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Table 2 Summary of the recommendations based on ≥ 80% agreement among experts

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

ESUR recommendations
Recommendations for MRI staging of vulvar cancer
 • Indications
  Tumour stromal invasion > 1 mm
  Tumour size > 4 cm
  Tumours with close proximity to or involvement of the urethra, vagina, or anus
 • Patient preparation:
  Fasting is recommended (4 – 6 h)
  The use of antiperistaltic agents is recommended (20 mg butyl scopolamine IM/IV or 1 mg of glucagon IV) unless their use is contraindicated due to patient medical background
  Supine patient positioning is recommended
  Vaginal gel is optional
  Rectal gel is not recommended
 • Hardware:
  The minimal recommended magnet field strength to stage vulvar cancer is 1.5 Tesla
 • Sequences and imaging planes:
  Pelvis
   T1WI
    Axial T1W Dixon sequence
   T2WI
    Axial, sagittal, and coronal two-dimensional T2W sequences
   T2W sequence with fat suppression is optional
    Slice thickness ≤ 4 mm
   T2WI with a small FOV (from the vaginal top to the entire perineum included)
    Axial or axial oblique (perpendicular to the urethra) and coronal or coronal oblique (parallel to the urethra)
    Slice thickness = 3 mm is recommended
   DWI-MRI
    In the axial plane, with a minimum of two b-values (low b = 0–50 or 100 s/mm2, high b ≥ 800 s/mm2)
   DCE-MRI
    Three-dimensional (3D) spoiled gradient-echo fat-suppressed T1-weighted imaging (3D T1WI FS) imaging on axial or axial oblique before and after the administration of intravenous contrast for three scans to obtain arterial, portal and equilibrium phases (the last acquisition may be obtained in the most informative plane for each particular case)
  Upper abdomen (to evaluate the Kidneys and lymph nodes)
    T2W HASTE axial from the renal hila to the inguinal region
    DWI axial from the renal hila to the inguinal region
Recommendations for CT staging of vulvar cancer
 • Indications
  Regional or locally advanced disease (FIGO stages III–IVA) or suspicious distant metastases (FIGO stage IVB)—alternatively to CT, PET/CT may be performed in these cases
 • Protocol
  Chest, abdominal and pelvic CT with coverage of the inguinal region after the administration of intravenous contrast with image acquisition on portal-venous phase (60 – 80 s)
Recommendations for inguinofemoral lymph node US and biopsy
 • Indications
  Ultrasound of the inguinal regions with biopsy of suspicious lymph nodes (either by FNA or core biopsy) should be performed in all patients with either clinical (palpation) or radiological suspicion of lymph node metastasis depicted on MRI, CT, or PET/CT