The aforementioned study by Land et al [25] reported on 44 patients with primary vulvar SCC who were imaged with one or more of the following modalities: CT, US, and/or US-guided FNAB prior to lymphadenectomy. The sensitivity, specificity, PPV, and NPV for US alone was 87%, 69%, 48%, and 94%, respectively, and for US-guided FNAB 80%, 100%, 93%, and 100%, respectively. Vulvar region, IFLN basins, multisite, and distant metastases are the most common locations of recurrence in decreasing order of frequency [13]. If the relapse is confirmed pathologically, FDG-PET/CT is recommended to detect lymph node and distant metastases, whereas MRI of pelvis aids the assessment of local tumor extent [44-46]. Treatment of recurrent vulvar cancer is determined by the tumor extent (vulva-confined, nodal recurrence, distant recurrence) and history of prior EBRT. Detailed discussion is beyond the scope of this guideline and is addressed comprehensively elsewhere [6]. In general, nonirradiated vulva-confined recurrent tumors are approached with multimodal strategy including surgical resection or IFLN dissection, and/or chemoradiotherapy. Surgery is the only potentially curative option in previously irradiated vulva-confined tumors. Similarly, if there is no prior EBRT, isolated lymph node or distant metastases are managed with multimodal approach; surgical resection and systemic therapy may be considered if there was prior EBRT. If there are multiple lymph node or distant metastases and prior EBRT, systemic therapy and best supporting care are advised [6]. CT Abdomen and Pelvis Contrast-enhanced CT of the abdomen and pelvis may be considered in patients with suspected vulvar cancer recurrence. However, contrast-enhanced CT of the 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.
Staging and Follow up of Vulvar Cancer. The aforementioned study by Land et al [25] reported on 44 patients with primary vulvar SCC who were imaged with one or more of the following modalities: CT, US, and/or US-guided FNAB prior to lymphadenectomy. The sensitivity, specificity, PPV, and NPV for US alone was 87%, 69%, 48%, and 94%, respectively, and for US-guided FNAB 80%, 100%, 93%, and 100%, respectively. Vulvar region, IFLN basins, multisite, and distant metastases are the most common locations of recurrence in decreasing order of frequency [13]. If the relapse is confirmed pathologically, FDG-PET/CT is recommended to detect lymph node and distant metastases, whereas MRI of pelvis aids the assessment of local tumor extent [44-46]. Treatment of recurrent vulvar cancer is determined by the tumor extent (vulva-confined, nodal recurrence, distant recurrence) and history of prior EBRT. Detailed discussion is beyond the scope of this guideline and is addressed comprehensively elsewhere [6]. In general, nonirradiated vulva-confined recurrent tumors are approached with multimodal strategy including surgical resection or IFLN dissection, and/or chemoradiotherapy. Surgery is the only potentially curative option in previously irradiated vulva-confined tumors. Similarly, if there is no prior EBRT, isolated lymph node or distant metastases are managed with multimodal approach; surgical resection and systemic therapy may be considered if there was prior EBRT. If there are multiple lymph node or distant metastases and prior EBRT, systemic therapy and best supporting care are advised [6]. CT Abdomen and Pelvis Contrast-enhanced CT of the abdomen and pelvis may be considered in patients with suspected vulvar cancer recurrence. However, contrast-enhanced CT of the 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.