AC Search
Document Navigator
Staging and Follow-up of Vulvar Cancer
Variant: 1
Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 2 cm, confined to the vulva or perineum, and with less than or equal to 1 mm stromal invasion.
| Procedure | Appropriateness Category | Relative Radiation Level |
| US duplex Doppler and US-guided fine-needle aspiration biopsy groin | Usually Not Appropriate | O |
| US duplex Doppler groin | Usually Not Appropriate | O |
| US-guided fine needle aspiration biopsy groin | Usually Not Appropriate | O |
| Radiography chest | Usually Not Appropriate | ☢ |
| MRI pelvis without and with IV contrast | Usually Not Appropriate | O |
| MRI pelvis without IV contrast | Usually Not Appropriate | O |
| Lymphoscintigraphy groin | Usually Not Appropriate | ☢☢ |
| CT abdomen and pelvis with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT pelvis with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT pelvis without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | Usually Not Appropriate | ☢☢☢☢ |
Variant: 2
Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 4 cm with greater than 1 mm stromal invasion, confined to vulva or perineum, or with minimal involvement of the urethra, vagina, or anus.
| Procedure | Appropriateness Category | Relative Radiation Level |
| MRI pelvis without and with IV contrast | Usually Appropriate | O |
| US duplex Doppler and US-guided fine-needle aspiration biopsy groin | May Be Appropriate | O |
| MRI pelvis without IV contrast | May Be Appropriate (Disagreement) | O |
| Lymphoscintigraphy groin | May Be Appropriate | ☢☢ |
| US duplex Doppler groin | Usually Not Appropriate | O |
| US-guided fine needle aspiration biopsy groin | Usually Not Appropriate | O |
| Radiography chest | Usually Not Appropriate | ☢ |
| CT abdomen and pelvis with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT pelvis with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT pelvis without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | Usually Not Appropriate | ☢☢☢☢ |
Variant: 3
Initial staging of pretreatment vulvar cancer: Primary tumor is greater than 4 cm or tumor of any size with more than minimal involvement of the urethra, vagina, or anus.
| Procedure | Appropriateness Category | Relative Radiation Level |
| MRI pelvis without and with IV contrast | Usually Appropriate | O |
| CT chest abdomen pelvis with IV contrast | Usually Appropriate | ☢☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | Usually Appropriate | ☢☢☢☢ |
| US duplex Doppler and US-guided fine-needle aspiration biopsy groin | May Be Appropriate (Disagreement) | O |
| US-guided fine needle aspiration biopsy groin | May Be Appropriate (Disagreement) | O |
| MRI pelvis without IV contrast | May Be Appropriate | O |
| CT abdomen and pelvis with IV contrast | May Be Appropriate | ☢☢☢ |
| CT abdomen and pelvis without IV contrast | May Be Appropriate (Disagreement) | ☢☢☢ |
| CT pelvis with IV contrast | May Be Appropriate | ☢☢☢ |
| CT chest abdomen pelvis without IV contrast | May Be Appropriate (Disagreement) | ☢☢☢☢ |
| US duplex Doppler groin | Usually Not Appropriate | O |
| Radiography chest | Usually Not Appropriate | ☢ |
| Lymphoscintigraphy groin | Usually Not Appropriate | ☢☢ |
| CT pelvis without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 4
Post-treatment assessment of clinically suspected recurrence of known vulvar cancer.
