These findings, if applied to vaginal cancer, suggest that modern multidetector CT abdomen and pelvis is a reasonable staging tool for regional and distant metastases, although is likely inferior to MRI for local staging, modestly inferior to FDG-PET/CT for nodal metastases, and inferior to FDG-PET/CT for osseous metastases. The use of IV contrast is strongly encouraged when possible, because the improved tissue contrast likely benefits primary tumor evaluation, delineation of lymph nodes from adjacent vessels, and detection of hepatic metastases. No studies have specifically evaluated the performance of CT of the abdomen and pelvis without IV contrast for vaginal cancer staging. FDG-PET/CT Skull Base to Mid-Thigh Data regarding the diagnostic performance of PET/CT for initial staging in patients with vaginal cancer are limited. Lamoreaux et al [18], in a prospective study, evaluated the comparative performance of PET versus CT in 23 patients with primary vaginal cancer prior to treatment. PET identified suspicious pelvic and/or groin lymph nodes in 35% (8 of 23) of patients, whereas CT did so in only 17% (4 of 23) of patients, although a pathologic reference standard was present in only two sampled groin nodes. No patient had extrapelvic nodal or distant disease, limiting the applicability of this study to metastases outside of the pelvis. Although data are limited for primary vaginal cancer staging, a growing body of literature supports the role of FDG- PET/CT in the initial staging of cervical cancer. Prospective data from the ACRIN 6671/GOG 0233 trial suggested, with borderline statistical significance, that FDG-PET/CT is more sensitive than CT alone for extrapelvic nodal metastases in cervical cancer (50% versus 42%, respectively), with similar specificity (85% versus 89%, respectively) [23], supporting prior retrospective data [22].
Staging and Follow up of Primary Vaginal Cancer. These findings, if applied to vaginal cancer, suggest that modern multidetector CT abdomen and pelvis is a reasonable staging tool for regional and distant metastases, although is likely inferior to MRI for local staging, modestly inferior to FDG-PET/CT for nodal metastases, and inferior to FDG-PET/CT for osseous metastases. The use of IV contrast is strongly encouraged when possible, because the improved tissue contrast likely benefits primary tumor evaluation, delineation of lymph nodes from adjacent vessels, and detection of hepatic metastases. No studies have specifically evaluated the performance of CT of the abdomen and pelvis without IV contrast for vaginal cancer staging. FDG-PET/CT Skull Base to Mid-Thigh Data regarding the diagnostic performance of PET/CT for initial staging in patients with vaginal cancer are limited. Lamoreaux et al [18], in a prospective study, evaluated the comparative performance of PET versus CT in 23 patients with primary vaginal cancer prior to treatment. PET identified suspicious pelvic and/or groin lymph nodes in 35% (8 of 23) of patients, whereas CT did so in only 17% (4 of 23) of patients, although a pathologic reference standard was present in only two sampled groin nodes. No patient had extrapelvic nodal or distant disease, limiting the applicability of this study to metastases outside of the pelvis. Although data are limited for primary vaginal cancer staging, a growing body of literature supports the role of FDG- PET/CT in the initial staging of cervical cancer. Prospective data from the ACRIN 6671/GOG 0233 trial suggested, with borderline statistical significance, that FDG-PET/CT is more sensitive than CT alone for extrapelvic nodal metastases in cervical cancer (50% versus 42%, respectively), with similar specificity (85% versus 89%, respectively) [23], supporting prior retrospective data [22].