Efficacy of ultrasound in the evaluation of inguinal lymph nodes in patients with vulvar cancer: an updated systematic review and meta-analysis
To evaluate the current diagnostic accuracy of ultrasound in evaluating inguinal lymph nodes in patients with vulvar cancer and to determine if there have been advancements since 2020. A systematic review of research up to August 26, 2025, that compares the efficacy of ultrasound to histological examination of inguinal lymph nodes in all types and all stages of vulvar cancer. All studies that reported the diagnostic performance of data, including at least one of sensitivity, specificity, predictive values, or overall accuracy, were included. Only studies published in English and with adult participants were considered, with no geographic restrictions applied. A total of 3840 articles were reviewed, and 12 studies fulfilled the eligibility criteria for this systematic review and meta-analysis. The pooled results were as follows: sensitivity of 0.88 (95% confidence interval [CI] 0.76 to 1.00), specificity of 0.87 (95% CI 0.69 to 0.97), negative predictive value of 0.95 (95% CI 0.87 to 1.00), positive predictive value of 0.63 (95% CI 0.07 to 0.92). Overall diagnostic accuracy was 0.86 (95% CI 0.73 to 0.98). The available evidence since 2020 supports the continued reliability of ultrasound in the context of inguinal node screening in vulvar cancer patients, reflected through the high negative predictive value. However, the limited number of recent publications restricts any definitive conclusions regarding true advancements in diagnostic accuracy. Integration with fine-needle aspiration cytology and individual patient factors may be beneficial to optimize diagnostic confidence.