in contralateral groins among those patients with LA and midline tumors who had unilateral-only LSGs. However, in these patients groin metastases were found in 4/32 patients with midline tumors undergoing contralateral dissection; none were found in 27 patients with LA tumors.

Conclusion: The likelihood of detectable bilateral drainage using preoperative LSG decreases as a function of distance from midline. Patients with LA primaries and unilateral drainage on LSG may safely undergo unilateral SLN.

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Conflict of interest statement

CONFLICT OF INTEREST

Dr. Linda Van Le is on the Speaker’s Bureau for Eisai and the Advisory Board for Biologics, Inc. All other co-authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Consort diagram
CONSORT diagram demonstrating patient exclusions producing the study cohort of 234.
Figure 2
Figure 2. Distribution of unilateral/bilateral localization by Lymphoscintography
Frequency of bilateral drainage by lymphoscintigraphy relative to the location of the primary lesion as assessed by hand-drawn schematics, and operative or pathological reports. There is significant reduction in bilateral drainage as the primary lesion moves lateral (midline: 70%, lateral/ambiguous: 58%, lateral: 22%). However, we observed that more than one in five patients with lateralized primary tumors (> 2 centimeters from the midline) had bilateral drainage on lymphoscintigraphy.
See this image and copyright information in PMC

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