Identification of inguinal lymph node metastases from vulval carcinoma by magnetic resonance imaging: an initial report.
OBJECTIVE
Magnetic Resonance Imaging (MRI) has the potential to assess inguinal lymph nodes more accurately than palpation and less invasively than surgical exploration. The objective of this study was to measure the accuracy of MRI in identifying inguinal metastases by demonstrating abnormal lymph node morphology.


METHODS
10 women with vulval malignancy underwent T1- and fat-suppressed T2-weighted surface coil MRI of both groins before surgery. Each groin was prospectively categorised as normal or as having metastatic lymphadenopathy using criteria established in normal volunteers. Histopathological findings in patients undergoing groin dissection for invasive vulval carcinoma were used as validation.


RESULTS
MRI had a positive predictive value of 89%, negative predictive value of 91%, sensitivity of 89%, specificity of 91% and accuracy of 90%. The most useful observations on MRI to identify metastatic lymphadenopathy were those of lymph node contour irregularity, cystic change in a lymph node, short axis diameter exceeding 10mm and abnormal long: short axis diameter ratio.


CONCLUSIONS
High resolution MRI of the inguinal regions has potential to screen for lymph node metastases in patients with vulval cancer, with the aim of reducing the number of women who have to undergo groin dissection.
Hawnaur
J M
JM
Department of Clinical Radiology, Manchester Royal Infirmary, Central Manchester and Manchester Children's University Hospitals NHS Trust, Manchester, UK. jhawnaur@hotmail.com
Reynolds
K
K
Wilson
G
G
Hillier
V
V
Kitchener
H C
HC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007264:Inguinal Canal; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014846:Vulvar Neoplasms / Q000473:pathology*