Robertson et al [30] reported on 50 patients who were enrolled in the National Oncologic PET Registry and underwent 83 FDG-PET/CT studies for suspected or known primary or recurrent vulvar or vaginal cancer. Fifty- four of 83 (65%) studies were performed in patients with vulvar cancer, the remaining 29 of 83 (35%) studies in patients with vaginal cancer. The authors did not specify numbers of patients with vulvar cancer (including primary Lymphoscintigraphy Groin Lymphoscintigraphy and SLN mapping are not indicated in patients with primary tumor >4 cm or tumor of any size with more than minimal involvement of the urethra, vagina, or anus. The aforementioned study by Land et al [25] reported on 44 patients with primary vulvar SCC who were imaged 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 80%, 100%, 93%, and 100%, respectively. 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, MRI can assess IFLN basins [32-34]. Similar to CT and FDG-PET/CT, if findings on MRI are suspicious for lymph node metastases, complete lymphadenectomy or, alternatively, US-guided FNAB is indicated [6]. 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.
Staging and Follow up of Vulvar Cancer. Robertson et al [30] reported on 50 patients who were enrolled in the National Oncologic PET Registry and underwent 83 FDG-PET/CT studies for suspected or known primary or recurrent vulvar or vaginal cancer. Fifty- four of 83 (65%) studies were performed in patients with vulvar cancer, the remaining 29 of 83 (35%) studies in patients with vaginal cancer. The authors did not specify numbers of patients with vulvar cancer (including primary Lymphoscintigraphy Groin Lymphoscintigraphy and SLN mapping are not indicated in patients with primary tumor >4 cm or tumor of any size with more than minimal involvement of the urethra, vagina, or anus. The aforementioned study by Land et al [25] reported on 44 patients with primary vulvar SCC who were imaged 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 80%, 100%, 93%, and 100%, respectively. 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, MRI can assess IFLN basins [32-34]. Similar to CT and FDG-PET/CT, if findings on MRI are suspicious for lymph node metastases, complete lymphadenectomy or, alternatively, US-guided FNAB is indicated [6]. 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.