| Procedure | Appropriateness Category | Relative Radiation Level |
| MRI pelvis without and with IV contrast | Usually Appropriate | O |
| CT chest abdomen pelvis with IV contrast | Usually Appropriate | ☢☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | Usually Appropriate | ☢☢☢☢ |
| US duplex Doppler and US-guided fine-needle aspiration biopsy groin | May Be Appropriate (Disagreement) | O |
| US-guided fine needle aspiration biopsy groin | May Be Appropriate (Disagreement) | O |
| MRI pelvis without IV contrast | May Be Appropriate | O |
| CT abdomen and pelvis with IV contrast | May Be Appropriate | ☢☢☢ |
| CT abdomen and pelvis without IV contrast | May Be Appropriate (Disagreement) | ☢☢☢ |
| CT pelvis with IV contrast | May Be Appropriate (Disagreement) | ☢☢☢ |
| CT pelvis without IV contrast | May Be Appropriate (Disagreement) | ☢☢☢ |
| CT chest abdomen pelvis without IV contrast | May Be Appropriate (Disagreement) | ☢☢☢☢ |
| US duplex Doppler groin | Usually Not Appropriate | O |
| Radiography chest | Usually Not Appropriate | ☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Panel Members
Summary of Literature Review
Introduction/Background
Special Imaging Considerations
Discussion of Procedures by Variant
Variant 1: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 2 cm, confined to the vulva or perineum, and with less than or equal to 1 mm stromal invasion.
Variant 1: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 2 cm, confined to the vulva or perineum, and with less than or equal to 1 mm stromal invasion.
A. CT Abdomen and Pelvis
A. CT Abdomen and Pelvis
Variant 1: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 2 cm, confined to the vulva or perineum, and with less than or equal to 1 mm stromal invasion.
B. CT Chest, Abdomen, and Pelvis
B. CT Chest, Abdomen, and Pelvis
Variant 1: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 2 cm, confined to the vulva or perineum, and with less than or equal to 1 mm stromal invasion.
C. CT Pelvis
C. CT Pelvis
Variant 1: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 2 cm, confined to the vulva or perineum, and with less than or equal to 1 mm stromal invasion.
D. FDG-PET/CT Skull Base to Mid-Thigh
D. FDG-PET/CT Skull Base to Mid-Thigh
Variant 1: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 2 cm, confined to the vulva or perineum, and with less than or equal to 1 mm stromal invasion.
E. Lymphoscintigraphy Pelvis
E. Lymphoscintigraphy Pelvis
Variant 1: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 2 cm, confined to the vulva or perineum, and with less than or equal to 1 mm stromal invasion.
F. MRI Pelvis
F. MRI Pelvis
Variant 1: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 2 cm, confined to the vulva or perineum, and with less than or equal to 1 mm stromal invasion.
G. Radiography Chest
G. Radiography Chest
Variant 1: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 2 cm, confined to the vulva or perineum, and with less than or equal to 1 mm stromal invasion.
H. US Duplex Doppler and US-Guided Fine-Needle Aspiration Biopsy Groin
H. US Duplex Doppler and US-Guided Fine-Needle Aspiration Biopsy Groin
Variant 1: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 2 cm, confined to the vulva or perineum, and with less than or equal to 1 mm stromal invasion.
I. US Duplex Doppler Groin
I. US Duplex Doppler Groin
Variant 1: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 2 cm, confined to the vulva or perineum, and with less than or equal to 1 mm stromal invasion.
J. US-Guided Fine-Needle Aspiration Biopsy Groin
J. US-Guided Fine-Needle Aspiration Biopsy Groin
Variant 2: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 4 cm with greater than 1 mm stromal invasion, confined to vulva or perineum, or with minimal involvement of the urethra, vagina, or anus.
Variant 2: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 4 cm with greater than 1 mm stromal invasion, confined to vulva or perineum, or with minimal involvement of the urethra, vagina, or anus.
A. CT Abdomen and Pelvis
A. CT Abdomen and Pelvis
Variant 2: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 4 cm with greater than 1 mm stromal invasion, confined to vulva or perineum, or with minimal involvement of the urethra, vagina, or anus.
B. CT Chest, Abdomen, and Pelvis
B. CT Chest, Abdomen, and Pelvis
Variant 2: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 4 cm with greater than 1 mm stromal invasion, confined to vulva or perineum, or with minimal involvement of the urethra, vagina, or anus.
