Pelvic MRI including the inguinal regions should be performed for local staging of SCC with stromal invasion >1 mm, tumour size >4 cm or tumours with suspicious involvement of the urethra, vagina, or anus according to clinical evaluation. A lack of evidence regarding the appropriateness of MRI staging of tumours sized between >2 cm and ≤4 cm with stromal invasion ≤1 mm is noted and, in those cases, the decision to refer the patient to MRI should depend on the clinical suspicion of tumour invasion of the nearby situated organs.
Recomendation ESUR guidelines 2021:
For primary tumours ≤2 cm, confined to the vulva and/ or perineum, and with ≤ 1 mm of stromal invasion, imaging staging is not recommended.
Pelvic MRI including the inguinal regions should be performed for local stag- ing of SCC with stromal invasion >1 mm, tumour size >4 cm, or tumours with suspicious involvement of the urethra, vagina, or anus according to clinical evaluation.
For tumours > 2 cm and ≤ 4 cm, clinical staging and groin ultrasound (with puncture of suspicious lymph nodes) or MRI staging are both considered valid options.
For regional or locally advanced disease (FIGO stages III–IVA) or suspicious distant metastases (FIGO stage IVB), chest, abdominal and pelvic CT (or PET/CT) with coverage of the inguinal regions should be performed. Intravenous contrast should be administrated with image acquisition on portal-venous phase (60–80 s) to increase diagnostic accuracy.
Lymph Nodes
The most widely accepted criterion for inguinofemoral lymphadenopathy is short-axis > 1 cm.
The most specific criterion for inguinofemoral lymphadenopathy is the presence of necrosis; however, it has low sensitivity.
For all imaging modalities, the most commonly used criterion for regional lymph node metastasis is the short-axis, usually considered suspicious when >1 cm; however, its reported sensitivity is low, ranging between 43 and 86%. Other features may be helpful, especially when combined, namely irregular contour, round shape, presence of necrosis, loss of fatty hilum and a ratio of short-to-long-axis diameter ≥0.75.
Care should be taken when MRI is performed shortly after a diagnostic vulvar biopsy, as this may result in reactive lymph node changes that may be mistaken by metastatic lymphadenopathy.
Comments