1
|
Ha M, Eva L. Imaging in Vulval Cancer. Cancers (Basel) 2024; 16:2269. [PMID: 38927973 PMCID: PMC11201686 DOI: 10.3390/cancers16122269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/13/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
Vulval cancer is a rare gynaecological cancer, accounting for 3% of all gynaecological malignancies, with 47,000 cases in 2022 globally. Various imaging modalities are widely used in conjunction with clinical assessment in the diagnosis and staging of vulval cancers; however, there is significant heterogeneity in which modalities are recommended in international guidelines, reflecting the paucity of evidence in this area. We reviewed the current evidence for the role of imaging in vulval cancer. A systematic search of the literature was performed on the PubMed database using the MeSH terms 'vulval neoplasm' and 'diagnostic imaging'. We found that there is insufficient evidence to support the routine use of imaging for primary vulval tumours. For nodal assessment, there is no ideal imaging modality with sensitivity or specificity that is superior to other modalities. For distant metastases, CT CAP and FDG-PET/CT have the most evidence to support their use. In conclusion, the evidence for role of imaging in vulval cancer is limited by the heterogeneity of the study design and diagnostic criteria used in each study and the small sample size and retrospective nature of most studies.
Collapse
Affiliation(s)
| | - Lois Eva
- Department of Gynaecological Oncology, Te Toka Tumai Auckland City Hospital, Auckland 1023, New Zealand;
| |
Collapse
|
2
|
Chargari C, Wasserman J, Gabro A, Canlobre G, Spano JP, Uzan C, Maingon P. Vulvar Carcinoma: Standard of Care and Perspectives. J Clin Oncol 2024; 42:961-972. [PMID: 38315939 DOI: 10.1200/jco.23.01187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/24/2023] [Accepted: 11/14/2023] [Indexed: 02/07/2024] Open
Abstract
PURPOSE Treatment of vulvar carcinoma (VC) is challenging. The objectives of this review were to describe for clinicians the epidemiologic and clinical aspects of VC, the standard of care in terms of primary local treatment and systemic therapies, and the recent innovations and perspectives emerging from translational research in immuno-oncology. DESIGN We conducted a comprehensive review outlying the clinical aspects and biologic background of vulvar cancer, highlighting modern treatment strategies on the basis of a personalized approach. RESULTS Epidemiologic data showed a recent rise in incidence of VC, attributed to human papillomavirus. Surgery is the mainstay of primary treatment, but multimodal approaches are frequently required in the presence of adverse prognosis histopathologic factors. Chemoradiation is indicated when organ-sparing surgery is not feasible. However, inability to achieve high locoregional control rates in advanced cases and the morbidity associated with local treatments are still key issues. Recent clinical data showed the benefit of individualized strategies combining organ-sparing surgical strategies, less invasive lymph node staging procedures, and refinement in radiotherapy modalities. Among the most important research area, there is a sound rationale for testing modern systemic approaches such as immune checkpoint inhibitors in selected patients with recurrent and/or metastatic tumors. Although no specific data exist for VC, the role of supportive care and post-treatment rehabilitation strategies is also crucial. CONCLUSION There are still insufficient studies dedicated to patients with VC. Public health programs for prevention, screening, and early diagnosis are required, and clinical research should be strengthened to provide high-quality clinical evidence and improve patients' oncologic and functional outcomes.
