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

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

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.

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Abbreviations

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.

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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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Authors and Affiliations

  1. Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan

    Gigin Lin & Koon-Kwan Ng

  2. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan

    Chao-Yu Chen, Huei-Jean Huang, Hung-Hsueh Chou & Chyong-Huey Lai

  3. Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan

    Feng-Yuan Liu

  4. Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Lan-Yan Yang

  5. Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan

    Yi-Ting Huang

  6. Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan

    Shih-Ming Jung

  7. Department of Diagnostic Radiology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan

    Koon-Kwan Ng

  8. Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Gigin Lin, Feng-Yuan Liu, Lan-Yan Yang, Huei-Jean Huang, Yi-Ting Huang, Hung-Hsueh Chou, Chyong-Huey Lai & Koon-Kwan Ng

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  1. Gigin Lin
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  2. Chao-Yu Chen
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Corresponding authors

Correspondence to Chyong-Huey Lai or Koon-Kwan Ng.

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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 25, 1267–1278 (2015). https://doi.org/10.1007/s00330-014-3530-1

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  • DOI: https://doi.org/10.1007/s00330-014-3530-1

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