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European Radiology

, Volume 25, Issue 5, pp 1267–1278 | Cite as

Computed tomography, magnetic resonance imaging and FDG positron emission tomography in the management of vulvar malignancies

  • Gigin Lin
  • Chao-Yu Chen
  • Feng-Yuan Liu
  • Lan-Yan Yang
  • Huei-Jean Huang
  • Yi-Ting Huang
  • Shih-Ming Jung
  • Hung-Hsueh Chou
  • Chyong-Huey LaiEmail author
  • Koon-Kwan NgEmail author
Oncology

Abstract

Objectives

To prospectively evaluate the value of CT or MRI (CT/MRI) and PET in the management of vulvar malignancies.

Methods

Abdominal and pelvic CT/MRI and whole-body 18 F-FDG (fluorodeoxyglucose) PET or PET/CT (collectively designated PET hereafter) were performed. Lesion status was determined by the pathological findings or clinical follow-up. The diagnostic efficacy was evaluated by receiver operating characteristic (ROC) curve analysis. The clinical impact of PET was determined on a per scan basis.

Results

Twenty-three patients were enrolled, and 38 PET examinations were performed. CT/MRI and PET studies were used for primary staging (n = 17), monitoring the response (n = 7) and restaging after recurrence (n = 14). In primary staging, there was no significant difference between CT/MRI and PET in detecting metastatic inguinal lymph nodes (ILN). CT/MRI was significantly more efficacious than PET in detecting pelvic lymph node (PLN) or distant metastasis (p = 0.007 by ROC per patient basis). PET findings resulted in two positive impacts and one negative impact for both primary staging and restaging.

Conclusions

False-positive PLN or distant metastasis PET findings are not uncommon, and hence should be interpreted with caution. PET can be supportive when metastatic ILN/PLN or distant metastasis is suspected on CT/MRI.

Key Points

False-positive metastatic PLN or distant metastasis PET findings are not uncommon.

CT/MRI has value in the management of vulvar malignancies.

PET can be supportive when metastasis is suspected by CT/MRI.

Keywords

Positron emission tomography Vulvar malignancies Computed tomography 18 F-FDG fluorodeoxyglucose Magnetic resonance imaging 

Abbreviations and acronyms

ADC

apparent diffusion coefficient

AJCC

the American Joint Committee on Cancer

AUC

the area under the curve

CCRT

concurrent chemoradiation

CT

computed tomography

FIGO

the International Federation of Gynecology and Obstetrics

18 F-FDG

18-fluorodeoxyglucose

ILN

inguinal lymph nodes

LN

lymph nodes

MRI

magnetic resonance imaging

NPV

negative predictive value

PET

positron emission tomography

PET/CT

PET integrated computed tomography

PLN

pelvic lymph nodes

PPV

positive predictive value

ROC

receiver operating characteristic curve

RT

radiotherapy

SUV

standardised uptake value

SUVmax

maximum standardised uptake values

TE

echo time

TR

repetition time

Gigin Lin

Chao-Yu Chen and Feng-Yuan Liu contributed equally to this paper.

Notes

Acknowledgments

We would like to thank ATS Medical Editing and Review Solutions for providing language editing services.

The scientific guarantor of this publication is Koon-Kwan Ng. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study received funding by CMRPG290262 and CMRPG381132 from the Chang Gung Medical Foundation and the Department of Health-Taiwan (DOH102-TD-C-111-006). Lan-Yan Yang provided statistical analysis for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective study/diagnostic or prognostic study/performed at one institution

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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Gigin Lin
    • 1
    • 8
  • Chao-Yu Chen
    • 2
  • Feng-Yuan Liu
    • 3
    • 8
  • Lan-Yan Yang
    • 4
    • 8
  • Huei-Jean Huang
    • 2
    • 8
  • Yi-Ting Huang
    • 5
    • 8
  • Shih-Ming Jung
    • 6
  • Hung-Hsueh Chou
    • 2
    • 8
  • Chyong-Huey Lai
    • 2
    • 8
    Email author
  • Koon-Kwan Ng
    • 1
    • 7
    • 8
    Email author
  1. 1.Department of Medical Imaging and InterventionChang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuanTaiwan
  2. 2.Department of Obstetrics and GynecologyChang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuanTaiwan
  3. 3.Department of Nuclear MedicineChang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuanTaiwan
  4. 4.Biostatistics and Informatics Unit, Clinical Trial CenterChang Gung Memorial HospitalTaoyuanTaiwan
  5. 5.Department of Radiation OncologyChang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuanTaiwan
  6. 6.Department of PathologyChang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuanTaiwan
  7. 7.Department of Diagnostic RadiologyKeelung Chang Gung Memorial HospitalKeelungTaiwan
  8. 8.Gynecologic Cancer Research CenterChang Gung Memorial HospitalTaoyuanTaiwan

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