Lymph node staging in vulvar and vaginal cancer

Lymph node involvement is the central prognostic factor for overall and recurrence-free survival in vulvar and vaginal cancer. Lymphatic drainage from the vulva runs via the inguinal lymph nodes (LNs), while drainage from the vagina is highly variable. The indication for inguinofemoral lymphadenectomy must be strictly defined due to high complication rates. From a traditionally measured infiltration depth of > 1 mm, relevant nodal metastasis can be expected. Imaging procedures do not rule out lymphatic involvement with sufficient certainty, so staging is carried out using surgery. If there is an indication for surgical staging of the groin, sentinel lymph node (SLN) biopsy should generally be attempted if the criteria are met (< 4 cm unifocal tumor, clinical/sonographic node-negative groin, ultrastaging of negative SLN); in all other cases, lymphadenectomy is performed. In the case of vulvar cancer, the indication for clarification/therapy of the pelvic LNs only exists if there are multiple inguinal LN metastases or metastases with extracapsular growth. In the case of vaginal cancer, all potential drainage areas should generally be included in the surgical staging. An SLN biopsy procedure can also be offered here for tumor sizes up to 4 cm.