Collapse
Affiliation(s)
- Cyrus Chargari
- Service d'oncologie radiothérapie, Hôpital Universitaire Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
| | - Johanna Wasserman
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
- Service d'oncologie médicale, Hôpital Universitaire Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
| | - Alexandra Gabro
- Service d'oncologie radiothérapie, Hôpital Universitaire Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
| | - Geoffroy Canlobre
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
- Service de chirurgie et cancérologie gynécologique et mammaire, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
- INSERM UMR S938, Biologie et Thérapeutique des cancers, Paris, France
| | - Jean-Philippe Spano
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
- Service d'oncologie médicale, Hôpital Universitaire Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
| | - Catherine Uzan
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
- Service de chirurgie et cancérologie gynécologique et mammaire, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
- INSERM UMR S938, Biologie et Thérapeutique des cancers, Paris, France
| | - Philippe Maingon
- Service d'oncologie radiothérapie, Hôpital Universitaire Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) Sorbonne Université, Paris, France
- Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
| |
Collapse
|
3
|
Fischerova D, Smet C, Scovazzi U, Sousa DN, Hundarova K, Haldorsen IS. Staging by imaging in gynecologic cancer and the role of ultrasound: an update of European joint consensus statements. Int J Gynecol Cancer 2024; 34:363-378. [PMID: 38438175 PMCID: PMC10958454 DOI: 10.1136/ijgc-2023-004609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/05/2024] [Indexed: 03/06/2024] Open
Abstract
In recent years the role of diagnostic imaging by pelvic ultrasound in the diagnosis and staging of gynecological cancers has been growing exponentially. Evidence from recent prospective multicenter studies has demonstrated high accuracy for pre-operative locoregional ultrasound staging in gynecological cancers. Therefore, in many leading gynecologic oncology units, ultrasound is implemented next to pelvic MRI as the first-line imaging modality for gynecological cancer. The work herein is a consensus statement on the role of pre-operative imaging by ultrasound and other imaging modalities in gynecological cancer, following European Society guidelines.
Collapse
Affiliation(s)
- Daniela Fischerova
- Gynecologic Oncology Center, Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Carolina Smet
- Department of Obstetrics and Gynecology, São Francisco de Xavier Hospital in Lisbon, Lisbon, Portugal
| | - Umberto Scovazzi
- Department of Gynecology and Obstetrics, Ospedale Policlinico San Martino and University of Genoa, Genoa, Italy
| | | | - Kristina Hundarova
- Department of Gynecology and Obstetrics A, Hospital and University Centre of Coimbra, Coimbra, Portugal
| | - Ingfrid Salvesen Haldorsen
- Mohn Medical Imaging and Visualization Centre (MMIV), Department of Radiology and Department of Clinical Medicine, Haukeland University Hospital and the University of Bergen, Bergen, Norway
| |
Collapse
|
4
|
Pleunis N, Pouwer AFW, Oonk MHM, van Doorn HC, Tjiong MY, van der Velden J, Zijlmans H, van Poelgeest MIE, van Dorst EB, Slangen BFM, Verhoef LCG, Pijnenborg JMA, de Hullu JA. Incidence of inguinofemoral lymph node metastases at the first local recurrence of vulvar cancer: a Dutch nationwide study. Br J Cancer 2023; 129:956-964. [PMID: 37507545 PMCID: PMC10491599 DOI: 10.1038/s41416-023-02373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/05/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Up to 40% of vulvar cancer patients present with local recurrence within 10 years of follow-up. An inguinofemoral lymphadenectomy (IFL) is indicated if not performed at primary treatment. The incidence and risk factors for lymph node metastases (LNM) at first local recurrence, however, are unclear. Our aim was to determine the incidence of LNM at first local recurrence, in relation to previous groin treatment and clinicopathological factors. METHODS A multicenter cohort study including vulvar cancer patients with a first macroinvasive local recurrence after primary surgical treatment between 2000 and 2015 was conducted in the Netherlands. Groin status at local recurrence was defined as positive (N+), negative (N-) or unknown (N?) and based on histology, imaging and follow-up. Patient-, tumour- and treatment characteristics of primary and recurrent disease were analysed. RESULTS Overall, 16.3% (66/404) had a N+ groin status at first local recurrence, 66.4% (268/404) N- and 17.3% (70/404) N? groin status. The incidence of a N+ groin status was comparable after previous SLN and IFL, 11.5% and 13.8%, respectively. A N+ groin status was related to tumour size (25 vs.12 mm; P < 0.001), depth of invasion (5 vs. 3 mm; P < 0.001) and poorly differentiated tumours (22.9 vs. 11.9%; P = 0.050) at local recurrence. CONCLUSIONS The incidence of LNM at first local recurrence in vulvar cancer patients was 16.3%, and independent of previous type of groin surgery. In accordance with primary diagnosis, tumour size, depth of invasion, and tumour grade were significantly associated with a positive groin status.
