Chi_Principles and Practice of Gynecologic Oncology 8e

18 SECTION 2 ■ Vulvar Cancer

■ TABLE 2.5-1. Sensitivity and Specificity of Different Imaging Techniques

Imaging Technique

Author

Number of Patients Sensitivity

Specificity

Ultrasound

Garganese et al.(45)

144

90% 76%

78% 91% 92%

De Gregorio et al.(46) Pouwer et al.(47) Angelico et al.(48)

60 76 43 44 49 60 10 39

100%

Ultrasound FNA

77% 80% 87% 52% 89% 86% 43% 58% 86% 95%

100% 100%

Land et al.(49)

MRI

Kataoka et al.(50)

81%

Bipat et al.(51)

85-89%

Hawnaur et al.(52) Singh et al.(53) Bohlin et al.(54)

91% 82% 96% 75% 66% 75% 89%

CT

134

Land et al.(49) Rufini et al.(55)

44

18F-FDG-PET/CT

160

Collarino et al.(56)

33 21

Oldan et al.(57)

100%

■ TABLE 2.5-2. Integrated 2021 FIGO and AJCC Staging System for Squamous Cell Carcinoma of the Vulva

AJCC 8 th Edition T

FIGO

N

M

T0: No evidence of primary tumor (not in FIGO system)

N0(i+): Isolated tumor cells in regional lymph node no greater than 0.2 mm (not in FIGO system)

I: Tumor confined to the vulva IA Lesions ≤2 cm in size, confined to vulva or perineum and with stromal invasion ≤1 mm, with negative nodes IB Lesions >2 cm in size or with stromal invasion >1 mm, confined to the vulva or perineum, with negative nodes Tumor of any size with extension to adjacent perineal structures (lower 1/3 urethra, lower 1/3 lower vagina, lower 1/3 anus), with negative nodes IIIA Tumor of any size with extension to upper 2/3 urethra, upper 2/3 vagina, bladder mucosa, rectal mucosa, or regional lymph node metastases ≤5 mm II IIIC Regional lymph node metastases with extracapsular spread IVA Tumor of any size fixed to bone, OR fixed or ulcerated regional lymph node metastases IVB Distant metastasis: includes pelvic nodes AJCC 8 th Edition Prognostic Stage Groupings Stage T, N, M combination IIIB Regional lymph node metastases >5 mm

T1a

N0

M0

T1b

N0

M0

T2

N0

M0

T1, T2, or T3; T3 = upper 2/3 urethra, upper 2/3 vagina, bladder mucosa, rectal mucosa

N1a = 1-2 lymph nodes each <5 mm) N2a = ≥3 lymph nodes each <5 mm

M0

T1, T2, or T3

N1b = 1 lymph node ≥5 mm N2b = ≥2 lymph nodes ≥5 mm

M0

T1, T2, or T3

N2c

M0

T1, T2, or T3; fixed to pelvic bone = T3

N3 = inguinal skin ulceration or fixed nodes

M0

Any

Any

M1

IA IB

T1a, N0, M0 T1b, N0, M0

Copyright © 2024 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. II T2, N0, M0

IIIA IIIB IIIC IVA IVB

T1 or T2, N1, M0

T1 or T2, N2a or N2b, M0

T1 or T2, N2c, M0

Either T1 or T2, N3, M0 or T3, any N, M0

any T, any N, M1

From Rogers LJ, Cuello MA, Olawaiye AB. Cancer of the vulva: 2021 update. Int J Gynecol Obstet . 2021;155 suppl 1 (suppl 1):7-18, John Wiley and Sons.