Vulva lesions as characterized by F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

Abstract

Aim: Vulva malignancy (primary or metastatic lesions) has significant FDG accumulation according to previous literature. The aim of this study is to analyze the metabolic imaging characteristics of apparently malignant vulva lesions determined by Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed tomography (F-18 FDG PET-CT). Materials and Methods: 27 female patients (mean: 56 years) with suspicious vulva lesions were retrospectively analyzed. The F-18 FDG PET- CT characteristics of the lesions, the first diagnosis of the patients and other metastatic sites were recorded and compared with pathology and or follow up and pelvic examination results. Results: The SUVmax levels of the true positive results (primary vulva lesions (n=4), metastatic lesions (n=5), local invasion (n=2), sarcoma (n=2), lymphoma (n=1)) was 19,35 and false positive results was 14,48. The accuracy of the F-18 FDG PET-CT in estimation of the vulva lesions was 48%. Conclusion: There are several false positive causes in the diagnosis of vulva lesions on F-18 FDG PET-CT and this issue should be considered but pelvic examination is necessary in case of increased metabolic activity in a vulva lesion.

Keywords

• vulva
• malignancy
• positron emission tomography
• fluorodeoxyglucose.

References

1. Brar, H., May, T., Tau, N., Langer, D., MacCrostie, P., Han, K., & Metser, U. (2017). Detection of extra-regional tumour recurrence with 18F-FDG-PET/CT in patients with recurrent gynaecological malignancies being considered for radical salvage surgery. Clinical radiology, 72(4), 302–306. https://doi.org/10.1016/j.crad.2016.12.009
2. Rao, Y. J., Hassanzadeh, C., Chundury, A., Hui, C., Siegel, B. A., Dehdashti, F., DeWees, T., Mullen, D., Powell, M. A., Mutch, D. G., Schwarz, J. K., & Grigsby, P. W. (2017). Association of post-treatment positron emission tomography with locoregional control and survival after radiation therapy for squamous cell carcinoma of the vulva. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 122(3), 445–451. https://doi.org/10.1016/j.radonc.2016.12.019
3. Lin, G., Chen, C. Y., Liu, F. Y., Yang, L. Y., Huang, H. J., Huang, Y. T., Jung, S. M., Chou, H. H., Lai, C. H., & Ng, K. K. (2015). Computed tomography, magnetic resonance imaging and FDG positron emission tomography in the management of vulvar malignancies. European radiology, 25(5), 1267–1278. https://doi.org/10.1007/s00330-014-3530-1
4. Shen, G., Wang, R., Pan, L., & Kuang, A. (2021). Malignant Extrarenal Rhabdoid Tumor of the Vagina on FDG PET/CT. Clinical nuclear medicine, 46(12), 1020–1021. https://doi.org/10.1097/RLU.0000000000003751
5. Beyhan, E., Ergül, N., Bektaş, S., Erol, Ö., & Çermik, T. F. (2021). Solitary Vulvar Involvement of Ovarian Non-Hodgkin Lymphoma Mimicking Bartholin's Abscess on 18F-FDG PET/CT. Clinical nuclear medicine, 46(3), 255–257. https://doi.org/10.1097/RLU.0000000000003494
6. Guglielmo, P., Paderno, M., Elisei, F., Guerra, L., Landoni, C., Buda, A., & Crivellaro, C. (2019). 18F-FDG PET/CT in a Case of Metastatic Breast Cancer to the Vulva. Clinical nuclear medicine, 44(7), 572–573. https://doi.org/10.1097/RLU.0000000000002583
7. Gandhi, A. K., Roy, S., Mridha, A. R., & Sharma, D. N. (2015). Vulvar metastasis from carcinoma breast unveiling distant metastasis: Exploring an unusual metastatic pattern. Journal of the Egyptian National Cancer Institute, 27(4), 243–246. https://doi.org/10.1016/j.jnci.2015.05.005
8. Treglia, G., Paone, G., Perriard, U., Ceriani, L., & Giovanella, L. (2014). An unusual case of diffuse large B-cell lymphoma involving the vulva evaluated by 18F-FDG PET/CT. Clinical nuclear medicine, 39(10), e439–e441. https://doi.org/10.1097/RLU.0000000000000258

