European journal of cancer (Oxford, England : 1990) · 2026
FIGO 2021 depth of invasion measurement and missed lymph node involvement in microinvasive vulvar squamous cell carcinoma: Is the gain worth the cost?
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van der Kolk Willemijn L, Landsbergen Kim, van der Zee Ate G J, de Bock Geertruida H, Oonk Maaike H M, Bart Joost
Аннотация
BACKGROUND: For patients with early-stage vulvar squamous cell carcinoma (VSCC), the indication for groin surgery currently depends mainly on the depth of invasion (DOI). In 2021, the International Federation of Gynaecology and Obstretrics (FIGO) revised the DOI measurement method in its updated guidelines, addressing the clinical need to improve the prognostic distinction between stage IA and IB. Our aim was to investigate the extent to which stage migration occurs when the FIGO 2021 method is applied, and whether lymph node involvement may be missed due to the omission of groin exploration in FIGO 2021 stage IA disease.
METHOD: Patients who participated in GROINSS-V I or II and treated in the University Medical Center Groningen (UMCG) were included (n = 245). All patients had primary VSCC < 4 cm, with a DOI > 1 mm and non-suspicious groin nodes. Tumor thickness, the FIGO 2009 method, and the FIGO 2021 method were annotated on each slide.
FINDINGS: In total, 212/245 (86.5%) patients were available for analysis. Twenty-four (24/212,11.3%) had a DOI > 1 mm according to the FIGO 2009 method and ≤ 1 mm according to the FIGO 2021 method, which would have resulted in a stage shift to IA. Of the downstaged patients, four had a SN metastasis and one had an isolated groin recurrence after a negative SN (5/24, 20.8% [95% CI: 9.2% - 40.5%]).
INTERPRETATION: Our results indicate that, although the implementation of the FIGO 2021 method will result in less SN procedures and thereby less treatment related morbidity, this comes at the cost of more missed metastases in microinvasive disease, risking worse outcomes for these patients. We urgently request the FIGO committee to reconsider the recommended DOI method.
METHOD: Patients who participated in GROINSS-V I or II and treated in the University Medical Center Groningen (UMCG) were included (n = 245). All patients had primary VSCC < 4 cm, with a DOI > 1 mm and non-suspicious groin nodes. Tumor thickness, the FIGO 2009 method, and the FIGO 2021 method were annotated on each slide.
FINDINGS: In total, 212/245 (86.5%) patients were available for analysis. Twenty-four (24/212,11.3%) had a DOI > 1 mm according to the FIGO 2009 method and ≤ 1 mm according to the FIGO 2021 method, which would have resulted in a stage shift to IA. Of the downstaged patients, four had a SN metastasis and one had an isolated groin recurrence after a negative SN (5/24, 20.8% [95% CI: 9.2% - 40.5%]).
INTERPRETATION: Our results indicate that, although the implementation of the FIGO 2021 method will result in less SN procedures and thereby less treatment related morbidity, this comes at the cost of more missed metastases in microinvasive disease, risking worse outcomes for these patients. We urgently request the FIGO committee to reconsider the recommended DOI method.