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

Abstract

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.

Cancer of the vulva

“… 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 …”

Vulvar cancer recurrence — an analysis of prognostic factors in tumour-free pathological margins patients group

“…The optimal management of these cases -inguinofemoral lymphadenectomy or groin node debulking -has not been defined yet [3,19]. The exclusion of the presence of disease in the pelvis using PET/CT or PET/MRI is important to determine a rational treatment strategy [20,21]. In case a patient's condition is suitable, pelvic debulking may be considered as an option despite the fact that pelvic disease is already considered a distant metastatic involvement [3].…”

When an Unexpected Diagnosis Occurs: a Vaginal Premenopausal Sarcoma

“…9 Despite the fact that the majority of available evidence is for squamous cell carcinoma and adenocarcinoma, the positron emission tomographycomputed tomography (PET-CT) value appears to be useful to address metastization, mainly in advanced stages. 10,11 The guided biopsy performed may have a role in cancer dissemination, but this appear to be very unlikely. In the first place, the lymphadenopathies were reactive (even in pathologic revision).…”