Table 1 Treatment pathways used in the decision model

From: Cost-effectiveness of sentinel lymph node biopsy vs inguinofemoral lymphadenectomy in women with vulval cancer

No.

Treatment pathway

Description

1

IFL

IFL for all patients, with no SLN biopsy.

2

Blue dye+H&E

Blue dye is injected around the tumour intraoperatively to identify the SLN. This is followed by histopathology consisting of H&E staining of the SLN in order to identify the presence of metastasis.

3

Blue dye+ultrastaging

As for 2 but with ultrastaging of SLNs testing negative on routine H&E.

4

99mTc+H&E

99mTc (technetium-99m-labelled nanocolloid) is injected around the tumour preoperatively, and then pre-op imaging is performed to confirm tracer-uptake in one or more SLNs. A probe is then used to detect the radioactive signal at surgery to identify the SLN. This is followed by histopathology consisting of H&E staining of the SLN to identify the presence of metastasis.

5

99mTc+ultrastaging

As for 4 but with ultrastaging of SLNs testing negative on routine H&E.

6

Blue dye+99mTc+H&E

Both blue dye and 99mTc test are used to identify the SLN. Followed by H&E staining to identify the presence of metastasis.

7

Blue dye+99mTc+ultrastaging

As for 6 but with ultrastaging of SLNs testing negative on routine H&E.

  1. Abbreviations: H&E=haematoxylin and eosin; IFL=inguinofemoral lymphadenectomy; SLN=sentinel lymph node.
  2. Note: ultrastaging here can be considered to be representative of more sensitive techniques such as immunohistochemistry.
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