Vulvar carcinoma is a rare cancer affecting the genital tract, constituting 4% of gynecological tumors. Vulvar squamous cell carcinoma (VSCC) is the most common type. Diagnosis relies on biopsy during vulvoscopy, plus imaging such as ultrasonography (USG), magnetic resonance imaging (MRI) and positron emission tomography (PET). This review aims to lay out a thorough overview as to the current preoperative management of VSCC, both in case of vulvar and lymph node involvement. The data research was conducted using the following databases: MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID and Cochrane Library from 2010 to 2024. The selection criteria included only original articles. Seventeen studies were assessed for eligibility. A concordance rate of 62.3% for vHSIL and 65.2% for carcinoma at vulvoscopy, with a sensitivity of 98%, specificity of 40%, PPV (Positive Predictive Value) of 37% and NPV (Negative Predictive Value) of 98% in identifying malignant lesions was found. Regarding the reliability of PET for staging and assessing lymph node involvement, a mean SUV (Standardized Uptake Value) for malignant vulvar lesions of 8.4 (range 2.5–14.7) was reported. In the case of MRI, useful for the evaluation of loco-regional infiltration and lymph node involvement, the ratio of the short-to-long-axis diameter and the reader’s diagnostic confidence for the presence of lymph node metastasis yielded accuracy of 84.8% and 86.9%, sensitivity of 86.7% and 87.5%, specificity of 81.3% and 86.2%, PPV of 89.7% and 87.5% and NPV of 76.5% and 86.2%, respectively. A long lymph node axis >10 mm and a short diameter >5.8 mm were found to be predictors of malignancy. At USG, instead, the two main characteristics of potentially malignant lymph nodes are cortical thickness and short axis length; the combination of these ultrasound parameters yielded the highest accuracy in distinguishing between negative and positive lymph nodes. Despite the heterogeneity of the included studies and the lack of randomized clinical trials, this review provides a broad overview of the three imaging tools used for the presurgical management of VSCC. Nowadays, although MRI and PET represent the gold standard, ultrasound evaluation is taking on a growing role, as long as it is carried out by expert sonographer. The management of this rare disease should be always performed by a multidisciplinary team in order to precisely stage the tumor and determine the most suitable treatment approach.
外阴癌是一种罕见的生殖道恶性肿瘤，占妇科肿瘤的4%。外阴鳞状细胞癌（VSCC）是其最常见的病理类型。诊断依赖于外阴镜检查下的活检，并结合超声检查（USG）、磁共振成像（MRI）和正电子发射断层扫描（PET）等影像学手段。本综述旨在全面概述当前针对VSCC（包括外阴原发灶及淋巴结受累情况）的术前管理策略。数据检索使用了以下数据库：MEDLINE、EMBASE、Web of Sciences、Scopus、ClinicalTrial.gov、OVID和Cochrane Library，时间范围为2010年至2024年。筛选标准仅纳入原创性研究文章。共评估了17项研究。研究发现，外阴镜检查对于外阴高级别鳞状上皮内病变（vHSIL）和癌的诊断符合率分别为62.3%和65.2%；在识别恶性病变方面，其敏感性为98%，特异性为40%，阳性预测值（PPV）为37%，阴性预测值（NPV）为98%。关于PET在分期和评估淋巴结受累方面的可靠性，报告显示恶性外阴病变的平均标准化摄取值（SUV）为8.4（范围2.5–14.7）。对于MRI（可用于评估局部区域浸润和淋巴结受累情况），短径与长径比值以及阅片者对存在淋巴结转移的诊断信心，其准确率分别为84.8%和86.9%，敏感性为86.7%和87.5%，特异性为81.3%和86.2%，PPV为89.7%和87.5%，NPV为76.5%和86.2%。研究发现，淋巴结长轴>10 mm且短径>5.8 mm是预测恶性的指标。而在超声检查中，潜在恶性淋巴结的两个主要特征是皮质厚度和短轴长度；结合这些超声参数在区分阴性和阳性淋巴结方面获得了最高的准确率。尽管纳入的研究存在异质性且缺乏随机临床试验，本综述仍广泛概述了用于VSCC术前管理的三种影像学工具。目前，虽然MRI和PET是金标准，但超声评估正发挥着越来越重要的作用，前提是由经验丰富的超声医师进行操作。对于这种罕见疾病的处理，应始终由多学科团队协作进行，以便精确分期并确定最合适的治疗方案。
Current Preoperative Management of Vulvar Squamous Cell Carcinoma: An Overview
肿瘤(癌症)患者之家