If SLN is involved by tumor, management options include bilateral lymphadenectomy or external beam radiation therapy (EBRT) with or without chemotherapy [6]. In situations when lymph node metastases are suspected because of imaging, SLN is not recommended. Instead, complete lymphadenectomy or, alternatively, US-guided FNAB is performed [6]. MRI Pelvis MRI with IV contrast is the best available imaging modality to define local extent of primary tumor because MRI has superior soft-tissue contrast and multiplanar capability. MRI is considered for patients with primary tumors >2 cm and >1 mm of stromal invasion, or primary tumors with close proximity to or involvement of the urethra, vagina, and anus because MRI can aid primary treatment planning [6]. In addition to primary tumor size/extent, MRI can assess IFLN basins [32-34]. Similar to CT and FDG-PET/CT, if findings on MRI are suspicious for lymph node metastases, SLN is not recommended. Instead, complete lymphadenectomy or, alternatively, US-guided FNAB is indicated [6]. Normal findings do not reliably exclude IFLN metastases (because of inadequate sensitivity) and do not alleviate the need for SLN sampling. Hawnaur et al [35] used unenhanced MRI to evaluate IFLN in 10 patients with primary vulvar cancer. Lymph node metastases were diagnosed if any of the following criteria were present: long-axis diameter >21 mm, short-axis diameter >10 mm, long- to short-axis diameter ratio <1.3:1, irregular contour, and cystic changes within a lymph node. On a groin-based analysis, MRI had the sensitivity of 89%, specificity of 91%, PPV of 89%, NPV of 91%, and accuracy of 90%. Staging and Follow-up of Vulvar Cancer Radiography Chest There is no relevant literature to support the use of routine pretreatment radiographs in patients with clinical early- stage vulvar cancer. There is only one report regarding the role of chest radiography for the initial staging of patients with vulvar cancer.
Staging and Follow up of Vulvar Cancer. If SLN is involved by tumor, management options include bilateral lymphadenectomy or external beam radiation therapy (EBRT) with or without chemotherapy [6]. In situations when lymph node metastases are suspected because of imaging, SLN is not recommended. Instead, complete lymphadenectomy or, alternatively, US-guided FNAB is performed [6]. MRI Pelvis MRI with IV contrast is the best available imaging modality to define local extent of primary tumor because MRI has superior soft-tissue contrast and multiplanar capability. MRI is considered for patients with primary tumors >2 cm and >1 mm of stromal invasion, or primary tumors with close proximity to or involvement of the urethra, vagina, and anus because MRI can aid primary treatment planning [6]. In addition to primary tumor size/extent, MRI can assess IFLN basins [32-34]. Similar to CT and FDG-PET/CT, if findings on MRI are suspicious for lymph node metastases, SLN is not recommended. Instead, complete lymphadenectomy or, alternatively, US-guided FNAB is indicated [6]. Normal findings do not reliably exclude IFLN metastases (because of inadequate sensitivity) and do not alleviate the need for SLN sampling. Hawnaur et al [35] used unenhanced MRI to evaluate IFLN in 10 patients with primary vulvar cancer. Lymph node metastases were diagnosed if any of the following criteria were present: long-axis diameter >21 mm, short-axis diameter >10 mm, long- to short-axis diameter ratio <1.3:1, irregular contour, and cystic changes within a lymph node. On a groin-based analysis, MRI had the sensitivity of 89%, specificity of 91%, PPV of 89%, NPV of 91%, and accuracy of 90%. Staging and Follow-up of Vulvar Cancer Radiography Chest There is no relevant literature to support the use of routine pretreatment radiographs in patients with clinical early- stage vulvar cancer. There is only one report regarding the role of chest radiography for the initial staging of patients with vulvar cancer.