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To determine chances for additional metastatic non-SNs in vulvar cancer patients with a positive SN. In the GROningen INternational Study on Sentinel nodes in Vulvar cancer (GROINSS-V) SN detection is performed in early stage patients without clinically suspicious nodes. At surgery, frozen section of the SN (s) is performed and after routine H&E examination, when negative, pathologic ultrastaging by step sectioning and immunohistochemistry. Patients with a positive SN will undergo a full inguinofemoral lymphadenectomy. From 2000-2005 SN detection was performed in 357 patients, of which 80 (23%) had one or more positive SNs (97 groins). Here we report only on patients with metastatic SNs. Metastatic SNs were found at frozen section in 39/97 (40%) groins, at routine H&E in 17/97 (18%) groins and at pathologic ultrastaging in 41/97 (42%) groins. When the metastatic SN was …