In 2008, the first Groningen International Study on Sentinel nodes in
Vulvar cancer (GROINSS-V) showed that omission of inguinofemoral
lymphadenectomy is safe in patients with early-stage
vulvar cancer and a negative sentinel node and it simultaneously decreases treatment-related morbidity. An important part of the sentinel node procedure is pathologic ultrastaging of the removed sentinel nodes. Subsequently, since the introduction of this procedure in the standard care of patients with early-stage
vulvar cancer, more and smaller inguinofemoral
lymph node metastases have been diagnosed. The clinical consequences of these
micrometastases are not clear yet. With increasing size of the sentinel node
metastasis, chances of non-sentinel node
metastases increase and those of survival decrease. The size of
lymph node metastases is included in the latest staging system for
vulvar cancer, however at this moment without clinical implications. Furthermore, a separate category for
micrometastases is not incorporated yet. More research is needed to determine the clinical consequences of the size of (sentinel) lymph node
metastases.