C. CT Pelvis
C. CT Pelvis
Variant 2: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 4 cm with greater than 1 mm stromal invasion, confined to vulva or perineum, or with minimal involvement of the urethra, vagina, or anus.
D. FDG-PET/CT Skull Base to Mid-Thigh
D. FDG-PET/CT Skull Base to Mid-Thigh
Variant 2: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 4 cm with greater than 1 mm stromal invasion, confined to vulva or perineum, or with minimal involvement of the urethra, vagina, or anus.
E. Lymphoscintigraphy Pelvis
E. Lymphoscintigraphy Pelvis
Variant 2: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 4 cm with greater than 1 mm stromal invasion, confined to vulva or perineum, or with minimal involvement of the urethra, vagina, or anus.
F. MRI Pelvis
F. MRI Pelvis
Variant 2: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 4 cm with greater than 1 mm stromal invasion, confined to vulva or perineum, or with minimal involvement of the urethra, vagina, or anus.
G. Radiography Chest
G. Radiography Chest
Variant 2: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 4 cm with greater than 1 mm stromal invasion, confined to vulva or perineum, or with minimal involvement of the urethra, vagina, or anus.
H. US Duplex Doppler and US-guided Fine-Needle Aspiration Biopsy Groin
H. US Duplex Doppler and US-guided Fine-Needle Aspiration Biopsy Groin
Variant 2: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 4 cm with greater than 1 mm stromal invasion, confined to vulva or perineum, or with minimal involvement of the urethra, vagina, or anus.
I. US Duplex Doppler Groin
I. US Duplex Doppler Groin
Variant 2: Initial staging of pretreatment vulvar cancer: Primary tumor is less than or equal to 4 cm with greater than 1 mm stromal invasion, confined to vulva or perineum, or with minimal involvement of the urethra, vagina, or anus.
J. US-Guided Fine-Needle Aspiration Biopsy Groin
J. US-Guided Fine-Needle Aspiration Biopsy Groin
Variant 3: Initial staging of pretreatment vulvar cancer: Primary tumor is greater than 4 cm or tumor of any size with more than minimal involvement of the urethra, vagina, or anus.
Variant 3: Initial staging of pretreatment vulvar cancer: Primary tumor is greater than 4 cm or tumor of any size with more than minimal involvement of the urethra, vagina, or anus.
A. CT Abdomen and Pelvis
A. CT Abdomen and Pelvis
Variant 3: Initial staging of pretreatment vulvar cancer: Primary tumor is greater than 4 cm or tumor of any size with more than minimal involvement of the urethra, vagina, or anus.
B. CT Chest, Abdomen, and Pelvis
B. CT Chest, Abdomen, and Pelvis
Variant 3: Initial staging of pretreatment vulvar cancer: Primary tumor is greater than 4 cm or tumor of any size with more than minimal involvement of the urethra, vagina, or anus.
C. CT Pelvis
C. CT Pelvis
Variant 3: Initial staging of pretreatment vulvar cancer: Primary tumor is greater than 4 cm or tumor of any size with more than minimal involvement of the urethra, vagina, or anus.
D. FDG-PET/CT Skull Base to Mid-Thigh
D. FDG-PET/CT Skull Base to Mid-Thigh
Variant 3: Initial staging of pretreatment vulvar cancer: Primary tumor is greater than 4 cm or tumor of any size with more than minimal involvement of the urethra, vagina, or anus.
E. Lymphoscintigraphy Groin
E. Lymphoscintigraphy Groin
Variant 3: Initial staging of pretreatment vulvar cancer: Primary tumor is greater than 4 cm or tumor of any size with more than minimal involvement of the urethra, vagina, or anus.
F. MRI Pelvis
F. MRI Pelvis
Variant 3: Initial staging of pretreatment vulvar cancer: Primary tumor is greater than 4 cm or tumor of any size with more than minimal involvement of the urethra, vagina, or anus.
