Ultrasound Correlation of Groin Nodes with clinical and pathological findings in Squamous cell Carcinoma of Vulva.

Volume : VIII, Issue : V, May - 2018

Baruah Upasana, Barmon Debabrata, Deka Pankaj, Kataki Ch. Amal, Pattanayak Manisa

INTRODUCTION:

Carcinoma of the vulva is a rare genital malignancy which accounts for 5 % of all genital malignancies . Patients with

vulvar carcinoma are traditionally managed by surgical staging by radical/modied radical vulvectomy and inguinofemoral

lymphadenectomy. As regional lymph node metastatic spread is the most important prognostic factor that correlates with depth of tumor

invasion, preoperative information about regional nodal metastasis and depth of tumor invasion is essential in tailoring the treatment. Clinical

examination by palpation of the inguinofemoral lymph nodes is a simple approach for determining the inguinofemoral lymph node status but is

impaired by several conditions like obesity of the patients, small sized metasatic nodes, metastases located deep in the

subcutaneous fatty tissue, and scar tissue due to former surgery and / or radiation.

There is limited data on the role of imaging in the diagnosis and staging of vulvar carcinoma.The resolution of computed tomography is too poor

to detect disease in lymph nodesmeasuring lessthan 1 cm in diameter and magnetic resonance imaging has not so far been able to characterise

nodal tissue accutely. Ultrasound examination of the groin nodes on the otherhand is safe, noninvasive, cheap and highly acceptable to patients.

This study was undertaken to evaluate the signicance of routine ultrasonography of inguinal lymphnodes in operable squamous cell carcinoma

of vulva with the primary objective of Determining whether the value of ultrasound reporting of groin node positivity is complete for conrmed

cases of vulval cancer and to correlate Ultrasound and clinical ndings with the nal histological nding.

MATERIALS AND METHODS.

This was a prospective study which was conducted in The Department of Gynaecologic oncology of Dr B Borooah Cancer Institute (Regional

cancer Centre), Guwahati. Patients were recruited the from the period of June 2013 to June 2014. Patients were followed up for a period of 2

years. All operable patients with proven histology of squamous cell carcinoma vulva were included. The sensitivity, specicity and predictive

values of ultrasound and clinical examinations were calculated using the standard 2 x2 method. Comparisons between the groups were done by

using Man Whitany – U test. Results were statistically analysed IBM SPSS Statistics 19.

RESULTS & OBSERVATIONS

Total of 15 patients were enrolled in the study over a period of 1 year. Clinically 10(66.67%) patients were suspected to have enlarged metastatic

lymphnodes whereas 8 (53.33%) patients were suspected to have enlarged metastatic lymphnodes. Final histopahological examination revealed

metastatic lymphnodes in 6 patients(40%) On statistical analysis it was found that sensitivity of USG examination of groin nodes was 85.71%

(95% CI: 42.23 % to 97.63 %) whereas specicity was 71.43% (95% CI: 29.27 % to 95.48 %). On the other hand sensitivity for clinical

examination was 71.43% (95% CI: 29.27 % to 95.48 %) whereas specicity was 44.44% (95% CI: 13.97 % to 78.60 %).

CONCLUSION

From our study we found that USG examination of the groin nodes was more sensitive as well as specic than clinical examination for detection

of lymph node involvement in vulvar cancer[p value=0.04 ]. Our study demonstrates that ultrasound is a sensitive investigative tool in assessing

the preoperative inguinal node status. However a negative inguinal nodal status cannot be used to omit inguinal node dissection as it lacks the

high sensitivity and specicity that are necessary to avoid surgery.