Collapse
Affiliation(s)
- Noortje Pleunis
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands.
- Department of Obstetrics and Gynaecology, Rijnstate Hospital, Arnhem, the Netherlands.
| | - Anne-Floor W Pouwer
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maaike H M Oonk
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Helena C van Doorn
- Department of Gynaecological Oncology, ErasmusMC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Ming Y Tjiong
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Jacobus van der Velden
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Henry Zijlmans
- Department of Gynaecological Oncology, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | | | - Eleonora B van Dorst
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Brigitte F M Slangen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, GROW-School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - Lia C G Verhoef
- Department of Radiotherapy, Radboud University Medical Center and Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Johanna M A Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joanne A de Hullu
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
5
|
Oonk MHM, Planchamp F, Baldwin P, Mahner S, Mirza MR, Fischerová D, Creutzberg CL, Guillot E, Garganese G, Lax S, Redondo A, Sturdza A, Taylor A, Ulrikh E, Vandecaveye V, van der Zee A, Wölber L, Zach D, Zannoni GF, Zapardiel I. European Society of Gynaecological Oncology Guidelines for the Management of Patients with Vulvar Cancer - Update 2023. Int J Gynecol Cancer 2023; 33:1023-1043. [PMID: 37369376 PMCID: PMC10359596 DOI: 10.1136/ijgc-2023-004486] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/20/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND As part of its mission to improve the quality of care for women with gynecological cancers across Europe, the European Society of Gynaecological Oncology (ESGO) first published in 2017 evidence-based guidelines for the management of patients with vulvar cancer. OBJECTIVE To update the ESGO guidelines based on the new evidence addressing the management of vulvar cancer and to cover new topics in order to provide comprehensive guidelines on all relevant issues of diagnosis and treatment of vulvar cancer. METHODS The ESGO Council nominated an international development group comprised of practicing clinicians who provide care to vulvar cancer patients and have demonstrated leadership through their expertize in clinical care and research, national and international engagement and profile as well as dedication to the topics addressed to serve on the expert panel (18 experts across Europe). To ensure that the statements were evidence-based, new data identified from a systematic search were reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Prior to publication, the guidelines were reviewed by 206 international practitioners in cancer care delivery and patient representatives. RESULTS The updated guidelines cover comprehensively diagnosis and referral, staging, pathology, pre-operative investigations, surgical management (local treatment, groin treatment, sentinel lymph node procedure, reconstructive surgery), (chemo)radiotherapy, systemic treatment, treatment of recurrent disease (vulvar, inguinal, pelvic, and distant recurrences), and follow-up. Management algorithms are also defined.
