Ultrasound morphometric and cytologic preoperative assessment of inguinal lymph‐node status in women with vulvar cancer: MorphoNode study

Abstract

Objective To assess the accuracy of preoperative ultrasound examination for predicting lymph‐node (LN) status in patients with vulvar cancer. Methods This was a single‐institution retrospective observational study of all women with a histological diagnosis of vulvar cancer triaged to inguinal surgery within 30 days following ultrasound evaluation between December 2010 and January 2016. For each groin examined, 15 morphological and dimensional sonographic parameters associated with suspicion for LN involvement were examined. A morphometric ultrasound pattern (MUP) was expressed for each groin, classifying the inguinal LN status into five groups (normal; reactive‐but‐negative; minimally suspicious/probably negative; moderately suspicious; and highly suspicious/positive) according to subjective judgment, followed by stratification as positive or negative for metastasis according to morphometric binomial assessment (MBA). In cases of positive MBA, fine‐needle aspiration cytology was performed. Combining the information obtained from MUP and cytologic results, a binomial final overall assessment (FOA) was assigned for each groin. The final histology was considered as the reference standard. Comparison was performed between patients with negative and those with positive LNs on histology, and receiver‐operating‐characteristics curves were generated for statistically significant variables on univariate analysis, to evaluate their diagnostic ability to predict negative LN status. Results Of 144 patients included in the analysis, 87 had negative inguinal LNs and 57 had positive LNs on histology. A total of 256 groins were analyzed, of which 171 were negative and 85 showed at least one metastatic LN on histology. The following parameters showed the greatest accuracy, with the best balance between specificity and sensitivity, in predicting negative LN status: cortical (C) thickness of the dominant LN (cut‐off, 2.5 mm; sensitivity, 90.0%; specificity, 77.9%); short‐axis (S) length of the dominant LN (cut‐off, 8.4 mm; sensitivity, 63.9%; specificity, 90.6%); C/medulla (M) thickness ratio of the dominant LN (cut‐off, 1.2 mm; sensitivity, 70.4%; specificity, 91.5%), the combination of S length and C/M thickness ratio (sensitivity, 88.9%; specificity, 82.4%); and the FOA analysis (sensitivity, 85.9%; specificity, 84.2%). Conclusions Preoperative ultrasound assessment, with or without the addition of cytology, has a high accuracy in assessing inguinal LN status in patients with vulvar cancer. In particular, the combination of two ultrasound parameters (S length and C/M thickness ratio) provided the greatest accuracy in discriminating between negative and positive LNs. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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

“…Surgery varies from the minimally invasive sentinel node biopsy (SNB) to the more demolitive radical lymphadenectomy, which is often followed by lymphedema of the lower limbs [8]. LN assessment is mainly performed by ultrasonography with or without cytological evaluation of suspicious LNs and computed tomography (CT) [9][10][11][12]. 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].…”

Prognostic factors and surgical treatment in vulvar carcinoma: Single center experience

“…Results of our study confirm data of literature focusing attention on sentinel lymph node (SLN) technique. ESGO guidelines 7 recommend sentinel node procedure for mono‐focal tumor less‐than 4 cm without suspected nodes at clinical examination or imaging 20–22 in order to minimize complication of radical lymphadenectomy. In fact, about 50% of patients underwent to inguinal lymphadenectomy have post‐operatory complications including infections, wound dehiscence, lymphocele and lymphedema 23,24 .…”

Personalizing vulvar cancer workflow in COVID-19 era: a proposal from Vul.Can MDT

“…Nevertheless, considering the need for reducing the severe morbidity related to this surgical procedure (DiSaia et al 1979 ; Carlson et al 2018 ), a sentinel lymph node biopsy could be considered instead of standard radical lymphadenectomy always after discussion in MDTB. Recent preliminary evidences showed the safety of the procedure even in this setting only if provided that an accurate ultrasound and metabolic (PET/CT) assessment of the lymph node status is performed by expert examiners (Garganese et al 2017 , 2020 ). Possible modulation in radiation therapy approach is reported in Table 4 .…”