Garganese et al [41] reported on FDG-PET/CT in 47 patients with vulvar cancer (44 primary and 3 recurrent) who underwent inguinofemoral lymphadenectomy because they were not candidates for SLN evaluation because of primary tumor >4 cm (n = 12), multifocal tumor (n = 9), prior surgery (n = 16), IFLN involvement (n = 7) or recurrent disease (n = 3). On a groin-based analysis, FDG-PET/CT demonstrated a sensitivity of 56%, specificity of 88%, PPV of 38%, NPV of 93%, and accuracy of 84% in detecting nodal metastases. MRI Pelvis MRI of the pelvis has superior soft-tissue contrast and multiplanar capability. Thus, MRI is the preferred imaging modality to define local extent of suspected or confirmed recurrent vulvar cancers, especially those in close proximity to or involving the urethra, vagina, and anus as it can aid treatment planning [6]. Contrast-enhanced imaging is advised [6]. Radiography Chest Routine radiography is usually not indicated in the evaluation of clinically suspected recurrence of vulvar cancer. There is only one report regarding the role of chest radiography for the initial staging of patients with vulvar cancer. Andersen et al [26] prospectively evaluated 27 patients with vulvar cancer (23 primary and 4 recurrent). Chest radiographs was performed in 24 of 27 patients and contrast-enhanced CT scan of the chest, abdomen, and pelvis was performed 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. Staging and Follow-up of Vulvar Cancer US Duplex Doppler and US-guided Fine-Needle Aspiration Biopsy Groin There is no relevant literature to support or refute the use of US with Doppler and US-guided FNAB for the assessment of suspected vulvar cancer recurrence. Nevertheless, this procedure may be useful to confirm suspected IFLN metastases.
Staging and Follow up of Vulvar Cancer. Garganese et al [41] reported on FDG-PET/CT in 47 patients with vulvar cancer (44 primary and 3 recurrent) who underwent inguinofemoral lymphadenectomy because they were not candidates for SLN evaluation because of primary tumor >4 cm (n = 12), multifocal tumor (n = 9), prior surgery (n = 16), IFLN involvement (n = 7) or recurrent disease (n = 3). On a groin-based analysis, FDG-PET/CT demonstrated a sensitivity of 56%, specificity of 88%, PPV of 38%, NPV of 93%, and accuracy of 84% in detecting nodal metastases. MRI Pelvis MRI of the pelvis has superior soft-tissue contrast and multiplanar capability. Thus, MRI is the preferred imaging modality to define local extent of suspected or confirmed recurrent vulvar cancers, especially those in close proximity to or involving the urethra, vagina, and anus as it can aid treatment planning [6]. Contrast-enhanced imaging is advised [6]. Radiography Chest Routine radiography is usually not indicated in the evaluation of clinically suspected recurrence of vulvar cancer. There is only one report regarding the role of chest radiography for the initial staging of patients with vulvar cancer. Andersen et al [26] prospectively evaluated 27 patients with vulvar cancer (23 primary and 4 recurrent). Chest radiographs was performed in 24 of 27 patients and contrast-enhanced CT scan of the chest, abdomen, and pelvis was performed 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. Staging and Follow-up of Vulvar Cancer US Duplex Doppler and US-guided Fine-Needle Aspiration Biopsy Groin There is no relevant literature to support or refute the use of US with Doppler and US-guided FNAB for the assessment of suspected vulvar cancer recurrence. Nevertheless, this procedure may be useful to confirm suspected IFLN metastases.