Routine computerized tomography scanning, groin ultrasound with or without fine needle aspiration cytology in the surgical management of primary squamous cell carcinoma of the vulva

Abstract

We set out to study whether computerized tomography (CT) scanning of the vulva and the groin and groin ultrasound scanning (USS) alone or with fine needle aspiration cytology (FNAC) (USS/FNAC) influenced or could influence the surgical management of primary squamous cell carcinoma of the vulva (SCCaV). Forty-four patients underwent surgery for primary SCCaV following radiologic imaging by one or more modalities. Patient details included the clinical assessment of the carcinoma, radiologic findings, the operation performed, and whether the decision regarding the type and extent of surgery for the vulval carcinoma and, in particular, for the groin node dissection was or could be influenced by the radiologic findings. The age range was 38-87 years, with a median of 74 years. A total of 75 groin dissections were performed. Twenty-five of the 44 patients (56.8%) did not have groin node metastasis, 14 had unilateral metastasis (31.8%), and 5 (11.4%) had bilateral metastasis. All cases with histologically proven nodal status were analyzed to compare the preoperative imaging status with the histology. The calculated sensitivity, specificity, negative predictive value, and positive predictive value for CT were 58%, 75%, 75%, and 58%, for USS alone-87%, 69%, 94%, and 48%, and for USS-guided FNAC-80%, 100%, 93%, and 100%, respectively. There was no patient in whom surgical planning for the vulval carcinoma or the groin nodes was or could be altered by the CT findings. The data do not support the routine use of CT scanning in patients with primary SCCaV, either in assessment of the primary vulval carcinoma or in detecting groin nodal metastases. For the groin nodes, USS/FNAC is superior to CT in assessing disease status. In contrast to CT, USS/FNAC may have a useful clinical role in the management of the groin nodes in vulval carcinoma.

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

“…However, in some cases CT confirmed regional tumor spread found at the gynecological examination. This is in accordance with a retrospective study, which could not recommend a CT scan in the preoperative examination of vulvar carcinoma, due to low sensitivity and specificity in the diagnosis of lymph node metastases [11]. Preoperative palpation of the groin [15] and other imaging modalities, such as PET/CT [8, 9] and MRI [10], have also shown to be inaccurate in the detection of inguinal lymph node metastases.…”

“…Outside Denmark, these supplementary cross-sectional imaging modalities are recommended routinely [6, 7]. However, the literature is scarce regarding the benefit of these preoperative examinations for the decisive surgical procedure and the final outcome of the patients, including identification of lymph node metastases and probable comorbidity and incidental findings detected [8–11]. The final stage of the disease is determined by the combined gynecological, pathological and radiological findings, in accordance to the revised guidelines proposed by the International Federation of Gynecology and Obstetrics (FIGO) [12, 13].…”

Current controversies in the management of patients with early-stage vulvar cancer

“…In a single institution study of 44 vulvar cancer patients, ultrasound with FNAC has shown high sensitivity and specificity of 80 and 100%, respectively, with FNAC being performed in each groin on the largest or most abnormal looking lymph node [12]. Computed tomography (CT) scanning performed less well with a sensitivity of 58% and specificity of 75% in this same group of patients [12]. The use of MRI for determining inguinal node status has shown a sensitivity of 52-87% and a specificity of 85-89% [13,14 ].…”

Imaging Features of Uncommon Gynecologic Cancers

“…Typical ultrasound features are increase in size (e.g., > 5 mm in short-axis diameter), rounded shape, irregular contour, and loss of the fatty hilum. Ultrasound-guided fine-needle aspiration can help with proving nodal metastatic disease [40–42]. …”

“…CT provides information on the presence of pelvic lymphadenopathy and distant metastases with a sensitivity and specificity of 58% and 75%, respectively [40]. …”