G. Radiography Chest
G. Radiography Chest
Variant 3: Initial staging of pretreatment vulvar cancer: Primary tumor is greater than 4 cm or tumor of any size with more than minimal involvement of the urethra, vagina, or anus.
H. US Duplex Doppler and US-guided Fine-Needle Aspiration Biopsy Groin
H. US Duplex Doppler and US-guided Fine-Needle Aspiration Biopsy Groin
Variant 3: Initial staging of pretreatment vulvar cancer: Primary tumor is greater than 4 cm or tumor of any size with more than minimal involvement of the urethra, vagina, or anus.
I. US Duplex Doppler Groin
I. US Duplex Doppler Groin
Variant 3: Initial staging of pretreatment vulvar cancer: Primary tumor is greater than 4 cm or tumor of any size with more than minimal involvement of the urethra, vagina, or anus.
J. US-Guided Fine-Needle Aspiration Biopsy Groin
J. US-Guided Fine-Needle Aspiration Biopsy Groin
Variant 4: Post-treatment assessment of clinically suspected recurrence of known vulvar cancer.
Variant 4: Post-treatment assessment of clinically suspected recurrence of known vulvar cancer.
A. CT Abdomen and Pelvis
A. CT Abdomen and Pelvis
Variant 4: Post-treatment assessment of clinically suspected recurrence of known vulvar cancer.
B. CT Chest, Abdomen, and Pelvis
B. CT Chest, Abdomen, and Pelvis
Variant 4: Post-treatment assessment of clinically suspected recurrence of known vulvar cancer.
C. CT Pelvis
C. CT Pelvis
Variant 4: Post-treatment assessment of clinically suspected recurrence of known vulvar cancer.
D. FDG-PET/CT Skull Base to Mid-Thigh
D. FDG-PET/CT Skull Base to Mid-Thigh
Variant 4: Post-treatment assessment of clinically suspected recurrence of known vulvar cancer.
E. MRI Pelvis
E. MRI Pelvis
Variant 4: Post-treatment assessment of clinically suspected recurrence of known vulvar cancer.
F. Radiography Chest
F. Radiography Chest
Variant 4: Post-treatment assessment of clinically suspected recurrence of known vulvar cancer.
G. US Duplex Doppler and US-guided Fine-Needle Aspiration Biopsy Groin
G. US Duplex Doppler and US-guided Fine-Needle Aspiration Biopsy Groin
Variant 4: Post-treatment assessment of clinically suspected recurrence of known vulvar cancer.
H. US Duplex Doppler Groin
H. US Duplex Doppler Groin
Variant 4: Post-treatment assessment of clinically suspected recurrence of known vulvar cancer.
I. US-guided Fine-Needle Aspiration Biopsy Groin
I. US-guided Fine-Needle Aspiration Biopsy Groin
Summary of Recommendations
Supporting Documents
The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.
For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.
Appropriateness Category Names and Definitions
|
Appropriateness Category Name |
Appropriateness Rating |
Appropriateness Category Definition |
|
Usually Appropriate |
7, 8, or 9 |
The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients. |
|
May Be Appropriate |
4, 5, or 6 |
The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal. |
|
May Be Appropriate (Disagreement) |
5 |
The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned. |
|
Usually Not Appropriate |
1, 2, or 3 |
The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable. |
Relative Radiation Level Information
Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level (RRL) indication has been included for each imaging examination. The RRLs are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk associated with an imaging procedure. Patients in the pediatric age group are at inherently higher risk from exposure, because of both organ sensitivity and longer life expectancy (relevant to the long latency that appears to accompany radiation exposure). For these reasons, the RRL dose estimate ranges for pediatric examinations are lower as compared with those specified for adults (see Table below). Additional information regarding radiation dose assessment for imaging examinations can be found in the ACR Appropriateness Criteria® Radiation Dose Assessment Introduction document.
