Lymphatic mapping and sentinel node biopsy in invasive Vulvar Paget's disease: A retrospective study and systematic review of the literature

OBJECTIVE: This retrospective study and systematic review of the literature aimed to investigate the oncologic outcomes of sentinel node biopsy (SNB) procedure in patients with invasive Vulvar Paget's Disease (iVPD). METHODS: Tc]Tc-nanocolloid, followed by SNB between January 2015 and July 2024 were analyzed. A comprehensive search of PubMed/MEDLINE and Scopus was conducted. Original articles evaluating SNB in iVPD patients were eligible. RESULTS: A total of 27 patients were included, 16 (59.3%) had a depth of stromal invasion ≤1 mm (microinvasive disease). SNs were identified preoperatively in 26 available cases (41/44 groins, 93.2%) and intra-operatively in 26/27 cases (44/45 groins, 97.8%). Four groins (8.9%) had metastatic SNs, two with micrometastases and two with macrometastases. Among 16 patients with microinvasive VPD, 2 (12.5%) had metastastic SNs. No groin recurrences were observed in the whole population after a median follow-up of 36 months (95% CI: 27-49 months). The 5-years disease-free survival and overall survival were 74.3% and 83.7%, respectively. A total of 12 studies (100 iVPD patients) were included after systematic review of the literature. Metastatic SNs were reported in 22 patients (22.0%). Among 9 patients with microinvasive disease, 3 (33.3%) had metastatic SNs. Among the 23 patients with available follow-up data, one case of locoregional lymph-node recurrence occurred. CONCLUSIONS: Our data, together with evidence from the literature, suggest that SNB technique may be an acceptable approach for nodal staging in iVPD patients, opening the way for an expansion of SN indications in vulvar neoplasms. Microinvasive VPD is associated with a significant rate of metastatic SNs, thus inguino-femoral surgical staging is recommended in this clinical setting.