Regarding distant metastases, detection of extraregional nodal or solid organ lesions can obviate unnecessarily morbid radical pelvic surgery and instead direct care toward palliative regimens or radiotherapy with an extended field. Finally, the ability to accurately stage noninvasively can avoid the need for invasive staging procedures such as cystoscopy (for bladder mucosal invasion) and proctoscopy (for rectal mucosal invasion), both of which are historical components of the FIGO clinical staging system [1]. CT Chest Although thoracic metastases are known to occur in vaginal cancer, no studies specifically address their incidence or the incremental value of chest CT for initial staging. Pulmonary metastases have been studied to a limited degree in cervical cancer, occurring in approximately 5% to 10% of patients at diagnosis [13,14]. Pulmonary metastases appear to occur slightly more frequently as a site of recurrent disease, with one large study of recurrent cervical cancer indicating an overall incidence of 13%, and the lungs representing the only site of recurrence in 6% of cases [15]. 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 intravenous (IV) contrast in the early posttreatment evaluation of cervical cancer, as endorsed by the National Comprehensive Cancer Network (NCCN) guidelines, and suggest that a similar strategy would be useful for vaginal cancer. Staging and Follow-up of Primary Vaginal Cancer CT Abdomen and Pelvis Data on the diagnostic performance of CT in primary vaginal cancer staging are very limited.
Staging and Follow up of Primary Vaginal Cancer. Regarding distant metastases, detection of extraregional nodal or solid organ lesions can obviate unnecessarily morbid radical pelvic surgery and instead direct care toward palliative regimens or radiotherapy with an extended field. Finally, the ability to accurately stage noninvasively can avoid the need for invasive staging procedures such as cystoscopy (for bladder mucosal invasion) and proctoscopy (for rectal mucosal invasion), both of which are historical components of the FIGO clinical staging system [1]. CT Chest Although thoracic metastases are known to occur in vaginal cancer, no studies specifically address their incidence or the incremental value of chest CT for initial staging. Pulmonary metastases have been studied to a limited degree in cervical cancer, occurring in approximately 5% to 10% of patients at diagnosis [13,14]. Pulmonary metastases appear to occur slightly more frequently as a site of recurrent disease, with one large study of recurrent cervical cancer indicating an overall incidence of 13%, and the lungs representing the only site of recurrence in 6% of cases [15]. 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 intravenous (IV) contrast in the early posttreatment evaluation of cervical cancer, as endorsed by the National Comprehensive Cancer Network (NCCN) guidelines, and suggest that a similar strategy would be useful for vaginal cancer. Staging and Follow-up of Primary Vaginal Cancer CT Abdomen and Pelvis Data on the diagnostic performance of CT in primary vaginal cancer staging are very limited.