Concordant with these findings, the NCCN guidelines recommend whole-body FDG-PET/CT in patients with suspected recurrence of cervical cancer [27], although no such formal guidelines exist for vaginal cancer. Staging and Follow-up of Primary Vaginal Cancer Fluoroscopy Contrast Enema There is no relevant literature regarding the use of fluoroscopic contrast enema in the modern imaging workup of vaginal cancer, and its use has largely been replaced by cross-sectional imaging techniques. Although MRI readily depicts lymph nodes, it has constraints similar to CT with regard to the limited sensitivity and specificity of size and morphologic criteria. No study has evaluated the diagnostic performance of MRI for nodal staging isolated to a cohort of primary vaginal cancer patients with disease recurrence. However, data from mixed cohorts of patients with recurrence of cervical, vaginal, and other gynecologic cancers have suggested superior sensitivity of FDG-PET/CT for pelvic nodal metastases compared with pelvic MRI and CT [29,30]. The use of IV contrast may improve tissue characterization but is not considered essential, with variable inclusion in published protocols for evaluation of vaginal [28,31] and cervical cancer [7,32-34]. No study has specifically compared the incremental utility of gadolinium-enhanced sequences over T2-weighted sequences for pelvic MRI in this context. Regarding the use of vaginal gel in MRI of the pelvis, there is insufficient primary data in the literature to support its routine use. Although MRI readily depicts lymph nodes, it has constraints similar to CT with regard to the limited sensitivity and specificity of size and morphologic criteria. No study has evaluated the diagnostic performance of MRI for nodal staging isolated to a cohort of primary vaginal cancer patients with disease recurrence.
Staging and Follow up of Primary Vaginal Cancer. Concordant with these findings, the NCCN guidelines recommend whole-body FDG-PET/CT in patients with suspected recurrence of cervical cancer [27], although no such formal guidelines exist for vaginal cancer. Staging and Follow-up of Primary Vaginal Cancer Fluoroscopy Contrast Enema There is no relevant literature regarding the use of fluoroscopic contrast enema in the modern imaging workup of vaginal cancer, and its use has largely been replaced by cross-sectional imaging techniques. Although MRI readily depicts lymph nodes, it has constraints similar to CT with regard to the limited sensitivity and specificity of size and morphologic criteria. No study has evaluated the diagnostic performance of MRI for nodal staging isolated to a cohort of primary vaginal cancer patients with disease recurrence. However, data from mixed cohorts of patients with recurrence of cervical, vaginal, and other gynecologic cancers have suggested superior sensitivity of FDG-PET/CT for pelvic nodal metastases compared with pelvic MRI and CT [29,30]. The use of IV contrast may improve tissue characterization but is not considered essential, with variable inclusion in published protocols for evaluation of vaginal [28,31] and cervical cancer [7,32-34]. No study has specifically compared the incremental utility of gadolinium-enhanced sequences over T2-weighted sequences for pelvic MRI in this context. Regarding the use of vaginal gel in MRI of the pelvis, there is insufficient primary data in the literature to support its routine use. Although MRI readily depicts lymph nodes, it has constraints similar to CT with regard to the limited sensitivity and specificity of size and morphologic criteria. No study has evaluated the diagnostic performance of MRI for nodal staging isolated to a cohort of primary vaginal cancer patients with disease recurrence.