Abstract
PurposeThe aim of this retrospective multicentric study was to investigate the diagnostic performance, the prognostic value and the impact of 18F-FDG PET/CT on treatment decision-making in patients with suspected recurrent vulvar cancer (VC).Materials and methodsSixty-three patients affected by VC performed 18F-FDG-PET/CT for restaging purposes in case of suspected clinical and/or radiological recurrence. Histopatology results if available and/or clinical-imaging follow-up for at least 12 months were considered as reference standard. The diagnostic accuracy and the clinical impact of 18F-FDG PET/CT were investigated. Progression free survival (PFS) and overall survival (OS) were calculated using Kaplan–Meier curves.ResultsFifty-two (82.5%) PET/CT showed the presence of recurrence, while the remaining 11 (17.5%) were negative. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT were 100% (95%CI 93–100%), 92% (95%CI 62–100%), 98% (95%CI 89–99%), 100% and 98% (95%CI 92–100%). A relevant impact of 18F-FDG PET/CT imaging was registered in 28 cases: in 12 cases moving from local therapy to chemotherapy due to the recognition of disseminate localizations; in 10 showing the site of recurrence in presence of negative conventional imaging, and in 6 cases confirming to be true negative and avoiding unnecessary therapies. Beside advanced age and HPV status, a positive restaging 18F-FDG PET/CT scan was significantly correlated with shorter PFS and OS compared to negative scan (p < 0.001).Conclusions18F-FDG PET/CT demonstrated to be an accurate tool in the assessing of recurrent VC with high sensitivity and specificity and with a significant impact on clinical decision-making. Restaging 18F-FDG PET/CT findings were associated with survival.
Highlights
Vulvar cancer (VC) is a rare gynecologic malignancy, with an incidence rate of 1.5–2.4 per 100,000 women per year [1, 2]
We reviewed and analyzed the main epidemiological (age at diagnosis, The International Federation of Gynecology and Obstetrics (FIGO) stage, HIV status, HPV status), morphological and histological data, metabolic features derived by 18F-FDG PET/computed Histotype tomography (CT) and follow-up data
The recurrence was confirmed by histological report in 20 patients, whereas in the other 31 the diagnosis was confirmed by clinical and/or imaging follow-up. 18FFDG PET/CT scan showed the presence of FDG-avid disease in 52 (82.5%) patients displaying the presence of at least 1 lesion with increased FDG uptake suspected for local or distant disease, while it was negative in the other 11 scans (17.5%) (Figs. 1, 2)
Summary
Vulvar cancer (VC) is a rare gynecologic malignancy, with an incidence rate of 1.5–2.4 per 100,000 women per year [1, 2]. Vulvar squamous cell carcinoma is the most common histotype followed by melanoma, basal cell carcinoma, adenocarcinoma and Paget disease [3]. Vulvar squamous cell carcinoma has usually two tumor pathways: a non-Human. The pattern of dissemination of VC is predominantly lymphogenic to the inguinofemoral lymph nodes, while distant metastases are very rare [5]. The 5-year overall survival (OS) rate ranges from 95% in patients without nodal disease to 61% in women with nodal metastases [6]. Adjuvant radiotherapy is usually performed in case of other coexistent risk factors or aggressive disease [7]. Adjuvant radiotherapy is usually performed in case of other coexistent risk factors or aggressive disease [7]. 18-fluorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) is a non-invasive
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