|
Relative Radiation Level Designations |
||
|
Relative Radiation Level* |
Adult Effective Dose Estimate Range |
Pediatric Effective Dose Estimate Range |
|
O |
0 mSv |
0 mSv |
|
☢ |
<0.1 mSv |
<0.03 mSv |
|
☢☢ |
0.1-1 mSv |
0.03-0.3 mSv |
|
☢☢☢ |
1-10 mSv |
0.3-3 mSv |
|
☢☢☢☢ |
10-30 mSv |
3-10 mSv |
|
☢☢☢☢☢ |
30-100 mSv |
10-30 mSv |
|
*RRL assignments for some of the examinations cannot be made, because the actual patient doses in these procedures vary as a function of a number of factors (e.g., region of the body exposed to ionizing radiation, the imaging guidance that is used). The RRLs for these examinations are designated as “Varies.” |
||
References
| 1. | Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 70(1):7-30, 2020 01. | |
| 2. | Beller U, Quinn MA, Benedet JL, et al. Carcinoma of the vulva. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet. 2006;95 Suppl 1:S7-27. | |
| 3. | Stroup AM, Harlan LC, Trimble EL. Demographic, clinical, and treatment trends among women diagnosed with vulvar cancer in the United States. Gynecol Oncol. 2008;108(3):577-583. | |
| 4. | National Cancer Institute. SEER Program. Cancer Stat Facts: Vulvar Cancer. Available at: www.seer.cancer.gov/statfacts/html/vulva.html. | |
| 5. | Viens LJ, Henley SJ, Watson M, et al. Human Papillomavirus-Associated Cancers - United States, 2008-2012. MMWR Morb Mortal Wkly Rep. 2016;65(26):661-666. | |
| 6. | NCCN Clinical Practice Guidelines in Oncology. Vulvar Cancer (Squamous Cell Carcinoma). Version 2. 2019. Available at: https://www.nccn.org/professionals/physician_gls/pdf/vulvar_blocks.pdf | |
| 7. | Hacker NF. Revised FIGO staging for carcinoma of the vulva. Int J Gynaecol Obstet. 2009;105(2):105-106. | |
| 8. | Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105(2):103-104. | |
| 9. | Amin MB, Edge S, Greene F, et al. AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017. | |
| 10. | Sedlis A, Homesley H, Bundy BN, et al. Positive groin lymph nodes in superficial squamous cell vulvar cancer. A Gynecologic Oncology Group Study. Am J Obstet Gynecol. 1987;156(5):1159-1164. | |
| 11. | Burger MP, Hollema H, Emanuels AG, Krans M, Pras E, Bouma J. The importance of the groin node status for the survival of T1 and T2 vulval carcinoma patients. Gynecol Oncol. 1995;57(3):327-334. | |
| 12. | Homesley HD, Bundy BN, Sedlis A, et al. Assessment of current International Federation of Gynecology and Obstetrics staging of vulvar carcinoma relative to prognostic factors for survival (a Gynecologic Oncology Group study). Am J Obstet Gynecol. 1991;164(4):997-1003; discussion 1003-1004. | |
| 13. | Maggino T, Landoni F, Sartori E, et al. Patterns of recurrence in patients with squamous cell carcinoma of the vulva. A multicenter CTF Study. Cancer. 2000;89(1):116-122. | |
| 14. | Aragona AM, Cuneo NA, Soderini AH, Alcoba EB. An analysis of reported independent prognostic factors for survival in squamous cell carcinoma of the vulva: is tumor size significance being underrated? Gynecol Oncol. 2014;132(3):643-648. | |
| 15. | Klapdor R, Wolber L, Hanker L, et al. Predictive factors for lymph node metastases in vulvar cancer. An analysis of the AGO-CaRE-1 multicenter study. Gynecol Oncol 2019;154:565-70. | |
| 16. | Van der Zee AG, Oonk MH, De Hullu JA, et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol. 2008;26(6):884-889. | |
