CT did not reveal distant metastases from vulvar cancer or alter original treatment plan in any patients. Incidental synchronous cancers were detected in 2 patients. CT Pelvis Contrast-enhanced CT of pelvis may be considered in patients with primary tumors >4 cm; urethral, vaginal, or anal involvement; or clinical suspicion for lymph node metastases. However, CT of chest, abdomen, and pelvis or FDG- PET/CT is preferred in this group. Size enlargement and abnormal pattern of enhancement are the main criteria used to detect lymph node metastases on CT. Complete lymphadenectomy or, alternatively, US-guided FNAB is performed if imaging findings are suspicious for lymph node metastases [6]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT is considered in patients with primary tumors >4 cm; urethral, vaginal, or anal involvement; or clinical suspicion for lymph node metastases. Complete lymphadenectomy or, alternatively, US-guided FNAB is performed if imaging findings are suspicious for lymph node metastases [6]. Several recent studies examined the value of FDG-PET/CT in the detection of lymph node metastases. Kamran et al [27] retrospectively evaluated the performance of FDG-PET/CT prior to lymphadenectomy in 20 patients with primary vulvar SCC (size unspecified) and >1 mm of stromal invasion. He found that on a patient-by-patients basis, FDG-PET/CT demonstrated a sensitivity of 50%, specificity of 100%, PPV of 100%, and NPV of 57.1%. 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.
Staging and Follow up of Vulvar Cancer. CT did not reveal distant metastases from vulvar cancer or alter original treatment plan in any patients. Incidental synchronous cancers were detected in 2 patients. CT Pelvis Contrast-enhanced CT of pelvis may be considered in patients with primary tumors >4 cm; urethral, vaginal, or anal involvement; or clinical suspicion for lymph node metastases. However, CT of chest, abdomen, and pelvis or FDG- PET/CT is preferred in this group. Size enlargement and abnormal pattern of enhancement are the main criteria used to detect lymph node metastases on CT. Complete lymphadenectomy or, alternatively, US-guided FNAB is performed if imaging findings are suspicious for lymph node metastases [6]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT is considered in patients with primary tumors >4 cm; urethral, vaginal, or anal involvement; or clinical suspicion for lymph node metastases. Complete lymphadenectomy or, alternatively, US-guided FNAB is performed if imaging findings are suspicious for lymph node metastases [6]. Several recent studies examined the value of FDG-PET/CT in the detection of lymph node metastases. Kamran et al [27] retrospectively evaluated the performance of FDG-PET/CT prior to lymphadenectomy in 20 patients with primary vulvar SCC (size unspecified) and >1 mm of stromal invasion. He found that on a patient-by-patients basis, FDG-PET/CT demonstrated a sensitivity of 50%, specificity of 100%, PPV of 100%, and NPV of 57.1%. 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.