Computed tomography, magnetic resonance imaging and FDG positron emission tomography in the management of vulvar malignancies

Lin, Gigin; Chen, Chao‐Yu; Liu, Feng-Yuan; Yang, Lan-Yan; Huang, Hsuan-Rong; Huang, Yi‐Ting; Jung, Shih‐Ming; Chou, Hung-Hsueh; Lai, Chyong‐Huey; Ng, Koon‐Kwan

doi:10.1007/s00330-014-3530-1

Cited by 50 publications

(46 citation statements)

References 28 publications

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“…Furthermore, we showed that ultrasound performance was comparable, if not better, to that of CT scan and both single‐ and dual‐phase FDG‐PET/CT found in our series, and reported in the literature, for predicting LN status. It is worth underlining that such a high predictive power of ultrasound examination can be guaranteed only by dedication and specific training of the ultrasound examiner in vulvar cancer diagnosis and treatment.…”

Section: Discussionsupporting

confidence: 78%

“…Currently, several imaging methods are available for this purpose, comprising ultrasound examination, ultrasound-guided fine-needle aspiration cytology (FNAC), computed tomography (CT), magnetic resonance imaging (MRI) and fluorodeoxyglucose-positron emission tomography (FDG-PET) 12,[17][18][19][20][21][22][23][24] . In particular, ultrasound examination shows a relatively high sensitivity and specificity, while at the same time it is cost-effective, easy-to-learn and easy-to-perform, and it does not require use of radiation or contrast agents 17 .…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound morphometric and cytologic preoperative assessment of inguinal lymph‐node status in women with vulvar cancer: MorphoNode study

Garganese

Fragomeni

Pasciuto

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To assess the accuracy of preoperative ultrasound examination for predicting lymph‐node (LN) status in patients with vulvar cancer. Methods This was a single‐institution retrospective observational study of all women with a histological diagnosis of vulvar cancer triaged to inguinal surgery within 30 days following ultrasound evaluation between December 2010 and January 2016. For each groin examined, 15 morphological and dimensional sonographic parameters associated with suspicion for LN involvement were examined. A morphometric ultrasound pattern (MUP) was expressed for each groin, classifying the inguinal LN status into five groups (normal; reactive‐but‐negative; minimally suspicious/probably negative; moderately suspicious; and highly suspicious/positive) according to subjective judgment, followed by stratification as positive or negative for metastasis according to morphometric binomial assessment (MBA). In cases of positive MBA, fine‐needle aspiration cytology was performed. Combining the information obtained from MUP and cytologic results, a binomial final overall assessment (FOA) was assigned for each groin. The final histology was considered as the reference standard. Comparison was performed between patients with negative and those with positive LNs on histology, and receiver‐operating‐characteristics curves were generated for statistically significant variables on univariate analysis, to evaluate their diagnostic ability to predict negative LN status. Results Of 144 patients included in the analysis, 87 had negative inguinal LNs and 57 had positive LNs on histology. A total of 256 groins were analyzed, of which 171 were negative and 85 showed at least one metastatic LN on histology. The following parameters showed the greatest accuracy, with the best balance between specificity and sensitivity, in predicting negative LN status: cortical (C) thickness of the dominant LN (cut‐off, 2.5 mm; sensitivity, 90.0%; specificity, 77.9%); short‐axis (S) length of the dominant LN (cut‐off, 8.4 mm; sensitivity, 63.9%; specificity, 90.6%); C/medulla (M) thickness ratio of the dominant LN (cut‐off, 1.2 mm; sensitivity, 70.4%; specificity, 91.5%), the combination of S length and C/M thickness ratio (sensitivity, 88.9%; specificity, 82.4%); and the FOA analysis (sensitivity, 85.9%; specificity, 84.2%). Conclusions Preoperative ultrasound assessment, with or without the addition of cytology, has a high accuracy in assessing inguinal LN status in patients with vulvar cancer. In particular, the combination of two ultrasound parameters (S length and C/M thickness ratio) provided the greatest accuracy in discriminating between negative and positive LNs. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Ultrasound morphometric and cytologic preoperative assessment of inguinal lymph‐node status in women with vulvar cancer: MorphoNode study

Garganese

Fragomeni

Pasciuto

et al. 2020

Ultrasound in Obstet & Gyne

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“…On retrospective review of 5/7 false-positive cases, the group state that FP pelvic adenopathy most likely corresponded to urinary FDG excretion; and FP thoracic lymph node enlargement probably represented reactive adenopathy given the typical spread of vulvar cancer. They concluded that PET can have a positive impact, however should be interpreted with caution as false positive lymph node and distant metastasis findings are not uncommon [18]. …”

