In studies evaluating pulmonary metastases from cervical cancer, chest CT was the most frequent diagnostic modality employed, with the vast majority of patients asymptomatic at the time of imaging [16,17]. These findings support the use of chest CT with or without IV contrast in the early posttreatment evaluation of cervical cancer, as endorsed by the NCCN guidelines, and suggest that a similar strategy would be useful for vaginal cancer. CT Abdomen and Pelvis Data on the diagnostic performance of CT in known or suspected recurrence of vaginal cancer are very limited, requiring extrapolation from pretreatment vaginal cancer cohorts as well as cohorts of patients with other gynecologic malignancies. Regarding local extent evaluation, the prospective ACRIN 6651 study of patients with cervical cancer prior to treatment, found that CT was insensitive for detection of rectal and bladder invasion, suggesting that performance would be similarly poor in the setting of recurrent disease prior to pelvic exenteration [19]. A small retrospective study evaluating FDG-PET/CT in 23 patients with primary vaginal cancer prior to treatment found that CT and FDG-PET detected pelvic nodal metastases in 17% (4 of 23) and 35% (8 of 23) of patients, respectively, suggesting inferior sensitivity of CT alone for nodal metastases. Although older literature suggested that CT is less sensitive than PET/CT for nodal metastases [22], the more recent ACRIN 6671/GOG 0233 trial in cervical cancer patients prior to treatment showed a more modest difference in sensitivity for abdominal nodes (42% versus 50%, respectively), and no significant difference in sensitivity for pelvic nodes (79% versus 83%, respectively) [23]. Likewise, CT had only modestly lower AUC (0.83) compared with PET/CT (0.90) for detection of nodal metastases from cervical cancer in a recent meta-analysis [24].
Staging and Follow up of Primary Vaginal Cancer. In studies evaluating pulmonary metastases from cervical cancer, chest CT was the most frequent diagnostic modality employed, with the vast majority of patients asymptomatic at the time of imaging [16,17]. These findings support the use of chest CT with or without IV contrast in the early posttreatment evaluation of cervical cancer, as endorsed by the NCCN guidelines, and suggest that a similar strategy would be useful for vaginal cancer. CT Abdomen and Pelvis Data on the diagnostic performance of CT in known or suspected recurrence of vaginal cancer are very limited, requiring extrapolation from pretreatment vaginal cancer cohorts as well as cohorts of patients with other gynecologic malignancies. Regarding local extent evaluation, the prospective ACRIN 6651 study of patients with cervical cancer prior to treatment, found that CT was insensitive for detection of rectal and bladder invasion, suggesting that performance would be similarly poor in the setting of recurrent disease prior to pelvic exenteration [19]. A small retrospective study evaluating FDG-PET/CT in 23 patients with primary vaginal cancer prior to treatment found that CT and FDG-PET detected pelvic nodal metastases in 17% (4 of 23) and 35% (8 of 23) of patients, respectively, suggesting inferior sensitivity of CT alone for nodal metastases. Although older literature suggested that CT is less sensitive than PET/CT for nodal metastases [22], the more recent ACRIN 6671/GOG 0233 trial in cervical cancer patients prior to treatment showed a more modest difference in sensitivity for abdominal nodes (42% versus 50%, respectively), and no significant difference in sensitivity for pelvic nodes (79% versus 83%, respectively) [23]. Likewise, CT had only modestly lower AUC (0.83) compared with PET/CT (0.90) for detection of nodal metastases from cervical cancer in a recent meta-analysis [24].