Sentinel lymph node biopsy in vulvar cancer - Review article - current evidence, limitations, and future perspectives

Sep 23, 2026

Vulvar cancer is a rare gynecologic malignancy where regional lymph node status is the strongest prognostic determinant and guides treatment choices. For about 60 years, bilateral inguinofemoral lymphadenectomy was used for staging and control despite causing relevant morbidity and long-term quality-of-life impairment. Over the last 20 years, sentinel lymph node mapping for selected patients has shown feasibility and safety, with reduced postoperative morbidity while preserving oncologic outcomes. Persistent false-negative risk and missed nodal disease require balancing undertreatment against benefit through expertise, ultrastaging, and structured surveillance.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Background and rationale

Evidence for sentinel lymph node mapping

Limitations and clinical implications

Practice considerations and future research

J Gynecol Oncol. 2026 May;37(3):e110 [https://doi.org/10.3802/jgo.2026.37.e110](https://doi.org/10.3802/jgo.2026.37.e110)[ ](https://doi.org/10.3802/jgo.2026.37.e110)pISSN 2005-0380·eISSN 2005-0399 Review Article Received: Feb 20, 2026 Revised: Mar 31, 2026 Accepted: Apr 11, 2026 Published online: May 6, 2026 Correspondence to Giorgio Bogani Department of Surgery, Fondazione IRCCSIstituto Nazionale Dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy. [Email: giorgiobogani@yahoo.it](Email: giorgiobogani@yahoo.it) © 2026. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([https://](https://)[ ](https://)[creativecommons.org/licenses/by-nc/4.0/](creativecommons.org/licenses/by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ORCID iDs Giorgio Bogani [https://orcid.org/0000-0001-8373-8569](https://orcid.org/0000-0001-8373-8569)[ ](https://orcid.org/0000-0001-8373-8569)Andreas Obermair [https://orcid.org/0000-0003-2199-1117](https://orcid.org/0000-0003-2199-1117)[ ](https://orcid.org/0000-0003-2199-1117)Antonia Testa [https://orcid.org/0000-0003-2217-8726](https://orcid.org/0000-0003-2217-8726)[ ](https://orcid.org/0000-0003-2217-8726)Giorgia Gargenese [https://orcid.org/0000-0002-4209-5285](https://orcid.org/0000-0002-4209-5285)[ ](https://orcid.org/0000-0002-4209-5285)Valentina Chiappa [https://orcid.org/0000-0002-1811-209X](https://orcid.org/0000-0002-1811-209X)[ ](https://orcid.org/0000-0002-1811-209X)Francesco Raspagliesi [https://orcid.org/0000-0001-8953-1657](https://orcid.org/0000-0001-8953-1657)[ ](https://orcid.org/0000-0001-8953-1657)Neville Hacker [https://orcid.org/0000-0002-1445-2302](https://orcid.org/0000-0002-1445-2302) Sentinel lymph node biopsy in vulvar cancer: current evidence, limitations, and future perspectives Giorgio Bogani ,1 Andreas Obermair ,2 Antonia Testa ,3,4 Giorgia Gargenese ,5,6 Valentina Chiappa ,1 Francesco Raspagliesi ,1 Neville Hacker 7 1Department of Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy 2The University of Queensland, Centre for Clinical Research, Brisbane, Australia 3IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, del Bambino e di Sanità Pubblica, Dipartimento Scienze della Salute della Donna, Rome, Italy 4Università Cattolica del Sacro Cuore, Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Rome, Italy 5Unità di Chirurgia degli Organi Genitali Esterni Femminili, Divisione di Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy 6Gemelli Women's Health Center for Digital and Personalized Medicine, Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Sezione di Ginecologia ed Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy 7School of Women's and Children's Health, Faculty of Medicine & Health, University of New South Wales, Kensington, Australia ABSTRACT Vulvar cancer is a rare gynecologic malignancy in which regional lymph node status represents the most powerful prognostic factor and a key determinant of therapeutic strategy. For the past 60 years, bilateral inguinofemoral lymphadenectomy was the standard approach for staging and disease control. Although effective, this procedure was associated with substantial morbidity, including wound complications, chronic lower limb lymphedema, and longterm impairment of quality of life. In the past 20 years, sentinel lymph node (SLN) mapping has emerged as a less invasive alternative for selected patients with unifocal, clinically node-negative vulvar tumors less than 4 cm in diameter. Large prospectiv

FAQs

Why is regional lymph node status critical in vulvar cancer?

Regional lymph node status is identified as the most powerful prognostic factor and a key determinant of the therapeutic strategy in vulvar cancer.

What are the main drawbacks of bilateral inguinofemoral lymphadenectomy?

Although effective, it is associated with substantial morbidity, including wound complications, chronic lower limb lymphedema, and long-term impairment of quality of life.

What are the limitations of sentinel lymph node biopsy in selected patients?

Concerns remain about false-negative results reported up to about 7%–10% in some series, with anecdotal reports up to around 27%, which can lead to missed nodal disease and worse outcomes.

Sep 23, 2026

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