Traditionally, IFLN assessment entailed complete lymphadenectomy. High morbidity of this procedure and the fact that only a third of patients with early-stage disease have lymph node metastases at diagnosis led to a major shift toward less invasive assessment strategies including a combination of imaging, sentinel lymph node (SLN) mapping, and/or biopsy [16-21]. The SLN is the lymph node at the highest risk of metastasis because it is the first lymph node to receive lymphatic drainage from the primary tumor. Several prospective multi-institutional trials established the feasibility, safety, and effectiveness of SLN evaluation in early- stage vulvar cancer [16,19-23]. The peer-reviewed literature about the role of imaging in vulvar cancer is limited, likely because vulvar cancer is uncommon. Many studies report on patients with combined histotypes of vulvar cancer, wide range of disease stages, primary and recurrent disease, and vulvar and vaginal cancers combined. The imaging techniques are not uniform, and the descriptions of imaging studies are often limited with regard to the area imaged and the use of intravenous (IV) contrast. The above limits our ability to draw conclusions and provide evidence-based imaging recommendations. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Staging and Follow-up of Vulvar Cancer Special Imaging Considerations Vaginal gel is optional with MRI pelvis without and with IV contrast or MRI pelvis without IV contrast. Vaginal gel may be useful to delineate the extent of vaginal involvement by primary tumor.
Staging and Follow up of Vulvar Cancer. Traditionally, IFLN assessment entailed complete lymphadenectomy. High morbidity of this procedure and the fact that only a third of patients with early-stage disease have lymph node metastases at diagnosis led to a major shift toward less invasive assessment strategies including a combination of imaging, sentinel lymph node (SLN) mapping, and/or biopsy [16-21]. The SLN is the lymph node at the highest risk of metastasis because it is the first lymph node to receive lymphatic drainage from the primary tumor. Several prospective multi-institutional trials established the feasibility, safety, and effectiveness of SLN evaluation in early- stage vulvar cancer [16,19-23]. The peer-reviewed literature about the role of imaging in vulvar cancer is limited, likely because vulvar cancer is uncommon. Many studies report on patients with combined histotypes of vulvar cancer, wide range of disease stages, primary and recurrent disease, and vulvar and vaginal cancers combined. The imaging techniques are not uniform, and the descriptions of imaging studies are often limited with regard to the area imaged and the use of intravenous (IV) contrast. The above limits our ability to draw conclusions and provide evidence-based imaging recommendations. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Staging and Follow-up of Vulvar Cancer Special Imaging Considerations Vaginal gel is optional with MRI pelvis without and with IV contrast or MRI pelvis without IV contrast. Vaginal gel may be useful to delineate the extent of vaginal involvement by primary tumor.