Brigid Aherne¹, Peter Sykes^2,3, Ken Jaaback⁴, Marsali Newman⁵, Christina Selinger⁶, A/Prof James Scurry⁷, Rachael van der Griend¹

¹Canterbury Health Laboratories, Christchurch Hospital, Christchurch, New Zealand; ²Department of Obstetrics and Gynaecology, University of Otago, Christchurch, New Zealand; ³Christchurch Women’s Hospital, Christchurch, New Zealand; ⁴John Hunter Hospital, NSW, Australia; ⁵Austin Pathology, VIC, Australia; ⁶Royal College of Pathologists of Australasia (RCPA), NSW, Australia; ⁷New South Wales Health Pathology, NSW, Australia

 

Groin node status is the most important prognostic factor in vulval squamous cell carcinoma (SCC). Sentinel lymph node (SLN) biopsy is a safe alternative to formal groin dissection in early-stage vulval SCC and can avoid disabling complications.¹  However, failure to accurately assess the nodes can potentially lead to recurrence and early death.²  SLN biopsy has been widely in use since 2008 but there is still no international consensus around a standardised pathology protocol; we wanted to survey practices across Australia and Aotearoa New Zealand.³

 

After literature review, we designed a survey to capture pathologists’ recollections of local pathology protocols and workload. The survey was distributed via email and advertised in RCPA newsletters.

 

Fifteen laboratories from 10 geographical locations across Australia and New Zealand responded.  There is wide variation in practice with at least 9 different ultrastaging protocols in use and huge variability in number of slides generated.  Forty percent of laboratories do not cut through the whole lymph node and 27% do not do immunohistochemistry on every level.

 

We recommend standardising protocols to maximise patient safety, enable easier comparison of outcomes between centres and to aim for equity and efficient use of resources.

 

1.    Sentinel Node Dissection Is Safe in the Treatment of Early-Stage Vulvar Cancer. Van der Zee, Ate GJ, et al. "Sentinel node dissection is safe in the treatment of early-stage vulvar cancer." Journal of clinical oncology 26.6 (2008): 884-889.

2.    Pathological process has a crucial role in sentinel node biopsy for vulvar cancer. Sykes, P., Eva, L., van der Griend, R., McNally, O., Blomfield, P., Brand, A., Tristram, A., Bergzoll, C., Petrich, S., Kenwright, D. and Payne, K., 2019. Pathological process has a crucial role in sentinel node biopsy for vulvar cancer. Gynecologic oncology, 153(2), pp.292-296.

3.    Protocols for Pathological Processing of Sentinel Lymph Nodes in Endometrial, Vulval and Cervical Carcinomas.  Ganesan, Raji, et al. "Protocols for pathological processing of sentinel lymph nodes in endometrial, vulval and cervical carcinomas." BAGP Guidance Document: Sentinel Lymph Node Processing and Ultra Staging. Version 1 (2019).

Statement of originality: I personally carried out the literature review for this study.  I have assisted with the survey results data analysis and the presentation of these results.