Sentinel lymph node biopsy in vulval cancer: Systematic review and meta-analysis

C. Meads, A. J. Sutton, A. N. Rosenthal, S. Małysiak, M. Kowalska, A. Zapalska, E. Rogozińska, P. Baldwin, R. Ganesan, E. Borowiack, P. Barton, T. Roberts, K. Khan, S. Sundar*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

38 Citations (Scopus)


Background:The purpose of this study was to determine the accuracy of sentinel lymph node (SLN) biopsy with technetium 99 (99mTc) and/or blue dye-enhanced lymphoscintigraphy in vulval cancer.Methods:Sensitive searches of databases were performed upto October 2013. Studies with at least 75% of women with FIGO stage IB or II vulval cancer evaluating SLN biopsy with 99mTc, blue dye or both with reference standard of inguinofemoral lymphadenectomy (IFL) or clinical follow-up were included. Meta-analyses were performed using Meta-Disc version 1.4.Results:Of the 2950 references, 29 studies (1779 women) were included; most of them evaluated 99mTc combined with blue dye. Of these, 24 studies reported results for SLN followed by IFL, and 5 reported clinical follow-up only for SLN negatives. Pooling of all studies was inappropriate because of heterogeneity. Mean SLN detection rates were 94.0% for 99mTc, 68.7% for blue dye and 97.7% for both. SLN biopsy had pooled sensitivity of 95% (95% CI 92-98%) with negative predictive value (NPV) of 97.9% in studies using 99mTc/blue dye, ultrastaging and immunohistochemistry with IFL as reference. Pooled sensitivity for SLN with clinical follow-up for SLN-negatives was 91% (85-95%) with NPV 95.6%. Patients undergoing SLN biopsy experienced less morbidity than those undergoing IFL.Conclusions:Sentinel lymph node biopsy using 99mTC, blue dye and ultrastaging with immunohistochemistry is highly accurate when restricted to carefully selected patients, within a rigorous protocol, with close follow-up and where sufficient numbers for learning curve optimisation exist. Patients must make an informed choice between the slightly higher groin recurrence rates of SLN biopsy vs the greater morbidity of IFL.

Original languageEnglish
Pages (from-to)2837-2846
Number of pages10
JournalBritish Journal of Cancer
Issue number12
Early online date27 May 2014
Publication statusPublished - 10 Jun 2014


  • Blue dye
  • Groin node
  • Inguinofemoral lymphadenectomy
  • Morbidity
  • Sentinel node
  • Technetium
  • Ultrastaging
  • Vulval cancer

ASJC Scopus subject areas

  • Cancer Research
  • Oncology


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