How Safe Is Sentinel Lymph Node Biopsy in Patients With Vulvar Cancer?

In the current issue, Van der Zee et al1 provide important data suggesting that the sentinel lymph node (SLN) concept can be safely applied in patients with vulvar cancer. In this study, a group of 276 patients with a negative SLN biopsy (SLNB) were observed for a median of 35 months, and 202 patients had a minimum follow-up time of 2 years. Eight groin relapses (2.9%) were observed. Exclusion of patients with multifocal disease reduced the failure rate to 2.3%. The authors concluded that SLNB, when performed by a skilledmul-tidisciplinary team, was safe for patients with early vulvar cancer. To readerswhohave followed thedevelopment of SLNB for patientswith breast cancer or melanoma, this observation may seem obvious and slow in its development. To some gynecologic oncologists treating vulvar cancer, declaring SLNB safe will seem premature. How can these two seemingly disparate positions be true at the same time? It has been 30 years since Ramon Cabanas2 used lymphograph