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This study aimed to assess the value of dual-timepoint 18 F-FDG PET/CT in the prediction of lymph node (LN) status in patients with invasive vulvar cancer (VC) scheduled for inguinofemoral LN dissection. Methods: From April 2013 to July 2015, all consecutive patients with VC scheduled for inguinofemoral LN dissection were prospectively enrolled. All patients underwent a preoperative whole-body 18 F-FDG PET/CT scan at 1 h (standard examination) and an additional scan from T11 to the groins at 3 h (delayed examination) after 18 F-FDG injection. On both scans, each groin was visually scored 0 or 1 concerning 18 F-FDG LN uptake relative to background. Semiquantitative analysis included SUV max and the corresponding retention index of SUV max , measured on both scans. The optimal cutoff value of these parameters was defined using a receiver-operating-characteristic analysis. Histopathology was the standard of reference. Results: Thirty-three patients were included, with a total of 57 groins dissected and histologically evaluated. At histopathology, 21 of 57 (37%) groins contained metastatic LNs. Concerning visual score, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 95.2%, 75%, 96.4%, 69%, and 82.5% on standard scanning and 95.2%, 77.8%, 96.6%, 71.4%, and 84.2% on delayed scanning, respectively. At receiver-operating-characteristic analysis, sensitivity and specificity were 95.2% and 77.8% on standard and delayed 18 F-FDG PET/CT for an SUV max cutoff of greater than 1.32 and 1.88, respectively, and 95.2% and 80% for a retention index of SUV max cutoff of greater than 0. Conclusion: Standard 18 F-FDG PET/CT is an effective preoperative imaging method for the prediction of LN status in VC, allowing the prediction of pathologically negative groins and thus the selection of patients suitable for minimally invasive surgery. Delayed 18 F-FDG PET/CT did not improve the specificity and the positive predictive value in our series. Larger studies are needed for a further validation.

Evaluation of Dual-Timepoint 18F-FDG PET/CT Imaging for Lymph Node Staging in Vulvar Cancer

Evaluation of Dual-Timepoint ¹⁸F-FDG PET/CT Imaging for Lymph Node Staging in Vulvar Cancer