From the Journals

Preoperative CT shows little value in early vulvar SCC



Preoperative computerized tomography (CT) demonstrated limited value in the clinical management of patients with early-stage vulvar squamous cell carcinoma (VSCC) analyzed in a single-center study.

The findings suggest preoperative CT imaging could be excluded prior to sentinel inguinal lymph node biopsy or staging surgery in patients with early-stage disease.

“In this study, we aimed to investigate if preoperative CT scan influences the overall course of VSCC management in patients without clinical evidence of groin lymphadenopathy,” wrote Rachel Pounds, MD, of the University of Birmingham (England) and colleagues. The study was published in Gynecologic Oncology.

The researchers prospectively studied a cohort of 225 patients with primary or recurrent VSCC who underwent staging surgery at a single institution in the United Kingdom. The patients’ mean age was 67 years (range, 54-79 years), and most had stage 1B disease (57.8%).

The researchers compared preoperative imaging findings with histological results from sentinel inguinal lymph node biopsy. Other clinical information, including surgery type, evidence of groin node involvement, and age at diagnosis was collected from patient files and included in the analysis.

In all, 51.6% of patients underwent preoperative CT imaging. Among these patients, 37.9% had a positive report of radiological groin lymphatic metastases.

“True groin node metastases, confirmed histologically, were observed in 26 patients (22.4%) with a radiologically positive scan report (true positives) and in 18 patients (15.5%) with a radiological negative scan report (false negatives),” the researchers wrote.

The specificity and sensitivity of preoperative CT to detect groin lymphatic metastasis were 77.8% and 59.1%, respectively. The positive and negative predictive values were 61.9% and 75.7%, respectively.

There was no significant difference in overall survival, disease-specific or disease-free survival, or groin node recurrence between patients who underwent preoperative CT and patients who did not.

Groin node recurrence was observed in 10.3% of patients with preoperative CT and 11.5% of patients without it (P = .7768). Disease-specific death occurred in 16.4% of patients with preoperative CT and 13.5% of patients without it (P = .5451).

“Our results highlight the poor reliability of preoperative CT scans in detecting inguinal lymphatic metastasis,” the researchers wrote. “Preoperative CT scan may be omitted in early stage VSCC prior to surgical staging as it does not affect overall management and surgical outcomes.”

No funding sources were reported for this study. The authors reported having no conflicts of interest.

SOURCE: Pounds R et al. Gynecol Oncol. 2020 Jan 24. doi: 10.1016/j.ygyno.2020.01.031.

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