Photo Credit: Babul Hosen

The following is a summary of “Identification of groin node metastasis in squamous cell vulval cancer using preoperative [18F] FDG-PET/CT. Can unnecessary lymphadenectomy be prevented?”, published in the April 2025 issue of European Journal of Obstetrics and Gynecology and Reproductive Biology by Batog et al. 

Vulval cancer ranked fourth among gynecological cancers, with Federation of Gynaecology and Obstetrics (FIGO) staging requiring histopathological dissection of the primary tumor and inguinofemoral lymph nodes (IFLN), while inaccurate radiological assessments led to unnecessary dissections and associated morbidity.  

Researchers conducted a retrospective study to assess the accuracy of [¹⁸F] FDG-PET/CT as a preoperative assessment tool for groin lymph nodes in vulvar squamous cell carcinoma.  

They analyzed the predictive value of PET/CT for preoperative groin node metastasis assessment in individuals with vulvar cancer treated at St. James’s Hospital Dublin (2010–2022). The SUVmax of nodal uptake in each inguinal region, when present, was measured and compared with histologically confirmed groin metastases. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PET/CT in detecting groin node metastases were determined and overall survival (OS) was evaluated.  

The results showed that among 200 individuals, 107 (53.3%) underwent both full histopathological assessment of the inguinal region and PET/CT. A total of 197 groins were analyzed, including cases with bilateral or unilateral IFLN histology. The PET/CT demonstrated a sensitivity of 60.0% and a specificity of 92.10% for detecting IFLN metastases. The PPV was 74.30%, while the NPV reached 88.60%. The SUVmax for metastatic nodes (true positive) was 7, ranging from 1.6 to 30.0, whereas histologically negative nodes (false positive) had a mean SUVmax of 2.18, ranging from 1.9 to 3.1.  

Investigators concluded that PET/CT had moderate sensitivity in identifying individuals at risk of lymph node metastasis and that further prospective studies were needed to confirm its utility in distinguishing metastatic from non-metastatic IFLN. 

Source: ejog.org/article/S0301-2115(25)00228-3/fulltext