Positron emission tomography-computed tomography for inguinal nodes in vulvar cancer

Oldan, Jorge; Sullivan, Stephanie

doi:10.4103/wjnm.wjnm_32_17

Cited by 12 publications

(15 citation statements)

References 8 publications

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“…Similar results were observed in the pelvis-based analysis. Previous PET or PET/CT studies showed variable results in terms of diagnostic performance, with sensitivity ranging from 50 to 100% and NPV from 57 to 100% for detecting metastatic LNs in vulvar cancer [12][13][14][15][16][17][18][19][20]. All these studies referred to small series (8-47 NMHP, non-metastatic with high probability; MHP, metastatic with high probability.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies assessing the performance of [ 18 F]FDG-PET/CT mainly used qualitative assessment [ 12 – 14 , 17 ]. LN-SUV max values were reported only in few manuscripts [ 15 , 18 – 20 ]. In the current study, semi-quantitative analysis showed to be not superior to qualitative analysis, confirming our previous results in a small series of patients [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Positron emission tomography/CT with [ 18 F]fluorodeoxyglucose ([ 18 F]FDG-PET/CT) has been included in the National Comprehensive Cancer Network guidelines for vulvar cancer since 2016 and is recommended for T2 or larger tumours or when metastases are suspected [4]. However, only few studies on small series with controversial results on the role of [ 18 F]FDG-PET or PET/CT in vulvar cancer have been published [12][13][14][15][16][17][18][19][20][21]; they have been summarized in a recent metaanalysis [22].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic performance of preoperative [18F]FDG-PET/CT for lymph node staging in vulvar cancer: a large single-centre study

Rufini

Garganese

Ieria

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose This retrospective study aimed to assess the diagnostic performance of preoperative [18F]FDG-PET/CT in predicting the groin and pelvic lymph node (LN) status in a large single-centre series of vulvar cancer patients. Methods Between January 2013 and October 2018, among all consecutive women with proven vulvar cancer submitted to [18F]FDG-PET/CT, 160 patients were included. LNs were analysed by two qualitative methods assessing PET information (defined as visual assessment) and a combination of PET and low-dose CT information (defined as overall assessment), respectively, as well as semi-quantitative analysis (LN-SUVmax). Sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV) in predicting the groin and pelvic LN status were calculated in the overall study population; a subset analysis of groin parameters in clinically/ultrasonography negative patients was also performed. Histopathology was the reference standard. Results All patients underwent vulvar and inguinofemoral LN surgery, and 35 pelvic LN surgery. Overall, 338 LN sites (296 groins and 42 pelvic sites) were histologically examined with 30.4% prevalence of metastatic groins and 28.6% for metastatic pelvic sites. In the overall study population, sensitivity (95% confidence interval, CI), specificity (95% CI), accuracy (95% CI), PPV (95% CI) and NPV (95% CI) at the groin level were 85.6% (78.3–92.8), 65.5% (59.0–72.0), 71.6% (66.5–76.8), 52.0% (44.0–60.1) and 91.2% (86.7–95.8) for visual assessment; 78.9% (70.5–87.3), 78.2% (72.5–83.8), 78.4% (73.7–83.1), 61.2% (52.3–70.1) and 89.4% (85.0–93.9) for overall assessment; and 73.3% (64.2–82.5), 85.0% (80.1–89.8), 81.4% (77.0–85.8), 68.0% (58.8–77.3) and 87.9% (83.4–92.5) for semi-quantitative analysis (SUVmax cut-off value 1.89 achieved by ROC analysis). Similar results were observed in the pelvis-based analysis. Conclusion In this large single-centre series of vulvar cancer patients, [18F]FDG-PET/CT showed good values of sensitivity and NPV in discriminating metastatic from non-metastatic LNs. In routine clinical practice, qualitative analysis is a reliable interpretative criterion making unnecessary commonly used semi-quantitative methods such as SUVmax.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnostic performance of preoperative [18F]FDG-PET/CT for lymph node staging in vulvar cancer: a large single-centre study

