Therefore, although MRI may depict size regression of nodal metastases following therapy, it is likely at least modestly inferior for detecting new or residual disease in subcentimeter lymph nodes compared to FDG-PET/CT [22,23,29,30]. If MRI of the abdomen and pelvis is used in place of CT of the abdomen and pelvis, the addition of chest CT is encouraged to evaluate for pulmonary metastases. The use of IV contrast may improve tissue characterization and should be used especially when MRI of the abdomen is included, because it improves detection of hepatic metastases. Radiography Intravenous Urography There is no relevant literature regarding the use of radiographic IV urography in the modern imaging workup of vaginal cancer, and its use has largely been replaced by cross-sectional imaging techniques. US Abdomen and Pelvis Transabdominal There is no relevant literature regarding the role of TAUS in vaginal cancer staging. TAUS is inferior for visualizing the female genital tract compared with TVUS, and neither technique has a role in nodal or distant evaluation. US Pelvis Transvaginal There is no relevant literature regarding the role of TVUS in the early posttreatment evaluation of primary vaginal cancer. Limited studies in cervical cancer patients have evaluated the use of color and/or power Doppler US for detecting changes in tumor vascularity as a marker of treatment response [45]. However, the applicability of these findings to clinical practice remains unclear. The NCCN guidelines do not currently endorse the use of TVUS for early posttreatment evaluation in cervical cancer, and its role in vaginal cancer remains undefined. Additionally, TVUS has limited utility for pelvic nodal evaluation [39]. Variant 3: Vaginal cancer. Suspected or known recurrence. Evaluate extent of disease. Initial imaging.
Staging and Follow up of Primary Vaginal Cancer. Therefore, although MRI may depict size regression of nodal metastases following therapy, it is likely at least modestly inferior for detecting new or residual disease in subcentimeter lymph nodes compared to FDG-PET/CT [22,23,29,30]. If MRI of the abdomen and pelvis is used in place of CT of the abdomen and pelvis, the addition of chest CT is encouraged to evaluate for pulmonary metastases. The use of IV contrast may improve tissue characterization and should be used especially when MRI of the abdomen is included, because it improves detection of hepatic metastases. Radiography Intravenous Urography There is no relevant literature regarding the use of radiographic IV urography in the modern imaging workup of vaginal cancer, and its use has largely been replaced by cross-sectional imaging techniques. US Abdomen and Pelvis Transabdominal There is no relevant literature regarding the role of TAUS in vaginal cancer staging. TAUS is inferior for visualizing the female genital tract compared with TVUS, and neither technique has a role in nodal or distant evaluation. US Pelvis Transvaginal There is no relevant literature regarding the role of TVUS in the early posttreatment evaluation of primary vaginal cancer. Limited studies in cervical cancer patients have evaluated the use of color and/or power Doppler US for detecting changes in tumor vascularity as a marker of treatment response [45]. However, the applicability of these findings to clinical practice remains unclear. The NCCN guidelines do not currently endorse the use of TVUS for early posttreatment evaluation in cervical cancer, and its role in vaginal cancer remains undefined. Additionally, TVUS has limited utility for pelvic nodal evaluation [39]. Variant 3: Vaginal cancer. Suspected or known recurrence. Evaluate extent of disease. Initial imaging.