18F-FDG PET/MRI and 18F-FDG PET/CT for the Management of Gynecological Malignancies: A Comprehensive Review of the Literature

Abstract

Objective: Positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro- D-glucose integrated with computed tomography (18F-FDG PET/CT) or magnetic resonance imaging (18F-FDG PET/MRI) has emerged as a promising tool for managing various types of cancer. This review study was conducted to investigate the role of 18F- FDG PET/CT and FDG PET/MRI in the management of gynecological malignancies. Search strategy: We searched for relevant articles in the three databases PubMed/MEDLINE, Scopus, and Web of Science. Selection criteria: All studies reporting data on the FDG PET/CT and FDG PET MRI in the management of gynecological cancer, performed anywhere in the world and published exclusively in the English language, were included in the present study. Data collection and analysis: We used the EndNote software (EndNote X8.1, Thomson Reuters) to list the studies and screen them on the basis of the inclusion criteria. Data, including first author, publication year, sample size, clinical application, imaging type, and main result, were extracted and tabulated in Excel. The sensitivity, specificity, and diagnostic accuracy of the modalities were extracted and summarized. Main results: After screening 988 records, 166 studies published between 2004 and 2022 were included, covering various methodologies. Studies were divided into the following five categories: the role of FDG PET/CT and FDG-PET/MRI in the management of: (a) endometrial cancer (n = 30); (b) ovarian cancer (n = 60); (c) cervical cancer (n = 50); (d) vulvar and vagina cancers (n = 12); and (e) gynecological cancers (n = 14). Conclusions: FDG PET/CT and FDG PET/MRI have demonstrated potential as non-invasive imaging tools for enhancing the management of gynecological malignancies. Nevertheless, certain associated challenges warrant attention.

Survival of Women with Advanced Stage Cervical Cancer: Neo-Adjuvant Chemotherapy Followed by Radiotherapy and Hyperthermia versus Chemoradiotherapy

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Incidental endometrial cancer detected on FDG PET/CT imaging for melanoma

“…The American College of Obstetricians and Gynecologists recommends further work-up with either transvaginal ultrasound or tissue biopsy (definite diagnosis) for women above 45 years old with AUB or women less than 45 years old with a history of unopposed estrogen exposure and AUB [ 3 , 4 ]. The role of FDG PET/CT in gynecological malignancies has been reviewed in recent publications to include initial staging, treatment response, and surveillance imaging [ 5 , 6 ]. Endometrial cancer as a second primary accounts for about 6% of all endometrial cancers [7] .…”