Groin Surveillance by Serial Ultrasonography Rather Than Sentinel Node Biopsy or Inguinofemoral Lymphadenectomy for Patients with Vulvar Cancer: A Pilot Study

SIMPLE SUMMARY: Vulvar cancer is a rare disease, but its treatment often causes significant issues with body image. One such issue is chronic lower limb lymphedema, which commonly occurs following the resection of groin lymph nodes. The status of these nodes is the most important prognostic factor for patients with vulvar cancer, and all patients but those with small, superficially invasive cancers currently require some form of groin dissection. If patients recur in an undissected groin, there is a 90% mortality rate. We have hypothesized that it may be possible to avoid groin dissection in selected patients by performing serial ultrasonography of the groin for at least 12 months. In this pilot study on 32 patients, we were able to identify three patients (9.4%) with positive nodes upon ultrasound. After groin dissection and radiation therapy, one patient (3.1%) died while 90.7% of groins were preserved intact. ABSTRACT: A pilot study was conducted to determine whether 3-monthly groin ultrasonography could eliminate groin dissection after a negative bilateral groin ultrasound in three groups of patients: (i) Those with a unifocal stage 1B squamous cell carcinoma of up to 20 mm in diameter. (ii) Those with an ipsilateral squamous cell carcinoma of any size which extended to within 1 cm either side of the midline. These patients underwent ipsilateral inguinofemoral lymphadenectomy and ultrasonic surveillance of the contralateral groin. (iii) Patients with multifocal invasive lesions with the largest individual focus 20 mm or less in diameter. Three additional patients were added because they either refused groin dissection or were considered unfit for surgery. All ultrasonically positive nodes were confirmed histologically. Thirty-two patients were entered, and no patients were lost to follow-up. Forty-three groins were followed. With a median follow-up of 37 months, three positive nodes (9.4%) were detected. One patient died of her recurrence (3.1%), and 39 groins (90.7%) were preserved. The overall sensitivity of ultrasonic surveillance was 100% (95% CI: 44–100%), with a specificity of 97% (95% CI: 83–99%) and a negative predictive value of 100% (95% CI: 88–100%). This pilot justifies a larger study on serial ultrasonography in lieu of groin dissection in selected patients with vulvar cancer.