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Original Research

Open Access

Utility of Intraoperative Frozen Section of the Inguinofemoral Sentinel Lymph Node in Vulvar Cancer: A Retrospective Cohort

  • Naixin Zhang1,*,
  • Joann Gold1
  • Ben Wilson2
  • Catherine Coffman1
  • Mark Reed2
  • Adam C. ElNaggar2,*,

1Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN 38103, USA

2Division of Gynecologic Oncology, West Cancer Center and Research Institute, Memphis, TN 38138, USA

DOI: 10.31083/j.ejgo4302025 Vol.43,Issue 2,April 2022 pp.196-201

Submitted: 13 January 2022 Accepted: 24 February 2022

Published: 15 April 2022

*Corresponding Author(s): Naixin Zhang E-mail:
*Corresponding Author(s): Adam C. ElNaggar E-mail:


Objective: Sentinel lymph node dissection (SLND) spares most patients diagnosed with clinically early-stage vulvar cancer from undergoing complete inguinofemoral lymphadenectomy (IFLND). We sought to evaluate the intraoperative examination of frozen sentinel lymph node (SLN) sections to assess the need for IFLND. Methods: We identified patients with vulvar cancer treated at a tertiary referral center between January 2006 and December 2019 who either underwent SLND or met the eligibility criteria to receive SLND. All patients were restaged according to the International Federation of Gynaecology and Obstetrics (FIGO) 2009 guidelines. The records of each patient were reviewed for disease characteristics, follow-up status, patient demographics, SLN eligibility, and surgical and pathologic variables. Results: Of 142 eligible patients, 76 underwent SLND (53.5%) for a total of 118 groins assessed. We found no statistically significant differences in characteristics between the cohorts that received or lacked SLN examination. The SLN was detected in 90.8% (95% Confidence Interval (CI): 81.9%–96.2%) of patients. SLNs of 52 patients were sent for frozen section, and the results were used to direct further surgical intervention. The results of the frozen section pathology and the final pathology report exhibited a high degree of correlation per patient (100%) and per groin (98.7%). The 1 incorrect groin was negative on frozen but positive on final pathology and therefore no patients received an incorrect complete groin dissection. We observed no statistically significant differences in recurrence-free survival or overall survival rates between those patients who received or did not receive SLND. Conclusions: The use of intraoperative frozen section is appropriate for assessing node status at time of initial surgery. The use of this method decreases the incidence of reoperation by identifying those patients who warrant immediate IFLND.


vulvar; sentinel; lymph nodes; frozen section; surgery

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Naixin Zhang,Joann Gold,Ben Wilson,Catherine Coffman,Mark Reed,Adam C. ElNaggar. Utility of Intraoperative Frozen Section of the Inguinofemoral Sentinel Lymph Node in Vulvar Cancer: A Retrospective Cohort. European Journal of Gynaecological Oncology. 2022. 43(2);196-201.


[1] American Cancer Society. Key Statistics for Vulvar Csncer. 2022. Avaolable at: cer/about/key-statistics.html (Accessed: 18 February 2022).

[2] de Hullu JA, Hollema H, Lolkema S, Boezen M, Boonstra H, Burger MPM, et al. Vulvar carcinoma. The price of less radical surgery. Cancer. 2002; 95: 2331–2338.

[3] Keys H. Gynecologic oncology group randomized trials of combined technique therapy for vulvar cancer. Cancer. 1993; 71: 1691–1696.

[4] Woelber L, Mahner S, Voelker K, Eulenburg CZ, Gieseking F, Choschzick M, et al. Clinicopathological prognostic factors and patterns of recurrence in vulvar cancer. Anticancer Research. 2009; 29: 545–552.

[5] Oonk MH, van Hemel BM, Hollema H, de Hullu JA, Ansink AC, Vergote I, et al. Size of sentinel-node metastasis and chances of non-sentinel-node involvement and survival in early stage vul-var cancer: results from GROINSS-V, a multicentre observational study. The Lancet Oncology. 2010; 11: 646–652.

[6] Van der Zee AGJ, Oonk MH, De Hullu JA, Ansink AC, Vergote I, Verheijen RH, et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. Journal of Clinical Oncology. 2008; 26: 884–889.

[7] Carlson JW, Kauderer J, Hutson A, Carter J, Armer J, Lockwood S, et al. GOG 244-the lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients. Gynecologic Oncology. 2020; 156: 467–474.

[8] Gaarenstroom KN, Kenter GG, Trimbos JB, Agous I, Amant F, Peters AAW, et al. Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions. International Journal of Gynecological Cancer. 2003; 13: 522–527.

[9] Höckel M, Horn L, Einenkel J. (Laterally) extended endopelvic resection: surgical treatment of locally advanced and recurrent cancer of the uterine cervix and vagina based on ontogenetic anatomy. Gynecologic Oncology. 2012; 127: 297–302.

[10] Gemignani ML, Alektiar KM, Leitao M, Mychalczak B, Chi D, Venkatraman E, et al. Radical surgical resection and high-dose intraoperative radiation therapy (HDR-IORT) in patients with recurrent gynecologic cancers. International Journal of Radiation Oncology, Biology, Physics. 2001; 50: 687–694.

