PET Imaging in Vulvar Cancer: A Literature Review of the Current Evidence and Clinical Applications

Vulvar cancer is a rare gynecologic malignancy with a bimodal age distribution, predominantly affecting older women while demonstrating increasing HPV-related incidence in younger populations. Accurate staging is essential for individualized treatment strategies to optimize outcomes while minimizing morbidity. Positron Emission Tomography (PET) has emerged as an important imaging modality in oncology; however, its precise role in vulvar cancer requires critical evaluation given the limited prospective evidence. This review focuses on the role of ¹⁸F-FDG PET/CT in vulvar cancer based on the literature published to date. Current evidence suggests that PET/CT provides high sensitivity for primary tumor detection and is particularly valuable for nodal and distant staging in locally advanced disease, where it may significantly influence management. However, its limited spatial resolution precludes detection of micrometastases, and it cannot replace sentinel lymph node biopsy for groin staging. PET/CT also contributes to radiotherapy planning through improved target delineation and demonstrates utility in detecting recurrence, although false positives remain a limitation. MRI remains superior for local staging, supporting a complementary multimodality imaging approach. Emerging tracers, including Fibroblast Activation Protein Inhibitor (FAPI), along with artificial intelligence-based radiomics, represent promising but still investigational directions. In conclusion, ¹⁸F-FDG PET/CT is a useful adjunct in vulvar cancer, especially for advanced disease, but its interpretation should be integrated within a multimodal framework due to limited supporting evidence.