No study has specifically evaluated the performance of MRI for pretreatment nodal staging in vaginal cancer. 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]. If MRI of the abdomen and pelvis is used in place of CT of the abdomen and pelvis, the addition of chest CT is encouraged to evaluate for pulmonary metastases. The use of IV contrast may improve tissue characterization and is particularly beneficial when MRI of the abdomen is included, because it improves detection of hepatic metastases. Radiography Intravenous Urography There is no relevant literature regarding the use of radiographic IV urography in the modern imaging workup of vaginal cancer, and its use has largely been replaced by cross-sectional imaging techniques. US Abdomen and Pelvis Transabdominal There is no relevant literature regarding the role of transabdominal abdominopelvic (TA) US in vaginal cancer staging. TAUS is inferior for visualizing the female genital tract compared with TVUS, and neither technique has a role in the evaluation of regional or distant disease. Variant 2: Posttreatment evaluation of vaginal cancer. No suspected recurrence. Initial imaging. As the use of definitive chemoradiation for the treatment of primary vaginal cancer has grown, so too has the role of cross-imaging for assessment of treatment response. In contrast to extirpative surgery, in which pathologic margin assessment can confirm removal of viable tumor, evaluation for tumor eradication following chemoradiation relies in part on imaging assessment. Much of the support for the value of early posttreatment imaging in primary vaginal cancer is extrapolated from the large body of literature on cervical cancer, for which the treatment paradigm and endpoints are analogous.
Staging and Follow up of Primary Vaginal Cancer. No study has specifically evaluated the performance of MRI for pretreatment nodal staging in vaginal cancer. 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]. If MRI of the abdomen and pelvis is used in place of CT of the abdomen and pelvis, the addition of chest CT is encouraged to evaluate for pulmonary metastases. The use of IV contrast may improve tissue characterization and is particularly beneficial when MRI of the abdomen is included, because it improves detection of hepatic metastases. Radiography Intravenous Urography There is no relevant literature regarding the use of radiographic IV urography in the modern imaging workup of vaginal cancer, and its use has largely been replaced by cross-sectional imaging techniques. US Abdomen and Pelvis Transabdominal There is no relevant literature regarding the role of transabdominal abdominopelvic (TA) US in vaginal cancer staging. TAUS is inferior for visualizing the female genital tract compared with TVUS, and neither technique has a role in the evaluation of regional or distant disease. Variant 2: Posttreatment evaluation of vaginal cancer. No suspected recurrence. Initial imaging. As the use of definitive chemoradiation for the treatment of primary vaginal cancer has grown, so too has the role of cross-imaging for assessment of treatment response. In contrast to extirpative surgery, in which pathologic margin assessment can confirm removal of viable tumor, evaluation for tumor eradication following chemoradiation relies in part on imaging assessment. Much of the support for the value of early posttreatment imaging in primary vaginal cancer is extrapolated from the large body of literature on cervical cancer, for which the treatment paradigm and endpoints are analogous.