Rufini

Garganese

Ieria

et al. 2021

Eur J Nucl Med Mol Imaging

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“…MRI, ultrasound with or without puncture of inguinofemoral lymph nodes, CT and PET/CT may be used to define the extent of tumour and/or for treatment planning [11,20,21,39,40].…”

Section: Diagnosis and Initial Stagingmentioning

confidence: 99%

“…Lymph node biopsy may be performed either by FNA or by core biopsy. There are no published data comparing the performance of these to puncture techniques in the clinical setting of vulvar cancer staging, and the wider available experience addressing this topic comes from breast cancer studies [36][37][38][39][40][41]. In the study of Solon et al [36], core biopsy of suspicious nodes showed a sensitivity rate of 96%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 64%.…”

Section: Diagnosis and Initial Stagingmentioning

confidence: 99%

Vulvar cancer staging: guidelines of the European Society of Urogenital Radiology (ESUR)

Nikolić

Sousa

Cunha³

et al. 2021

Insights Imaging

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Objective The aim of the Female Pelvic Imaging Working Group of the European Society of Urogenital Radiology (ESUR) was to develop imaging staging guidelines for vulvar cancer and to propose standardised MRI protocols and reporting. Methods The guidelines recommended from the ESUR in this article resulted from a questionnaire analysis regarding imaging staging of vulvar cancer that was answered by all members of the Female Pelvic Imaging Working Group. Only the answers with an agreement equal to or more than 80% were considered. Additionally, the literature was reviewed to complement and further support our conclusions. Results The critical review of the literature and consensus obtained among experts allows for recommendations regarding imaging staging guidelines, patient preparation, MRI protocol, and a structured MRI report. Conclusions Standardising image acquisition techniques and MRI interpretation reduces ambiguity and ultimately improves the contribution of radiology to the staging and management of patients with vulvar cancer. Moreover, structured reporting assists with the communication of clinically relevant information to the referring physician.

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Gynecologic tumor board: a radiologist’s guide to vulvar and vaginal malignancies

et al. 2021

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Primary vulvar and vaginal cancers are rare female genital tract malignancies which are staged using the 2009 International Federation of Gynecology and Obstetrics (FIGO) staging. These cancers account for approximately 2,700 deaths annually in the USA. The most common histologic subtype of both vulvar and vaginal cancers is squamous cell carcinoma, with an increasing role of the human papillomavirus (HPV) in a significant number of these tumors. Lymph node involvement is the hallmark of FIGO stage 3 vulvar cancer while pelvic sidewall involvement is the hallmark of FIGO stage 3 vaginal cancer. Imaging techniques include computed tomography (CT), positron emission tomography (PET)-CT, magnetic resonance imaging (MRI), and PET-MRI. MRI is the imaging modality of choice for preoperative clinical staging of nodal and metastatic involvement while PET-CT is helpful with assessing response to neoadjuvant treatment and for guiding patient management. Determining the pretreatment extent of disease has become more important due to modern tailored operative approaches and use of neoadjuvant chemoradiation therapy to reduce surgical morbidity. Moreover, imaging is used to determine the full extent of disease for radiation planning and for evaluating treatment response. Understanding the relevant anatomy of the vulva and vaginal regions and the associated lymphatic pathways is helpful to recognize the potential routes of spread and to correctly identify the appropriate FIGO stage. The purpose of this article is to review the clinical features, pathology, and current treatment strategies for vulvar and vaginal malignancies and to identify multimodality diagnostic imaging features of these gynecologic cancers, in conjunction with its respective 2009 FIGO staging system guidelines.

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Positron emission tomography-computed tomography for inguinal nodes in vulvar cancer

Cited by 12 publications

References 8 publications

Diagnostic performance of preoperative [18F]FDG-PET/CT for lymph node staging in vulvar cancer: a large single-centre study

Diagnostic performance of preoperative [18F]FDG-PET/CT for lymph node staging in vulvar cancer: a large single-centre study

Vulvar cancer staging: guidelines of the European Society of Urogenital Radiology (ESUR)

Gynecologic tumor board: a radiologist’s guide to vulvar and vaginal malignancies

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