Isolated groin recurrence in vulval squamous cell cancer (VSCC). The importance of node count.

OBJECTIVE: To determine whether there is a node count which can define an adequate inguinofemoral lymphadenectomy (IFL) in primary VSCC. METHODS: A retrospective and prospective review of patients with node negative VSCC who had a full staging IFL. Detection of isolated groin recurrences (IGR) would allow groins with higher risk of groin recurrence to be identified. RESULTS: The median node count of 228 IFLs in 139 patients was eight (0-24). There were six IGR (4.3%). Increased rate of IGR was present in patients with increased age, tumour diameter and depth of invasion, lymphovascular space invasion, unilateral IFL, and moderate/poor tumour grade. In the 138 groins with node counts of eight or greater there were no IGRs compared to six in the patients with either undissected groins or groin node counts less than eight (p = 0.030) Interval to IGR was significantly shorter than other sites of recurrence. Both disease-specific and overall survival were significantly reduced in IGR. CONCLUSIONS: An inadequate IFL is a nodal count of less than eight per groin; both these groins and undissected groins are at increased risk of IGR and should have close surveillance.

The role of colposcopy in the follow up of women treated for cervical intraepithelial neoplasia.

OBJECTIVE: To determine the effect of colposcopy on the sensitivity and specificity of follow-up procedures in the detection of residual or recurrent disease after treatment for cervical intraepithelial neoplasia (CIN). DESIGN: A retrospective study of information held in a colposcopy database. SETTING: A teaching hospital colposcopy clinic. POPULATION: A total of 2244 women treated in Hammersmith Hospital for histologically confirmed CIN between 1 January 1988 and 31 December 2002. METHODS: Data from the records of women treated with some form of local conservative therapy for CIN1-CIN3 between January 1988 and December 2002 were extracted from the colposcopy database. Women with histological confirmation of post-treatment disease were identified. MAIN OUTCOME MEASURES: The sensitivity and specificity of cytology alone was compared with the sensitivity and specificity of the combination of colposcopy and cytology. RESULTS: Colposcopy improved the sensitivity of cytology for the detection of high-grade disease from 64 to 91% but reduced the specificity from 95 to 88%. With a 3% rate of post-treatment high-grade disease, colposcopy detected 8 extra cases per 1000 women but resulted in 88 more false alarms per 1000 women. Among women in whom the treatment margins were involved or uncertain, colposcopy detected 13 extra cases per 1000 women but resulted in 12 fewer false alarms per 1000 women because the prevalence of post-treatment disease was higher. CONCLUSIONS: Colposcopy does improve the detection rate of post-treatment disease but at a cost of additional false alarms. The benefit of colposcopy will be greater in high-risk groups of women with higher rates of treatment failure.