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

Abstract

Objective. To determine the efficacy of ultrasound in assessing the inguinal lymph nodes in patients with vulvar cancer. Methods. A systematic review of published research up to October 2020 that compares the results of ultrasound to determine groin node status with histology was conducted. All study types that reported primary data on the role of ultrasound in the evaluation of groin lymph nodes in vulvar cancer were included in the systematic review. Data retrieved from the included studies were pooled in random-effects meta-analyses. Results. After the screening and selection process, eight articles were deemed pertinent for inclusion in the systematic review and meta-analysis. The random-effects model showed a pooled Se of 0.85 (95% CI: 0.81–0.89), Sp of 0.86 (95% CI: 0.81–0.91), PPV of 0.65 (95% CI: 0.54–0.79) and NPV of 0.92 (95% CI: 0.91–0.94). There was a pooled LR+ and LR− of 6.44 (95% CI: 3.72–11.4) and 0.20 (95% CI: 0.14–0.27), respectively. The pooled accuracy was 0.85 (95% CI: 0.80–0.91). Conclusions. Although the studies had small sample sizes, this review represents the best summary of the data so far. Ultrasound has revealed high sensitivity and high negative predictive value in the assessment of nodal status in vulvar cancer.

Recommendations for the treatment of vulvar cancer in settings with limited resources: Report from the International Gynecological Cancer Society consensus meeting

“…Considering the staging, the combination of ultrasound and fine-needle aspiration cytology of groin nodes provides a sensitive and specific tool for preoperative assessment in selected patients with vulvar cancer. Ultrasound is easily available even in countries with limited resources and has lower costs compared with other imaging methods ( 17 – 19 ).…”

Sonographic localisation and description of inguinofemoral lymph nodes in patients with vulvar squamous cell carcinoma

“…It occurs in any part of the vulva, and most commonly in the labia minora, labia majora and perineum and is more common in postmenopausal women 3 . Patients will often present with a painful vulvar mass or ulcer which may be associated with pruritis, bleeding and discharge 4 . Squamous cell carcinoma (SCC) accounts for 80%–95% of malignant vulvar cancer cases 5,6 .…”

“…Vulvar cancer spreads by local invasion directly into local organs (vagina, urethra and anus), lymphatic metastasis to regional lymph nodes 2 and less commonly via haematogenous spread to distal sites (liver, lungs, and bones) 8 . Upon diagnosis, the groin is clinically assessed to determine if there is any inguinofemoral lymph node involvement 4 . The risk of nodal metastasis of vulvar cancer increases with the stage of disease, size of the lesion and depth of the invasion 2 .…”

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

“…This is the first approach to assess the extent of disease, providing information about the number of vulvar lesions and the relative site and size, the distance to midline, and finally, the presence of palpable inguinal lymph nodes. A concurrent ultrasound of the inguinal lymph nodes provides more accurate information about lymph node status [ 6 , 7 ].…”