Collapse
Affiliation(s)
- Maaike H M Oonk
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Sven Mahner
- University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | | | - Daniela Fischerová
- Charles University First Faculty of Medicine, Prague, Czech Republic
- General University Hospital in Prague, Prague, Czech Republic
| | | | | | - Giorgia Garganese
- Catholic University of the Sacred Heart, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sigurd Lax
- Hospital Graz II, Graz, Austria
- Johannes Kepler Universitat Linz, Linz, Austria
| | | | | | | | - Elena Ulrikh
- Almazov National Medical Research Center, Saint Petersburg, Russian Federation
| | | | - Ate van der Zee
- University Medical Center Groningen, Groningen, The Netherlands
| | - Linn Wölber
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Diana Zach
- Karolinska University Hospital, Stockholm, Sweden
- Karolinska Institutet Eugeniavägen, Stockholm, Sweden
| | - Gian Franco Zannoni
- Catholic University of the Sacred Heart, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | |
Collapse
|
6
|
Gaillard AL, Renaud T, Brocard C, Deleau F, Petit A, Guyon F, Lebreton C, Babin G, Mairé M, Chamming's F. Cancers de la vulve : dernières actualités et nouvelle classification Figo 2021. IMAGERIE DE LA FEMME 2023. [DOI: 10.1016/j.femme.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
|
7
|
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. Cancers (Basel) 2022; 14:cancers14163852. [PMID: 36010846 PMCID: PMC9406001 DOI: 10.3390/cancers14163852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/30/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Vulvar cancer is a rare gynecologic tumor (representing 4% of all gynecologic malignancies). We review the role of MRI in patients with locally advanced vulvar cancer (LAVC), highlighting the findings that influence clinical management. We also present the MRI findings of local recurrence according to its type and location. Abstract Magnetic resonance imaging (MRI) plays an essential role in the management of patients with locally advanced vulvar cancer (LAVC), who frequently benefit from a multidisciplinary approach. Accordingly, chemoradiotherapy (CRT) with radical or neoadjuvant intent seems to provide a better quality of life and less morbidity than extensive surgery alone. In this overview, we discuss the role of MRI in the post-CRT assessment of LAVC, emphasizing the evaluation of primary tumor response. In order to assess treatment response and select candidates for post-CRT local excision, the MRI findings are described according to signal intensity, restricted diffusion, enhancement, and invasion of adjacent organs. We also focus on the role of MRI in detecting vulvar cancer recurrence. It occurs in 30–50% of patients within two years after initial treatment, the majority appearing near the original resection margins or in ipsilateral inguinal or pelvic lymph nodes. Finally, we describe early and delayed complications of CRT, such as cellulitis, urethritis, vulvar edema, bone changes, myositis, and fistulization. By describing the role of MRI in assessing LAVC response to CRT and detecting recurrence, we hope to provide suitable indications for a personalized approach.
Collapse
|
8
|
Verri D, Moro F, Fragomeni SM, Zaçe D, Bove S, Pozzati F, Gui B, Scambia G, Testa AC, Garganese G. The Role of Ultrasound in the Evaluation of Inguinal Lymph Nodes in Patients with Vulvar Cancer: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14133082. [PMID: 35804853 PMCID: PMC9265034 DOI: 10.3390/cancers14133082] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/19/2022] [Accepted: 06/19/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Currently, around 30% of vulvar cancer cases at first diagnosis are spread to the inguinal lymph nodes. Preoperative staging of patients affected by vulvar carcinoma is still a hot topic. To date, MRI has shown a great diagnostic accuracy on defining disease extension to soft tissue and deep organs. At present, regarding the study of inguinal nodes, the PET/CT scan has shown a high negative predictive value, although in the presence of a suspicious/positive report it should be taken with caution. We report the results of a study aimed to investigate the role of groin ultrasound in the assessment of lymph nodal status in vulvar cancer. Furthermore, this review represents the most accurate collection of papers available in the literature. This work demonstrates that groin ultrasound can be considered a valuable tool for risk assessment of the presence of groin lymph node metastases. Achieving a high diagnostic accuracy would allow tailored surgical planning with access to minimally invasive surgery techniques for an increasing number of patients. 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.
Collapse
Affiliation(s)
- Debora Verri
- Gynecology and Breast Care Center, Mater Olbia Hospital, 07026 Olbia, Italy; (D.V.); (S.B.); (G.G.)
| | - Francesca Moro
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (F.P.); (G.S.); (A.C.T.)
| | - Simona Maria Fragomeni
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (F.P.); (G.S.); (A.C.T.)
