Variant 2: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 4 cm with greater than 1 mm stromal invasion, confined to vulva or perineum, or with minimal involvement of the urethra, vagina, or anus. For early-stage disease, present-day surgical approach consists of conservative vulvar resection (with at least 1 cm of tumor-free margin) and IFLN assessment carried out via two separate incisions [6]. If no lymph node metastases Staging and Follow-up of Vulvar Cancer are apparent at clinical assessment, the extent of lymph node evaluation is determined by the size of the primary tumor, the depth of stromal invasion, and location of the primary tumor relative to the midline [6]. If clinical and/or imaging evaluation shows no apparent IFLN metastases, SLN mapping is performed as detailed below. If IFLN metastases are suspected based on clinical and/or imaging evaluation, either minimally invasive lymph node sampling with US-guided FNAB and/or IFLN dissection may be performed. CT Abdomen and Pelvis CT of the abdomen and pelvis is not indicated in patients with clinical early-stage disease. There is no relevant literature detailing the role of CT in the evaluation of primary tumor size and extent, which is likely explained by the limited soft-tissue contrast of CT. Lymph node morphologic characteristics including size enlargement and abnormal pattern of enhancement are the main criteria used to detect lymph node metastases on CT. If IFLN metastases are suspected on imaging, SLN mapping is not recommended. Instead, complete lymphadenectomy or, alternatively, US-guided FNAB is performed [6]. Normal imaging findings do not exclude IFLN metastases (because of inadequate sensitivity) and do not alleviate the need for SLN mapping and sampling. CT Chest, Abdomen, and Pelvis CT of the chest, abdomen, and pelvis is not indicated in patients with clinical early-stage disease.
Staging and Follow up of Vulvar Cancer. Variant 2: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 4 cm with greater than 1 mm stromal invasion, confined to vulva or perineum, or with minimal involvement of the urethra, vagina, or anus. For early-stage disease, present-day surgical approach consists of conservative vulvar resection (with at least 1 cm of tumor-free margin) and IFLN assessment carried out via two separate incisions [6]. If no lymph node metastases Staging and Follow-up of Vulvar Cancer are apparent at clinical assessment, the extent of lymph node evaluation is determined by the size of the primary tumor, the depth of stromal invasion, and location of the primary tumor relative to the midline [6]. If clinical and/or imaging evaluation shows no apparent IFLN metastases, SLN mapping is performed as detailed below. If IFLN metastases are suspected based on clinical and/or imaging evaluation, either minimally invasive lymph node sampling with US-guided FNAB and/or IFLN dissection may be performed. CT Abdomen and Pelvis CT of the abdomen and pelvis is not indicated in patients with clinical early-stage disease. There is no relevant literature detailing the role of CT in the evaluation of primary tumor size and extent, which is likely explained by the limited soft-tissue contrast of CT. Lymph node morphologic characteristics including size enlargement and abnormal pattern of enhancement are the main criteria used to detect lymph node metastases on CT. If IFLN metastases are suspected on imaging, SLN mapping is not recommended. Instead, complete lymphadenectomy or, alternatively, US-guided FNAB is performed [6]. Normal imaging findings do not exclude IFLN metastases (because of inadequate sensitivity) and do not alleviate the need for SLN mapping and sampling. CT Chest, Abdomen, and Pelvis CT of the chest, abdomen, and pelvis is not indicated in patients with clinical early-stage disease.