On a groin-based analysis, MRI had the sensitivity of 89%, specificity of 91%, PPV of 89%, NPV of 91%, and accuracy of 90%. Staging and Follow-up of Vulvar Cancer with unenhanced MRI prior to lymphadenectomy. Two of the three criteria had to be met to diagnose lymph node metastases: 1) short-axis diameter >10 mm; 2) irregular or rounded shape; or 3) increased signal intensity on short tau inversion recovery imaging or heterogeneous signal intensity on T2-weighted imaging. Using this approach, on a groin-by-groin basis, unenhanced MRI had sensitivity of 85.7%, specificity of 82.1%, PPV of 64.3%, and NPV of 93.9%. Radiography Chest There is only one report regarding the role of chest radiography for the initial staging of patients with vulvar cancer. Andersen et al [26] prospectively evaluated 27 patients with vulvar cancer (23 primary and 4 recurrent). Chest radiographs was performed in 24 of 27 patients and contrast-enhanced CT scan of the chest, abdomen, and pelvis was performed in all 27 patients. Only 1 of 24 chest radiographs revealed a clinically important finding (ie, pulmonary metastases) from an asymptomatic and at that time unknown adenocarcinoma of the cecum. Chest radiographs did not alter initial gynecologic management in any of the patients. US Duplex Doppler and US-guided Fine-Needle Aspiration Biopsy Groin There is no relevant literature to support the use of US with Doppler and 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. 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.
Staging and Follow up of Vulvar Cancer. On a groin-based analysis, MRI had the sensitivity of 89%, specificity of 91%, PPV of 89%, NPV of 91%, and accuracy of 90%. Staging and Follow-up of Vulvar Cancer with unenhanced MRI prior to lymphadenectomy. Two of the three criteria had to be met to diagnose lymph node metastases: 1) short-axis diameter >10 mm; 2) irregular or rounded shape; or 3) increased signal intensity on short tau inversion recovery imaging or heterogeneous signal intensity on T2-weighted imaging. Using this approach, on a groin-by-groin basis, unenhanced MRI had sensitivity of 85.7%, specificity of 82.1%, PPV of 64.3%, and NPV of 93.9%. Radiography Chest There is only one report regarding the role of chest radiography for the initial staging of patients with vulvar cancer. Andersen et al [26] prospectively evaluated 27 patients with vulvar cancer (23 primary and 4 recurrent). Chest radiographs was performed in 24 of 27 patients and contrast-enhanced CT scan of the chest, abdomen, and pelvis was performed in all 27 patients. Only 1 of 24 chest radiographs revealed a clinically important finding (ie, pulmonary metastases) from an asymptomatic and at that time unknown adenocarcinoma of the cecum. Chest radiographs did not alter initial gynecologic management in any of the patients. US Duplex Doppler and US-guided Fine-Needle Aspiration Biopsy Groin There is no relevant literature to support the use of US with Doppler and 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. 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.