[11] Levenback CF, van der Zee AG, Rob L, Plante M, Covens A, Schneider A, et al. Sentinel lymph node biopsy in patients with gynecologic cancers Expert panel statement from the International Sentinel Node Society Meeting, February 21, 2008. Gynecologic Oncology. 2009; 114: 151–156.

[12] Brincat MR, Muscat Baron Y. Sentinel Lymph Node Biopsy in the Management of Vulvar Carcinoma: an Evidence-Based Insight. International Journal of Gynecological Cancer. 2017; 27: 1769–1773.

[13] Hassanzade M, Attaran M, Treglia G, Yousefi Z, Sadeghi R. Lymphatic mapping and sentinel node biopsy in squamous cell carcinoma of the vulva: Systematic review and meta-analysis of the literature. Gynecologic Oncology. 2013; 130: 237–245.

[14] Klapdor R, Hillemanns P, Wölber L, Jückstock J, Hilpert F, de Gregorio N, et al. Outcome after Sentinel Lymph Node Dissection in Vulvar Cancer: a Subgroup Analysis of the AGO-CaRE-1 Study. Annals of Surgical Oncology. 2017; 24: 1314–1321.

[15] Te Grootenhuis NC, van der Zee AGJ, van Doorn HC, van der Velden J, Vergote I, Zanagnolo V, et al. Sentinel nodes in vulvar cancer: Long-term follow-up of the GROningen INternational Study on Sentinel nodes in Vulvar cancer (GROINSS-V) i. Gnecologic Oncology. 2016; 140: 8–14.

[16] Oonk MHM, Slomovitz B, Baldwin P, Van Doorn H, Van Der Velden J, De Hullu J, et al. Radiotherapy instead of inguinofemoral lymphadenectomy in vulvar cancer patients with a metastatic sentinel node: results of GROINSS-V II. International Journal of Gynecologic Cancer, 2019. 29: A14.

[17] Hacker NF. Revised FIGO staging for carcinoma of the vulva. International Journal of Gynecology & Obstetrics. 2009; 105: 105–106.

[18] Garganese G, Collarino A, Fragomeni SM, Rufini V, Perotti G, Gentileschi S, et al. Groin sentinel node biopsy and 18F-FDG PET/CT-supported preoperative lymph node assessment in cN0 patients with vulvar cancer currently unfit for minimally invasive inguinal surgery: the GroSNaPET study. European Journal of Surgical Oncology. 2017; 43: 1776–1783.

[19] Garganese G, Fragomeni SM, Pasciuto T, Leombroni M, Moro F, Evangelista MT, et al. Ultrasound morphometric and cytologic preoperative assessment of inguinal lymph-node status in women with vulvar cancer: MorphoNode study. Ultrasound in Obstetrics & Gynecology. 2020; 55: 401–410.

[20] Liu L, Lang JE, Lu Y, Roe D, Hwang SE, Ewing CA, et al. Intraoperative frozen section analysis of sentinel lymph nodes in breast cancer patients: a meta-analysis and single-institution experience. Cancer. 2011; 117: 250–258.

[21] Brunner AH, Polterauer S, Tempfer C, Joura E, Reinthaller A, Horvat R, et al. The accuracy of intraoperative frozen section of the inguinal sentinel lymph node in vulvar cancer. Anticancer Research. 2008; 28: 4091–4094.

[22] Levenback CF, Ali S, Coleman RL, Gold MA, Fowler JM, Judson PL, et al. Lymphatic Mapping and Sentinel Lymph Node Biopsy in Women with Squamous Cell Carcinoma of the Vulva: a Gynecologic Oncology Group Study. Journal of Clinical Oncology. 2012; 30: 3786–3791.

[23] Broach V, Abu-Rustum NR, Sonoda Y, Brown CL, Jewell E, Gardner G, et al. Evolution and outcomes of sentinel lymph node mapping in vulvar cancer. International Journal of Gynecologic Cancer. 2020; 30: 383–386.

[24] Gershenwald JE, Tseng C, Thompson W, Mansfield PF, Lee JE, Bouvet M, et al. Improved sentinel lymph node localization in patients with primary melanoma with the use of radiolabeled colloid. Surgery. 1998; 124: 203–210.

[25] Covens A, Vella ET, Kennedy EB, Reade CJ, Jimenez W, Le T. Sentinel lymph node biopsy in vulvar cancer: Systematic review, meta-analysis and guideline recommendations. Gynecologic Oncology. 2015; 137: 351–361.

[26] Coleman RL, Ali S, Levenback CF, Gold MA, Fowler JM, Judson PL, et al. Is bilateral lymphadenectomy for midline squamous carcinoma of the vulva always necessary? An analysis from Gynecologic Oncology Group (GOG) 173. Gynecologic Oncology. 2013; 128: 155–159.

[27] Gershenwald JE, Colome MI, Lee JE, Mansfield PF, Tseng C, Lee JJ, et al. Patterns of recurrence following a negative sentinel lymph node biopsy in 243 patients with stage i or II melanoma. Journal of Clinical Oncology. 1998; 16: 2253–2260.

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