The advantage of this sampling approach is that it is minimally invasive; the limitation is the potential risk of undersampling in the setting of micrometastases. 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 it was 80%, 100%, 93%, and 100%, respectively. Staging and Follow-up of Vulvar Cancer US-Guided Fine-Needle Aspiration Biopsy Groin There is no relevant literature to support the use of US-guided FNAB for the assessment of primary tumor extent. A number of studies evaluated groin US with Doppler and US-guided FNAB for IFLN assessment [25,36-38]. Combined US and US-guided FNAB is the most accurate approach to confirm IFLN metastases that are suspected based on clinical and/or imaging assessment. Sampling is minimally invasive. Limitations of US include its risk of undersampling of micrometastases. 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. Variant 3: Initial staging of pretreatment vulvar cancer: Primary tumor is greater than 4 cm or tumor of any size with more than minimal involvement of the urethra, vagina, or anus. Patients with primary tumors >4 cm or tumors of any size with more than minimal involvement of urethra, vagina, or anus (TNM larger T2/T3 or larger FIGO II, FIGO III/IVA) are treated primarily with concurrent EBRT and chemotherapy [39,40]. This group of patients has >8% risk of IFLN basin metastases and are not candidates for SLN mapping and biopsy.
Staging and Follow up of Vulvar Cancer. The advantage of this sampling approach is that it is minimally invasive; the limitation is the potential risk of undersampling in the setting of micrometastases. 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 it was 80%, 100%, 93%, and 100%, respectively. Staging and Follow-up of Vulvar Cancer US-Guided Fine-Needle Aspiration Biopsy Groin There is no relevant literature to support the use of US-guided FNAB for the assessment of primary tumor extent. A number of studies evaluated groin US with Doppler and US-guided FNAB for IFLN assessment [25,36-38]. Combined US and US-guided FNAB is the most accurate approach to confirm IFLN metastases that are suspected based on clinical and/or imaging assessment. Sampling is minimally invasive. Limitations of US include its risk of undersampling of micrometastases. 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. Variant 3: Initial staging of pretreatment vulvar cancer: Primary tumor is greater than 4 cm or tumor of any size with more than minimal involvement of the urethra, vagina, or anus. Patients with primary tumors >4 cm or tumors of any size with more than minimal involvement of urethra, vagina, or anus (TNM larger T2/T3 or larger FIGO II, FIGO III/IVA) are treated primarily with concurrent EBRT and chemotherapy [39,40]. This group of patients has >8% risk of IFLN basin metastases and are not candidates for SLN mapping and biopsy.