Metastatic and non-metastatic sentinel inguinofemoral lymph nodes in vulvar cancer show an increased lymphangiogenesis
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Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
Faculty of Medicine and Health and Medical Science, Andrzej Frycz Modrzewski University, Krakow Poland
Department of Pathomorphology, Jagiellonian University Medical College, Krakow, Poland
Oncology Centre – M. Skłodowska-Curie Institute, Krakow, Poland
Department of Economic and System Analyses, National Institute of Public Health – National Institute of Hygiene, Warsaw, Poland
Department of Health Economics and Medical Law, Medical University of Warsaw, Warsaw, Poland
Department of Public Health, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
National Institute of Public Health – National Institute of Hygiene, Warsaw, Poland
Kazimierz Pityński   

Jagiellonian University Department of Gynecology and Oncology
Introduction and objective:
Lymph node involvement is a strong predictor of disease recurrence and patient survival in vulvar cancer. The aim of the study was to evaluate the feasibility of sentinel lymph node (SLN) screening, the incidence of skip metastases, and lymph node lymphangiogenesis.

Material and methods:
Fifty-five patients participated in this prospective, single centre study. A double SLN screening method was employed using radiocolloid (technetium-99 sulfur colloid) and 1.0% Isosulfan Blue. Immunohistochemistry, using a mouse monoclonal antibody against D2–40, was used to evaluate lymphatic vessel density (LVD). All calculations were performed using STATISTICA software v. 10 (StatSoft, USA, 2011); p < 0.05 was considered significant.

Using both methods of SLN detection, 100% accuracy was achieved, and skip metastases were diagnosed in only one woman (1.82%). Peri-tumour median LVD was significantly increased compared with matched intra-tumour samples (p < 0.001), while median LVD was significantly lower in negative, compared with positive SLN, regardless of whether matched non-SLN were negative (p < 0.001) or positive (p = 0.005). Metastatic SLN exhibited significantly higher median LVD compared with matched negative non-SLN (p = 0.015), while no significant difference in median LVD was detected between positive SLN and matched positive non-SLN. However, negative SLN had a significantly higher median LVD compared with matched negative non-SLN (p = 0.012).

SLN detection is a safe and feasible procedure in vulvar cancer. In patients without nodular involvement, SLN, compared with non-SLN, exhibited significantly higher median LVD, which may be an indication of its preparation to host metastases, and thus requires further investigation.

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