Andersen et al [26] prospectively evaluated 27 patients with vulvar cancer (23 primary and 4 recurrent). Chest radiographs were performed in 24 of 27 patients, and contrast-enhanced CT scan of the chest, abdomen, and pelvis was obtained in all 27 patients. Only 1 of 24 chest radiographs revealed a clinically important finding (pulmonary metastases) from an asymptomatic and at that time unknown adenocarcinoma of the cecum. Chest radiographs did not alter initial gynecologic management in any of the patients. US Duplex Doppler and US-guided Fine-Needle Aspiration Biopsy Groin There is no relevant literature to support the use of US with Doppler and US-guided FNAB for the assessment of primary tumor extent. A number of studies evaluated groin US with Doppler and US-guided FNAB for IFLN assessment [25,36-38]. Combined US and US-guided FNAB is the most accurate approach to confirm IFLN metastases that are suspected based on clinical and/or imaging assessment. The advantage of this sampling approach is that it is minimally invasive; the limitation is the potential risk of undersampling in the setting of micrometastases. The aforementioned study by Land et al [25] reported on 44 patients with primary vulvar SCC who underwent imaging with one or more of the following modalities: CT, US, and/or US-guided FNAB prior to lymphadenectomy. The sensitivity, specificity, PPV, and NPV for US alone was 87%, 69%, 48%, and 94%, respectively, and for US- guided FNAB it was 80%, 100%, 93%, and 100%, respectively. US Duplex Doppler Groin There is no relevant literature to support the use of US with duplex Doppler for the assessment of primary tumor extent. A number of studies evaluated groin US with Doppler and US-guided FNAB for IFLN assessment [25,36- 38]. Combined US and US-guided FNAB is the most accurate approach to confirm IFLN metastases that are suspected based on clinical and/or imaging assessment.
Staging and Follow up of Vulvar Cancer. Andersen et al [26] prospectively evaluated 27 patients with vulvar cancer (23 primary and 4 recurrent). Chest radiographs were performed in 24 of 27 patients, and contrast-enhanced CT scan of the chest, abdomen, and pelvis was obtained in all 27 patients. Only 1 of 24 chest radiographs revealed a clinically important finding (pulmonary metastases) from an asymptomatic and at that time unknown adenocarcinoma of the cecum. Chest radiographs did not alter initial gynecologic management in any of the patients. US Duplex Doppler and US-guided Fine-Needle Aspiration Biopsy Groin There is no relevant literature to support the use of US with Doppler and US-guided FNAB for the assessment of primary tumor extent. A number of studies evaluated groin US with Doppler and US-guided FNAB for IFLN assessment [25,36-38]. Combined US and US-guided FNAB is the most accurate approach to confirm IFLN metastases that are suspected based on clinical and/or imaging assessment. The advantage of this sampling approach is that it is minimally invasive; the limitation is the potential risk of undersampling in the setting of micrometastases. The aforementioned study by Land et al [25] reported on 44 patients with primary vulvar SCC who underwent imaging with one or more of the following modalities: CT, US, and/or US-guided FNAB prior to lymphadenectomy. The sensitivity, specificity, PPV, and NPV for US alone was 87%, 69%, 48%, and 94%, respectively, and for US- guided FNAB it was 80%, 100%, 93%, and 100%, respectively. US Duplex Doppler Groin There is no relevant literature to support the use of US with duplex Doppler for the assessment of primary tumor extent. A number of studies evaluated groin US with Doppler and US-guided FNAB for IFLN assessment [25,36- 38]. Combined US and US-guided FNAB is the most accurate approach to confirm IFLN metastases that are suspected based on clinical and/or imaging assessment.