Section: Discussionmentioning

confidence: 99%

The impact of FDG-PET/CT in the management of patients with vulvar and vaginal cancer

Robertson

Hricak

Sonoda

et al. 2016

Gynecologic Oncology

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OBJECTIVES To evaluate the changes in prognostic impression and patient management following PET/CT in patients with vulvar and vaginal carcinoma; and to compare PET/CT findings with those of conventional imaging modalities. METHODS We summarized prospectively and retrospectively collected data for 50 consecutive patients from our institution that enrolled in the National Oncologic PET Registry and underwent FDG-PET/CT for a suspected or known primary or recurrent vulvar/vaginal cancer. RESULTS 54/83 (65%) studies included had a diagnosis of vulvar cancer, and the remaining 29/83 (35%), a diagnosis of vaginal cancer. Following FDG-PET/CT, the physician’s prognostic impression changed in 51% of cases. A change in patient management, defined as a change to/from a non-interventional strategy (observation or additional imaging), to/from an interventional strategy (biopsy or treatment), was documented in 36% of studies. The electronic records demonstrated that 95% of the management strategies recorded in the physician questionnaires were implemented as planned. MRI and/or CT were performed within one month of the FDG-PET/CT in 20/83 (24%) and 28/83 (34%) cases, respectively. FDG-PET/CT detected nodes suspicious for metastases on 29/83 (35%) studies performed. MRI and CT detected positive nodes on 6 and 11 studies respectively. Distant metastases were identified in 10 cases imaged with FDG-PET and 5 cases that had additional conventional CT imaging. All suspicious lesions seen on CT were positively identified on PET/CT. In 4 cases, an abnormality identified on PET/CT, was not seen on diagnostic CT. CONCLUSIONS FDG-PET/CT may play an important role in the management of vulvar and vaginal carcinoma.

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“… Cervical cytology, and colposcopy of the cervix and vagina, if applicable, due to the association of HPV‐related cancers with other squamous intraepithelial lesions. Full blood count, biochemical profile, liver profile, and HIV testing. Chest X‐ray. CT or MRI scan of the pelvis and groins may be helpful, especially for locally advanced tumors, to detect any enlarged lymph nodes in the groins or pelvis, erosion into underlying bone, or other metastases . In addition, CT or MRI could be useful in further treatment planning. 18 F fluorodeoxyglucose ( 18 F‐FDG) positron emission tomography with computed tomography (PET‐CT) can more effectively assess and detect inguinofemoral lymph node involvement compared with CT, influencing the planning of primary surgery and inguinal lymph node dissection to determine the optimum surgical extent without sentinel lymph node dissection and use of frozen sections . Additionally, PET‐CT might be used with larger tumors when metastatic disease is suspected or in the recurrence scenario …”

Section: Management Of Squamous Cell Carcinomamentioning

confidence: 99%

Cancer of the vulva

Rogers

Cuello

2018

Intl J Gynecology & Obste

127

125

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Vulvar cancer is an uncommon gynecological malignancy primarily affecting postmenopausal women. There is no specific screening and the most effective strategy to reduce vulvar cancer incidence is the opportune treatment of predisposing and preneoplastic lesions associated with its development. While vulvar cancer may be asymptomatic, most women present with vulvar pruritus or pain, or have noticed a lump or ulcer. Therefore, any suspicious vulvar lesion should be biopsied to exclude invasion. Once established, the most common subtype is squamous cell carcinoma. Treatment of vulvar cancer depends primarily on histology and surgical staging. Treatment is predominantly surgical, particularly for squamous cell carcinoma, although concurrent chemoradiation is an effective alternative, particularly for advanced tumors. Management should be individualized, and carried out by a multidisciplinary team in a cancer center experienced in the treatment of these tumors.

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Computed tomography, magnetic resonance imaging and FDG positron emission tomography in the management of vulvar malignancies

Abstract: • False-positive metastatic PLN or distant metastasis PET findings are not uncommon. • CT/MRI has value in the management of vulvar malignancies. • PET can be supportive when metastasis is suspected by CT/MRI.

Cited by 50 publications

References 28 publications

Ultrasound morphometric and cytologic preoperative assessment of inguinal lymph‐node status in women with vulvar cancer: MorphoNode study

Ultrasound morphometric and cytologic preoperative assessment of inguinal lymph‐node status in women with vulvar cancer: MorphoNode study

The impact of FDG-PET/CT in the management of patients with vulvar and vaginal cancer

Cancer of the vulva

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