Vulvar/Vaginal Cancer MRI Staging

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Vulvar cancer · imaging staging indication
   Vulvar cancer — imaging staging needed? Extent? (ESUR: primary ≤2 cm, confined to the vulva/perineum, invasion ≤1 mm → no imaging needed; invasion >1 mm or >4 cm or suspected urethra/vagina/anus involvement → pelvic MRI including the groin; for >2–4 cm either clinical + groin ultrasound (FNA of suspicious nodes) or MRI. Nodal status is the most important prognostic factor. Vaginal cancer MRI staging follows similar FIGO/imaging principles (upper 1/3 drains to pelvic nodes, lower 1/3 to the groin).)
   • Regional/locally advanced (III–IVA) or suspected distant (IVB) → Advanced/regional · CT/PET-CT
   • Needs local MRI staging (invasion >1 mm/>4 cm/suspected adjacent organ, I–II) → Local MRI staging (I–II)
   • Tiny tumor (≤2 cm, confined, invasion ≤1 mm) → Tiny tumor · no imaging needed
2. [End] Tiny tumor · no imaging needed
   Tiny vulvar cancer (≤2 cm, confined to vulva/perineum, invasion ≤1 mm): no imaging staging needed; manage by clinical + pathology (wide local excision ± sentinel node), imaging only as a clinical adjunct when suspicious.
3. [End] Local MRI staging (I–II)
   Needs local MRI staging (invasion >1 mm or >4 cm or suspected urethra/vagina/anus): pelvic MRI including the groin — multiplanar T2 (sagittal for craniocaudal extension, axial/coronal for lateral) measuring size/depth/adjacent organs (urethra, vagina, anus, bladder/rectal mucosa); groin ultrasound ± FNA to assess nodes.
4. [End] Advanced/regional · CT/PET-CT
   Regional/locally advanced (III–IVA: upper 2/3 urethra-vagina, bladder/rectal mucosa, fixed to pelvic bone, inguinofemoral nodes) or suspected distant (IVB): chest-abdomen-pelvis CT or PET-CT including the groin; nodal status determines prognosis and surgery/chemoradiation choice; multidisciplinary decision (IVA often concurrent chemoradiation).

Source guidelines & references

• Vulvar cancer ESUR imaging staging guideline (Insights Imaging 2021) · source ↗
• Vulvar cancer 2021 FIGO revised staging and imaging (RadioGraphics 2022)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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