- Correspondence: ; Tel.: +39-3669392149; Fax: +39-0630156279
| | - Drieda Zaçe
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Sonia Bove
- Gynecology and Breast Care Center, Mater Olbia Hospital, 07026 Olbia, Italy; (D.V.); (S.B.); (G.G.)
| | - Federica Pozzati
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (F.P.); (G.S.); (A.C.T.)
| | - Benedetta Gui
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Giovanni Scambia
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (F.P.); (G.S.); (A.C.T.)
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Antonia Carla Testa
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (F.P.); (G.S.); (A.C.T.)
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Giorgia Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, 07026 Olbia, Italy; (D.V.); (S.B.); (G.G.)
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| |
Collapse
|
9
|
Virarkar M, Vulasala SS, Daoud T, Javadi S, Lall C, Bhosale P. Vulvar Cancer: 2021 Revised FIGO Staging System and the Role of Imaging. Cancers (Basel) 2022; 14:2264. [PMID: 35565394 PMCID: PMC9102312 DOI: 10.3390/cancers14092264] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 01/27/2023] Open
Abstract
Vulvar cancer is a rare gynecological malignancy. It constitutes 5-8% of all gynecologic neoplasms, and squamous cell carcinoma is the most common variant. This article aims to review the etiopathogenesis revised 2021 International Federation of Gynecology and Obstetrics (FIGO) classification and emphasize imaging in the staging of vulvar cancer. The staging has been regulated by FIGO since 1969 and is subjected to multiple revisions. Previous 2009 FIGO classification is limited by the prognostic capability, which prompted the 2021 revisions and issue of a new FIGO classification. Although vulvar cancer can be visualized clinically, imaging plays a crucial role in the staging of the tumor, assessing the tumor extent, and planning the management. In addition, sentinel lymph node biopsy facilitates the histopathological staging of the draining lymph node, thus enabling early detection of tumor metastases and better survival rates.
Collapse
Affiliation(s)
- Mayur Virarkar
- Department of Diagnostic Radiology, University of Florida College of Medicine, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL 32209, USA; (M.V.); (C.L.)
| | - Sai Swarupa Vulasala
- Department of Diagnostic Radiology, University of Florida College of Medicine, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL 32209, USA; (M.V.); (C.L.)
| | - Taher Daoud
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA; (T.D.); (S.J.); (P.B.)
| | - Sanaz Javadi
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA; (T.D.); (S.J.); (P.B.)
| | - Chandana Lall
- Department of Diagnostic Radiology, University of Florida College of Medicine, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL 32209, USA; (M.V.); (C.L.)
| | - Priya Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA; (T.D.); (S.J.); (P.B.)
| |
Collapse
|
10
|
MRI Staging in Locally Advanced Vulvar Cancer: From Anatomy to Clinico-Radiological Findings. A Multidisciplinary VulCan Team Point of View. J Pers Med 2021; 11:jpm11111219. [PMID: 34834571 PMCID: PMC8624255 DOI: 10.3390/jpm11111219] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022] Open
Abstract
MR imaging provides excellent spatial and contrast resolution to stage locally advanced vulvar cancer (LAVC) for tumor and nodal evaluation in order to facilitate the planning of treatment. Although there are no standard indications for how to estimate the clinical stage of International Federation of Gynecology and Obstetrics at diagnosis, MR imaging can depict the tumor and its extension to the vulvar region and adjacent organs, such as the vagina, urethra, and anus. Optimizing the MR imaging protocol and technique is fundamental for correct staging. The aim of this overview was to focus on the role of MR imaging in LAVC staging. We define vulvar anatomy and corresponding MR imaging findings, MR imaging protocol, and technique. Moreover, we describe the MR imaging findings of LAVC with example cases stage by stage. Key imaging findings based on signal intensity, diffusion restriction, and enhancement are portrayed to correctly identify and stage vulvar cancer. A structured report for LAVC staging is reported in order to give all necessary information to the clinicians and to facilitate MR imaging comprehension.
Collapse
|