MRI Staging in Locally Advanced Vulvar Cancer: From Anatomy to Clinico-Radiological Findings. A Multidisciplinary VulCan Team Point of View

Abstract

MR imaging provides excellent spatial and contrast resolution to stage locally advanced vulvar cancer (LAVC) for tumor and nodal evaluation in order to facilitate the planning of treatment. Although there are no standard indications for how to estimate the clinical stage of International Federation of Gynecology and Obstetrics at diagnosis, MR imaging can depict the tumor and its extension to the vulvar region and adjacent organs, such as the vagina, urethra, and anus. Optimizing the MR imaging protocol and technique is fundamental for correct staging. The aim of this overview was to focus on the role of MR imaging in LAVC staging. We define vulvar anatomy and corresponding MR imaging findings, MR imaging protocol, and technique. Moreover, we describe the MR imaging findings of LAVC with example cases stage by stage. Key imaging findings based on signal intensity, diffusion restriction, and enhancement are portrayed to correctly identify and stage vulvar cancer. A structured report for LAVC staging is reported in order to give all necessary information to the clinicians and to facilitate MR imaging comprehension.

MRI in the Evaluation of Locally Advanced Vulvar Cancer Treated with Chemoradiotherapy and Vulvar Cancer Recurrence: The 2021 Revision of FIGO Classification and the Need for Multidisciplinary Management

“…The female urethra has a characteristic target-like appearance on axial T2-WI, consisting of four concentric rings (mucosa, submucosa, muscularis, and serosa). In the setting of urethral invasion, this target appearance is disrupted by the intermediate-to-high signal intensity mass [ 8 , 11 ].…”

“…When at clinical examination, the surrounding perineal tissues or medial structures are infiltrated. Additional imaging is essential to assess the involvement of the deep organs such as the vagina, urethra, bladder, anal canal, and rectum, and specifically, MRI is recommended given the high soft tissue resolution [ 8 , 9 ].…”

“…On the contrary, patients with residual disease must be considered for tumor resection or additional RT/CRT [ 1 , 14 , 25 , 26 ]. Therefore, the multidisciplinary tumor board is crucial in defining the best approach for each patient with LAVC, either before or after multimodal treatment [ 8 , 14 , 25 , 29 ].…”

The Role of Ultrasound in the Evaluation of Inguinal Lymph Nodes in Patients with Vulvar Cancer: A Systematic Review and Meta-Analysis

“…Imaging techniques available and approved in the preoperative assessment of baseline staging in vulvar cancer include computed tomography scans (CT), magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography (FDG PET) [17,22,[24][25][26][27][28][29][30][31][32]. In the detection of inguinal lymph node metastases, CT scans have shown a negative predictive value around 75% [33][34][35].…”

“…In the detection of inguinal lymph node metastases, CT scans have shown a negative predictive value around 75% [33][34][35]. As part of a systematic review, However, it should be noted that the MRI criterion used for groin lymph node metastasis prediction varied between the studies [24,29]. Data reported in the literature on the efficacy of FDG PET to assess LN status in vulvar cancer showed a sensitivity from 50 to 75%, a specificity from 52 to 100% and a negative predictive value of 93% [30][31][32].…”