FDG-PET/CT is also more sensitive than conventional CT for osseous metastases [25], with sensitivity and specificity of 55% and 98%, respectively, for all distant metastases [13]. Accordingly, the NCCN guidelines endorse preference for whole-body FDG-PET/CT over conventional CT for initial staging of all cervical cancer designated stage II and above, with either FDG-PET/CT or conventional CT recommended in stage I disease [27]. Staging and Follow-up of Primary Vaginal Cancer Fluoroscopy Contrast Enema There is no relevant literature regarding the use of fluoroscopic contrast enema in the modern imaging workup of vaginal cancer, and its use has largely been replaced by cross-sectional imaging techniques. MRI Pelvis Because of the rarity of vaginal cancer, the primary data regarding the use of MRI in initial staging of vaginal cancer are sparse. Taylor et al [28] retrospectively evaluated pelvic MRI for initial staging in 25 patients with primary vaginal cancer spanning all disease stages. MRI depicted the primary tumor in 96% (24 of 25) of patients, demonstrating hyperintense signal compared to muscle on T2-weighted images, and enabled assignment of a radiologic disease stage based on adaptation of FIGO clinical staging criteria. Because 80% (20 of 25) of patients received either radiation or palliative therapy, pathologic confirmation of imaging findings could be obtained in only 20% (5 of 25) of cases. Of these cases, MRI stage was concordant with pathologic stage in 40% (2 of 5) of the cases. More recent data in cervical cancer patients support the use of MRI for initial staging, with a meta-analysis suggesting high sensitivity (76%) and specificity (94%) of MRI for parametrial invasion [20]. Although MRI readily depicts lymph nodes, it has constraints similar to CT with regard to the limited sensitivity and specificity of size and morphologic criteria. No study has specifically evaluated the performance of MRI for pretreatment nodal staging in vaginal cancer.
Staging and Follow up of Primary Vaginal Cancer. FDG-PET/CT is also more sensitive than conventional CT for osseous metastases [25], with sensitivity and specificity of 55% and 98%, respectively, for all distant metastases [13]. Accordingly, the NCCN guidelines endorse preference for whole-body FDG-PET/CT over conventional CT for initial staging of all cervical cancer designated stage II and above, with either FDG-PET/CT or conventional CT recommended in stage I disease [27]. Staging and Follow-up of Primary Vaginal Cancer Fluoroscopy Contrast Enema There is no relevant literature regarding the use of fluoroscopic contrast enema in the modern imaging workup of vaginal cancer, and its use has largely been replaced by cross-sectional imaging techniques. MRI Pelvis Because of the rarity of vaginal cancer, the primary data regarding the use of MRI in initial staging of vaginal cancer are sparse. Taylor et al [28] retrospectively evaluated pelvic MRI for initial staging in 25 patients with primary vaginal cancer spanning all disease stages. MRI depicted the primary tumor in 96% (24 of 25) of patients, demonstrating hyperintense signal compared to muscle on T2-weighted images, and enabled assignment of a radiologic disease stage based on adaptation of FIGO clinical staging criteria. Because 80% (20 of 25) of patients received either radiation or palliative therapy, pathologic confirmation of imaging findings could be obtained in only 20% (5 of 25) of cases. Of these cases, MRI stage was concordant with pathologic stage in 40% (2 of 5) of the cases. More recent data in cervical cancer patients support the use of MRI for initial staging, with a meta-analysis suggesting high sensitivity (76%) and specificity (94%) of MRI for parametrial invasion [20]. Although MRI readily depicts lymph nodes, it has constraints similar to CT with regard to the limited sensitivity and specificity of size and morphologic criteria. No study has specifically evaluated the performance of MRI for pretreatment nodal staging in vaginal cancer.