Preoperative biopsies as predictor for the necessity of inguinal lymph node surgery in squamous cell carcinoma of the vu
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ORIGINAL ARTICLE – CLINICAL ONCOLOGY
Preoperative biopsies as predictor for the necessity of inguinal lymph node surgery in squamous cell carcinoma of the vulva‑a retrospective tertiary center analysis Caroline Pahmeyer1 · Fabinshy Thangarajah1 · Dominik Ratiu1 · Anne Maria Schultheis2 · Birgid Schömig‑Markiefka2 · Peter Mallmann1 · Bernd Morgenstern1 Received: 28 March 2020 / Accepted: 14 May 2020 © The Author(s) 2020
Abstract Purpose Squamous cell carcinoma of the vulva (SQCV) is the fifth common cancer in women. Necessity of inguinal lymph node surgery depends on the depth of stromal invasion, inducing lymph node surgery, if depth of invasion is more than 1 mm. In this study we tested the prediction of stromal infiltration depth by measurements in preoperative biopsies. Methods We analyzed whether a different operative strategy in respect to lymph node surgery would have been chosen based on the pre- or postoperative depth of stromal invasion for each patient. Examination of infiltration depth in preoperative biopsies and surgical specimen were compared. Results In total 77 patients were included in this study. Of those 89.6% showed different depths of stromal invasion comparing the pre- and postoperative specimen. Within seventeen patients (22.1%) preoperative depth was 1 mm or less and a postoperative depth was > 1 mm. Conclusion We pointed, that only in 77.9% of the patients who should have undergo lymph node surgery based on the postoperative depth of infiltration underwent this procedure. Consequentially in 22.1% of the cases a second operation could not be prevented with a preoperative taken biopsy as indicator for the necessity of lymph node surgery. Keywords Vulvar cancer · Preoperative biopsies · Inguinal lymph node biopsies · Depth of infiltration
Introduction One of the greatest factors in reducing mortality of vulva cancer is an appropriate treatment of inguinal lymph nodes (Thangarajah et al. 2019). If the inguinal lymph nodes are clinically suspicious, a systematic inguinal lymphadenectomy is recommended. Following guidelines (AWMFLeitlinie Stand 2015; Koh et al. 2017; Oonk et al. 2017; Caroline Pahmeyer, Fabinshy Thangarajah equally contributed. * Caroline Pahmeyer Caroline.pahmeyer@uk‑koeln.de * Fabinshy Thangarajah fabinshy.thangarajah@uk‑koeln.de 1
Department of Obstetrics and Gynaecology, Medical Faculty, University Hospital Cologne, Kerpener Straße 34, 50931 Cologne, Germany
Department of Pathology, University Hospital Cologne, Kerpener Straße 62, 50937 Cologne, Germany
2
RCOG 2014),the indication for operative staging of the inguino-femoral lymph nodes in early stage disease depends on the stromal invasion. Infiltration of 1 mm or less is rarely associated with inguinal node metastases, whereas infiltration depth of 1 or more mm should be treated with lymph node surgery to reduce mortality (AWMF-Leitlinie Stand 2015). Depending on further factors this can be performed as sentinel lymph node biopsy (SNB) or systematic inguinofemoral lymphadenectomy. Following German and i
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