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Table 1 The accuracy of imaging techniques in determining inguinofemoral lymph node metastases confirmed by histological examination

From: Vulvar cancer staging: guidelines of the European Society of Urogenital Radiology (ESUR)

Imaging detection of inguinofemoral lymph nodes metastases
Diagnostic investigation, study (year), [reference number] Study design Number of patients Imaging modality Imaging criteria Sensitivity (%) Specificity (%)
Moskovic et al. [13] Prospective 24 US Round shape, or irregular configuration and loss of fatty hilum 85 83
US combined with FNA 83 82
Hall et al. [14] Prospective 44 US Combination of lymph node size, shape, preservation/absence of an echogenic hilum, general attenuation and vascularity on Doppler 86 96
US combined with FNA 93 100
Sohaib et al. [10] Retrospective 21 MRI Short axis ≥ 1 cm 40 97
Short axis ≥ 0.8 cm 50 100
Hawnaur et al. [15] Prospective 10 MRI Long axis > 2, 1 cm, short axis > 1 cm, long-to-short axis diameter ratio < 1.3:1, irregular contour, and intranodal cystic changes 89 91
Bipat et al. [16] Retrospective 60 MRI Combination of size (short axis), shape, contour, and aspect 52 85– 89
Singh et al. [17] Retrospective 39 MRI Combined criteria (2 out of 3): short-axis > 1 cm; irregular or rounded shape; increased signal intensity on STIR or heterogeneous signal-intensity on T2-WI 85.7 82.1
Kataoka et al. [11] Retrospective 49 MRI Short/long axis ratio ≥ 0.75 81.3 89.7
Contour 65.6 75.0
Necrosis 37.5 93.1
Loss of fatty hilum 75.0 72.4
Similarity of SI with primary tumour 82.1 60.0
Readers’s confidence of metastasis 87.5 86.2
Cohn et al. [18] Prospective 15 PET FDG uptake 67 90
Hullu et al. [19] Prospective 25 PET TYR uptake 75 62
Crivellaro et al. [20] Prospective 29 PET/CT FDG uptake 53 85
Andersen et al. [21] Prospective 27 CT Short axis > 1 cm or abnormal pattern of CE 60 90
Pounds et al. [22] Prospective 116 CT 59.1 77.8
Bohlin et al. [23] Retrospective 134 CT Short axis > 1 cm or abnormal shape, attenuation or CE Tumours < 4 cm (n = 87)
      17 95
      Tumours ≥ 4 cm (n = 47)
      67 100
  1. US—Ultrasound, FNA—fine needle aspiration, STIR—short tau inversion recovery, SI—signal intensity