Relevance of computerized tomography in the preoperative evaluation of patients with vulvar cancer: a prospective study

Abstract

BackgroundThe purpose of the study was to determine whether inclusion of computerized tomography (CT) in the prospective evaluation of vulvar cancer changed the surgical treatment strategy in terms of detection of lymph node metastases, tumor spread and comorbidity, and additionally to examine the logistical influence of adding further examinations prior to treating out-hospital patients referred from geographically distant areas.MethodsDuring an 8 month period we conducted a prospective study of patients with newly diagnosed or recurrent vulvar cancer consecutively referred to Copenhagen University Hospital, Rigshospitalet. The patients underwent a gynecological examination, chest x-ray and a preoperative CT scanning of the chest, abdomen and pelvis. It was registered whether the radiological findings regarding the extent of the tumor, lymph node involvement, incidental findings and comorbidity changed the surgical treatment plan. Further, the logistical influence of the long referral distances was registered.ResultsThirty patients with a median age of 69 years (range 44–93 years) were included in the study. CT did not significantly change the initial surgical treatment plan for the patients. CT did not reveal lymph node enlargement outside the inguinofemoral area and was inaccurate compared to the sentinal node examination of the local lymph nodes. CT diagnosed no cases with distant metastases from the primary malignancy, but two cases with a secondary malignant disease were found.ConclusionsCT scanning has no clinical impact as a routine screening examination prior to surgery. It may delay treatment, but can add important information when clinically indicated.

Ultrasound‐guided FNA cytology of groin lymph nodes improves the management of squamous cell carcinoma of the vulva: Results from a comparative cytohistological study

“…To date, the main diagnostic techniques used to preoperatively detect metastatic lymph node disease in vulvar cancer are represented by computed tomography and magnetic resonance imaging; however, both have demonstrated low specificity and sensitivity. Therefore, the common practice to improve patient outcome is represented by inguinofemoral lymphadenectomy …”

“…Therefore, the common practice to improve patient outcome is represented by inguinofemoral lymphadenectomy. 2,7,17 Actually, sentinel lymph node biopsy has become increasingly accepted as an alternative method to lymphadenectomy, especially in the management of patients with early-stage vulvar cancer. 8,9,18 The intraoperative evaluation of the sentinel lymph node, representing the first regional station that drains from the primary tumor, offers a high chance to define the negative or positive involvement of the entire regional lymph nodes.…”

“…5,6 Nonetheless, diagnostic techniques such as clinical examination, computed tomography, and magnetic resonance imaging have demonstrated low specificity, so that most malignant criteria are still based on size. 7 Actually, the most reliable technique to identify those patients who have lymph node metastases is represented by the sentinel lymph node biopsy procedure, which has become increasingly accepted in the management of vulvar cancer. 8,9 It makes sense that a reliable tool in the evaluation of lymph nodes is represented by ultrasound combined with fine-needle aspiration cytology (FNAC).…”

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

“…CT alone has generally not been found to be useful for preoperative vulvar cancer staging. [ 8 ] The use of FDG PET-CT in combination, however, may provide additional diagnostic information that improves sensitivity and specificity although further investigation is needed in larger cohorts. This combined modality (FDG PET-CT) is recommended by the National Comprehensive Cancer Network for cervical cancer to detect extrapelvic disease, determine volume of coverage for radiotherapy, and for surveillance after combined chemosensitizing radiotherapy.…”

Modern treatment of vulvar cancer

“…10,11 Other imaging methods have proven to be less reliable compared to ultrasound. 12,13 In the absence of a reliable method for detecting inguino-femoral lymph node involvement, inguino-femoral lymphadenectomy was part of the standard treatment of vulvar cancer. 1 Metastases in the inguino-femoral lymph nodes in early stages of the disease are found in only 20-30% of patients, which means that all other patients do not benefit from a complete lymphadenectomy.…”