Abstract
ObjectiveTo investigate the impact of a preoperative CT on surgical decision making in primary vulvar squamous cell carcinoma (VSCC) and the accuracy of detecting inguinal lymph node metastases (LNM). Secondly to assess prevalence and consequences of incidental findings and comorbidity using a CT. MethodsThis population-based study comprised of surgically treated patients with primary VSCC, at a regional tertiary center, using the Swedish Quality Registry for Gynecological Cancer for identification, and medical records were reviewed. Results from the preoperative CT was compared with the histological analysis from the lymphadenectomy in the total cohort and between tumor size <4 cm versus ≥4 cm. ResultsIn total 134 women had undergone CT before sentinel node (SN) biopsy (n = 83) or inguinofemoral lymphadenectomy (IFL) (n = 51). Fiftyone patients (38%) had groin LNM. Accuracy of CT in detecting groin LNM was 76%; sensitivity 43% and specificity 96%. Positive (PPV) and negative predictive values (NPV) were 88% and 73% respectively. In tumors <4 cm (n = 87), sensitivity, specificity, PPV and NPV were 17%, 95%, 57% and 75% and in tumors ≥4 cm (n = 47) 67%, 100%, 100% and 69% respectively. CT altered surgical method from SN biopsy to IFL in only two cases. Incidental findings led to extra follow-up resulting in a benign diagnosis in 22 patients and major important findings in five patients. ConclusionIn primary VSCC, a preoperative abdominal-inguinal CT is of limited value for surgical decision making. In tumors <4 cm, it may be omitted due to low diagnostic accuracy and disturbing incidental findings.
Highlights
To investigate the impact of a preoperative computer tomography (CT) on surgical decision making in primary vulvar squamous cell carcinoma (VSCC) and the accuracy of detecting inguinal lymph node metastases (LNM)
In primary VSCC, a preoperative abdominal-inguinal CT is of limited value for surgical decision making
Vulvar cancer treatment in the Western Sweden Healthcare Region, with a population of 1.9 million, has since the 1990s been centralized to a tertiary referral center forgynecological cancer;SahlgrenskaUniversityHospital.Abdominal CTincluding the inguinal regions has been recommended in the preoperative evaluation of inguinal lymph node metastases since 2012 in VSCC > FIGO stage IA according to regional guidelines reports on the diagnostic accuracy and benefits of this modality are scarce [15,16]
Summary
Vulvar squamous cell carcinoma (VSCC) is a rare disease with an incidence of 2.7 per 100.000 persons [1] and each year affects approximately 150 women in a population of 10.3 million in Sweden. If suspicious malignant inguinal lymph nodes in tumors FIGO stage IA according to regional guidelines reports on the diagnostic accuracy and benefits of this modality are scarce [15,16]. The aim of this study was to investigate the impact of a preoperative CT on surgical decision making in primary VSCC and the accuracy of detecting inguinal lymph node metastases. To assess prevalence and consequences of incidental findings and comorbidity using a CT
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