When, if ever, would you consider performing pelvic sentinel lymph node dissection for patients with vulvar cancer with positive inguinal lymph nodes?
As the incidence of positive pelvic lymph nodes approximates 20-30% as in GOG37 and patients with positive inguinal nodes will undergo radiation directed to the pelvic lymph nodes, would you consider evaluating for sentinel pelvic lymph nodes concurrently to sentinel inguinal lymphadenectomy with indigocyanine green dye for the potential to spare the patient of radiation to the pelvic nodal regions?