9. Lu, Y. Y., Lu, C. H., & Wang, H. Y. (2017). Clitoral Metastasis From Advanced Cervical Carcinoma on 18F-FDG-PET/CT. Clinical nuclear medicine, 42(1), 54–55. https://doi.org/10.1097/RLU.0000000000001410
10. Thaker, N. G., Klopp, A. H., Jhingran, A., Frumovitz, M., Iyer, R. B., & Eifel, P. J. (2015). Survival outcomes for patients with stage IVB vulvar cancer with grossly positive pelvic lymph nodes: time to reconsider the FIGO staging system?. Gynecologic oncology, 136(2), 269–273. https://doi.org/10.1016/j.ygyno.2014.12.013
11. Burger, I. A., Vargas, H. A., Donati, O. F., Andikyan, V., Sala, E., Gonen, M., Goldman, D. A., Chi, D. S., Schöder, H., & Hricak, H. (2013). The value of 18F-FDG PET/CT in recurrent gynecologic malignancies prior to pelvic exenteration. Gynecologic oncology, 129(3), 586–592. https://doi.org/10.1016/j.ygyno.2013.01.017
12. Cohn, D. E., Dehdashti, F., Gibb, R. K., Mutch, D. G., Rader, J. S., Siegel, B. A., & Herzog, T. J. (2002). Prospective evaluation of positron emission tomography for the detection of groin node metastases from vulvar cancer. Gynecologic oncology, 85(1), 179–184. https://doi.org/10.1006/gyno.2002.6605
13. Robertson, N. L., Hricak, H., Sonoda, Y., Sosa, R. E., Benz, M., Lyons, G., Abu-Rustum, N. R., Sala, E., & Vargas, H. A. (2016). The impact of FDG-PET/CT in the management of patients with vulvar and vaginal cancer. Gynecologic oncology, 140(3), 420–424. https://doi.org/10.1016/j.ygyno.2016.01.011
14. Mokoala, K. M. G., Lawal, I. O., Lengana, T., Popoola, G. O., Boshomane, T. M. G., Mokgoro, N. P., Vorster, M., & Sathekge, M. M. (2020). 18F-FDG PET/CT imaging of vulva cancer recurrence: A comparison of PET-derived metabolic parameters between women with and without HIV infection. 18F-FDG PET/CT-Bildgebung von Vulvakarzinom-Rezidiven: Ein Vergleich der PET-Stoffwechselparameter bei Frauen mit und ohne HIV-Infektion. Nuklearmedizin. Nuclear medicine, 59(6), 419–427. https://doi.org/10.1055/a-1221-7810
15. Boellaard, R., Delgado-Bolton, R., Oyen, W. J., Giammarile, F., Tatsch, K., Eschner, W., Verzijlbergen, F. J., Barrington, S. F., Pike, L. C., Weber, W. A., Stroobants, S., Delbeke, D., Donohoe, K. J., Holbrook, S., Graham, M. M., Testanera, G., Hoekstra, O. S., Zijlstra, J., Visser, E., Hoekstra, C. J., … European Association of Nuclear Medicine (EANM) (2015). FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. European journal of nuclear medicine and molecular imaging, 42(2), 328–354. https://doi.org/10.1007/s00259-014-2961-x
16. Collarino, A., Garganese, G., Fragomeni, S. M., Pereira Arias-Bouda, L. M., Ieria, F. P., Boellaard, R., Rufini, V., de Geus-Oei, L. F., Scambia, G., Valdés Olmos, R. A., Giordano, A., Grootjans, W., & van Velden, F. H. P. (2018). Radiomics in vulvar cancer: first clinical experience using 18F-FDG PET/CT images. Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 60(2), 199–206. Advance online publication. https://doi.org/10.2967/jnumed.118.215889
17. Peiró, V., Chiva, L., González, A., Bratos, R., Alonso, S., Márquez, R., Carballo, N., & Alonso-Farto, J. C. (2014). Utilidad de la PET/TC en el manejo del cáncer de vulva [Utility of the PET/CT in vulvar cancer management]. Revista espanola de medicina nuclear e imagen molecular, 33(2), 87–92. https://doi.org/10.1016/j.remn.2013.07.009