| 17. | Beesley V, Janda M, Eakin E, Obermair A, Battistutta D. Lymphedema after gynecological cancer treatment : prevalence, correlates, and supportive care needs. Cancer. 2007;109(12):2607-2614. | |
| 18. | Wills A, Obermair A. A review of complications associated with the surgical treatment of vulvar cancer. Gynecol Oncol. 2013;131(2):467-479. | |
| 19. | Oonk MH, van Hemel BM, Hollema H, et al. Size of sentinel-node metastasis and chances of non-sentinel-node involvement and survival in early stage vulvar cancer: results from GROINSS-V, a multicentre observational study. Lancet Oncol. 2010;11(7):646-652. | |
| 20. | Te Grootenhuis NC, van der Zee AG, van Doorn HC, et al. Sentinel nodes in vulvar cancer: Long-term follow-up of the GROningen INternational Study on Sentinel nodes in Vulvar cancer (GROINSS-V) I. Gynecol Oncol. 2016;140(1):8-14. | |
| 21. | Covens A, Vella ET, Kennedy EB, Reade CJ, Jimenez W, Le T. Sentinel lymph node biopsy in vulvar cancer: Systematic review, meta-analysis and guideline recommendations. Gynecol Oncol. 2015;137(2):351-361. | |
| 22. | Oonk MH, van Os MA, de Bock GH, de Hullu JA, Ansink AC, van der Zee AG. A comparison of quality of life between vulvar cancer patients after sentinel lymph node procedure only and inguinofemoral lymphadenectomy. Gynecol Oncol. 2009;113(3):301-305. | |
| 23. | Levenback CF, Ali S, Coleman RL, et al. Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: a gynecologic oncology group study. J Clin Oncol. 2012;30(31):3786-3791. | |
| 24. | Stehman FB, Look KY. Carcinoma of the vulva. Obstet Gynecol. 2006;107(3):719-733. | |
| 25. | Land R, Herod J, Moskovic E, et al. Routine computerized tomography scanning, groin ultrasound with or without fine needle aspiration cytology in the surgical management of primary squamous cell carcinoma of the vulva. Int J Gynecol Cancer. 2006;16(1):312-317. | |
| 26. | Andersen K, Zobbe V, Thranov IR, Pedersen KD. Relevance of computerized tomography in the preoperative evaluation of patients with vulvar cancer: a prospective study. Cancer Imaging. 15:8, 2015 Jun 10. | |
| 27. | Kamran MW, O'Toole F, Meghen K, Wahab AN, Saadeh FA, Gleeson N. Whole-body [18F]fluoro-2-deoxyglucose positron emission tomography scan as combined PET-CT staging prior to planned radical vulvectomy and inguinofemoral lymphadenectomy for squamous vulvar cancer: a correlation with groin node metastasis. Eur J Gynaecol Oncol. 2014;35(3):230-235. | |
| 28. | Crivellaro C, Guglielmo P, De Ponti E, et al. 18F-FDG PET/CT in preoperative staging of vulvar cancer patients: is it really effective? Medicine 2017;96:e7943. | |
| 29. | Lin G, Chen CY, Liu FY, et al. Computed tomography, magnetic resonance imaging and FDG positron emission tomography in the management of vulvar malignancies. Eur Radiol. 2015;25(5):1267-1278. | |
| 30. | Robertson NL, Hricak H, Sonoda Y, et al. The impact of FDG-PET/CT in the management of patients with vulvar and vaginal cancer. Gynecologic Oncology. 140(3):420-4, 2016 Mar. | |
| 31. | Sohaib SA, Richards PS, Ind T, et al. MR imaging of carcinoma of the vulva. AJR Am J Roentgenol. 2002;178(2):373-377. | |
| 32. | Kataoka MY, Sala E, Baldwin P, et al. The accuracy of magnetic resonance imaging in staging of vulvar cancer: a retrospective multi-centre study. Gynecol Oncol. 2010;117(1):82-87. | |
