Preliminary Diagnosis: Vulvovaginal Cancer
I. What imaging technique is first-line for this diagnosis?
Ultrasound of the lower pelvis.
II. Describe the advantages and disadvantages of this technique for diagnosing vulvovaginal cancer.
Advantages
- Does not expose patients to ionizing radiation.
- Highly portable imaging modality.
- Moderately sensitive and specific in detailing and characterizing vulvovaginal cancer.
- Relatively inexpensive compared to companion MR imaging.
Disadvantages
- Operator dependent.
- Limited in sensitivity and specificity in characterizing the extent of soft tissue infiltration and extension and any other secondary complications.
- Less adept at detailing and characterizing the surrounding soft tissues and osseous structures.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications to ultrasound exist.
IV. What alternative imaging techniques are available?
- MR imaging of the pelvis with IV contrast.
- CT imaging of the pelvis with and without contrast.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing vulvovaginal cancer.
MR imaging of the pelvis with IV contrast
Advantages
- Highly sensitive and specific in detailing the surrounding soft tissues.
- Offers exquisite visualization of the extent and infiltration of the soft tissue neoplasm.
- Does not expose patients to ionizing radiation.
- Offers limited evaluation of the surrounding osseous tissues.
Disadvantages
- Expensive.
- Time consuming.
- May be subject to motion and susceptibility weighted artifact, degrading image quality.
CT imaging of the pelvis with and without contrast
Advantages
- Offers exquisite visualization of the surrounding soft tissues and osseous structures.
- Relatively quick imaging modality when compared to MR imaging.
- May help guide percutaneous biopsy, treatment, and therapy.
- Highly sensitive and specific in characterizing the primary neolpastic process and any secondary complications.
- Highly adept in characterizing the surrounding osseous process.
Disadvantages
- Exposes patients to ionizing radiation.
VI. What are the contraindications for the alternative imaging techniques?
MR imaging of the pelvis with IV contrast
- May be contraindicated in patients with non-MR compatible hardware.
CT imaging of the pelvis with and without contrast
- May be contraindicated in pregnant patients.
- IV contrast may be contraindicated in patients with renal failure or a contrast allergy.
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