Prospective Evaluation of Positron Emission Tomography for the Detection of Groin Node Metastases from Vulvar Cancer

doi:10.1006/gyno.2002.6605

Gynecologic Oncology

Volume 85, Issue 1, April 2002, Pages 179-184

https://doi.org/10.1006/gyno.2002.6605 Get rights and content

Abstract

Objective. We set out to determine the ability of positron emission tomography with fluorodeoxyglucose to detect groin lymph node metastases from vulvar cancer.

Methods. From January 2000 to August 2001, patients with squamous cell cancer of the vulva undergoing radical excision and lymphadenectomy were offered preoperative positron emission tomography. The imaging and pathologic status of each patient and groin were compared, and the sensitivity, specificity, and predictive value of positron emission tomography in predicting nodal metastasis were determined.

Results. Fifteen patients underwent positron emission tomography prior to exploration of 29 groins. Six patients had positive scans, suggesting metastases in 8 groins. Pathologically, 5 patients had metastases in 9 groins, with positron emission tomography demonstrating metastases in 4 of 5 patients and 6 of 9 groins with disease. On a patient-by-patients basis, positron emission tomography had a sensitivity of 80%, specificity of 90%, positive predictive value of 80%, and negative predictive value of 90% in demonstrating metastases. On a groin-by-groin basis, positron emission tomography had a sensitivity of 67%, specificity of 95%, positive predictive value of 86%, and negative predictive value of 86%. Positron emission tomography was more accurate in detecting extranodal metastases than disease confined within the groin nodes (P = 0.048).

Conclusions. Positron emission tomography is relatively insensitive in predicting lymph node metastasis, and a negative study is not a reliable surrogate for a pathologically negative groin. However, the high specificity suggests that positron emission tomography is useful in planning radiation therapy and as an adjunct to lymphatic mapping and sentinel lymph node dissection.

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Citation Excerpt :
A possible objection to the above conclusions is that non-invasive tests may be neither sensitive nor specific enough to direct therapy. Retrospective data suggests that PET/CT, our institution's preferred staging strategy, has a sensitivity of approximately 60–80% and specificity of 80–90% [17,18]. While the data in the present study are fairly conclusive that the groins of patients with non-suspicious inguinal nodes who require vulvar radiation are adequately treated with 45–50 Gy alone and do not require biopsy, some clinicians may be hesitant to commit a patient to the higher dose recommended for positive nodes based on PET/CT alone.
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A retrospective review of patients treated with dose-escalated (≥ 55Gy) IMRT from 2012 to 2018 for locally-advanced vulvar cancer was performed. Patients treated with preoperative or definitive intent were included. Rates of cCR and pCR were assessed, and predictors of disease-free survival (DFS) were analyzed using the Kaplan Meier method with log rank test between groups and a parsimonious multivariate Cox model.
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Dose-escalated IMRT for locally-advanced vulvar cancer is well tolerated, with rates of cCR and pCR that compare favorably with published data.
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Vulvar squamous cell carcinoma (VSCC) commonly metastasises through groin lymphatics. However, the use of pre-operative imaging in detecting inguinal nodal metastasis before staging surgery or to triage patients for sentinel node biopsy remains unclear. Here, we investigated if pre-operative CT scan, the imaging choice in our cancer centre, influences the overall course of VSCC management in those patients without clinical evidence of groin lymphadenopathy.
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This chapter covers cervical cancer, vulvar cancer, and vaginal cancer. It discusses the etiology, diagnosis, and pathologic features of all the different cancers in each category. Diagnosis and treatment of preinvasive in addition to invasive disease in all three categories are examined, including surgical therapy, radiation therapy, and chemotherapy. Recent studies and evidence in the diagnosis and treatment of these three very different cancers are reported.
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¹: To whom reprint requests should be addressed at Division of Gynecologic Oncology, Ohio State University, James Cancer Hospital and Solove Research Institute, M-210 Starling Loving, 320 West 10th Avenue, Columbus, OH 43210. Fax: (614) 293-3078. E-mail: [email protected].

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Regular ArticleProspective Evaluation of Positron Emission Tomography for the Detection of Groin Node Metastases from Vulvar Cancer

Abstract

Am J Obstet Gynecol

Clin Positron Imaging

Int J Radiat Biol Phys

Cancer statistics, 2002

CA Cancer J Clin

Individualized treatment of stage I carcinoma of the vulva

Obstet Gynecol

The metabolism of tumors

Positron emission tomography for evaluating para-aortic nodal metastasis in locally advanced cervical cancer before surgical staging: a surgicopathologic study

J Clin Oncol

Regular Article
Prospective Evaluation of Positron Emission Tomography for the Detection of Groin Node Metastases from Vulvar Cancer