| 33. | Bipat S, Fransen GA, Spijkerboer AM, et al. Is there a role for magnetic resonance imaging in the evaluation of inguinal lymph node metastases in patients with vulva carcinoma? Gynecol Oncol. 2006;103(3):1001-1006. | |
| 34. | Singh K, Orakwue CO, Honest H, Balogun M, Lopez C, Luesley DM. Accuracy of magnetic resonance imaging of inguinofemoral lymph nodes in vulval cancer. Int J Gynecol Cancer. 2006;16(3):1179-1183. | |
| 35. | Hawnaur JM, Reynolds K, Wilson G, Hillier V, Kitchener HC. Identification of inguinal lymph node metastases from vulval carcinoma by magnetic resonance imaging: an initial report. Clin Radiol. 2002;57(11):995-1000. | |
| 36. | de Gregorio N, Ebner F, Schwentner L, et al. The role of preoperative ultrasound evaluation of inguinal lymph nodes in patients with vulvar malignancy. Gynecol Oncol. 2013;131(1):113-117. | |
| 37. | Moskovic EC, Shepherd JH, Barton DP, Trott PA, Nasiri N, Thomas JM. The role of high resolution ultrasound with guided cytology of groin lymph nodes in the management of squamous cell carcinoma of the vulva: a pilot study. Br J Obstet Gynaecol. 1999;106(8):863-867. | |
| 38. | Hall TB, Barton DP, Trott PA, et al. The role of ultrasound-guided cytology of groin lymph nodes in the management of squamous cell carcinoma of the vulva: 5-year experience in 44 patients. Clin Radiol. 2003;58(5):367-371. | |
| 39. | Shylasree TS, Bryant A, Howells RE. Chemoradiation for advanced primary vulval cancer. Cochrane Database Syst Rev. 2011(4):CD003752. | |
| 40. | van Doorn HC, Ansink A, Verhaar-Langereis M, Stalpers L. Neoadjuvant chemoradiation for advanced primary vulvar cancer. Cochrane Database Syst Rev. 2006(3):CD003752. | |
| 41. | Garganese G, Collarino A, Fragomeni SM, et al. Groin sentinel node biopsy and 18F-FDG PET/CT-supported preoperative lymph node assessment in cN0 patients with vulvar cancer currently unfit for minimally invasive inguinal surgery: The GroSNaPET study. Eur J Surg Oncol. 43(9):1776-1783, 2017 Sep. | |
| 42. | Gonzalez Bosquet J, Magrina JF, Gaffey TA, et al. Long-term survival and disease recurrence in patients with primary squamous cell carcinoma of the vulva. Gynecol Oncol. 2005;97(3):828-833. | |
| 43. | Salani R, Backes FJ, Fung MF, et al. Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. [Review]. American Journal of Obstetrics & Gynecology. 204(6):466-78, 2011 Jun. | |
| 44. | Donati OF, Lakhman Y, Sala E, et al. Role of preoperative MR imaging in the evaluation of patients with persistent or recurrent gynaecological malignancies before pelvic exenteration. Eur Radiol. 2013 Oct;23(10):2906-15. | |
| 45. | Vargas HA, Burger IA, Donati OF, et al. Magnetic resonance imaging/positron emission tomography provides a roadmap for surgical planning and serves as a predictive biomarker in patients with recurrent gynecological cancers undergoing pelvic exenteration. Int J Gynecol Cancer. 2013;23(8):1512-1519. | |
| 46. | Burger IA, Vargas HA, Donati OF, et al. The value of 18F-FDG PET/CT in recurrent gynecologic malignancies prior to pelvic exenteration. Gynecologic Oncology. 129(3):586-592, 2013 Jun. | |
| 47. | American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf. |
Disclaimer
The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.