Inguinal node status by ultrasound in vulva cancer

Objective. The objective of this study was to determine the value of ultras ound in preoperative assessment of groin node status in vulva cancer. Materials and methods. Women with clinically uninvolved groins who were und ergoing groin node dissection for vulva cancer in our department over an 18 -month period were recruited into the study. A preoperative scan of each gr oin to be dissected was performed to identify any suspicious lymph nodes co ntaining metastases. Suspicious nodes were defined by two sonographic crite ria: short axis diameter (>8 mm) and a long axis/short axis ratio (L/S less than or equal to 2), Each suspicious node was sampled by ultrasound-guided fine-needle aspiration (FNA), Results. Twenty women, with an average age of 70 years, consented to the st udy. Seventeen had bilateral groin node dissection and three had unilateral groin node dissection. Six (16%) of the seventeen dissected groins contain ed metastases, Short axis had a better overall accuracy (89%) but failed to detect a singular micrometastasis, The L/S ratio identified all positive g roins but had a high false-positive rate (62%) and an overall accuracy of 6 7%, The combination of both criteria did not improve the overall accuracy w hen compared with the individual criterion. FNA was not diagnostic in three , representative in two, and falsely negative in one. Conclusion, Although WS ratio has a lower overall accuracy, it correctly id entified all groins with metastases, This has a great impact on treatment a nd prognosis. Its high false-positive rate may be improved by more diagnost ic FNA, These sonographic criteria show good potential for segregating thos e with groin metastases requiring surgical treatment from those with uninvo lved nodes. This experience has to be expanded to prove its clinical effect iveness. (C) 2000 Academic Press.