Diagnostic Strategies for Recurrent Cervical Cancer: A Cohort Study

Abstract

ObjectiveThe effectiveness of various strategies for the post-treatment monitoring of cervical cancer is unclear. This pilot study was conducted to explore recurrence patterns in and diagnostic strategies for patients with uterine cervical cancer who were meticulously followed using a customized monitoring plan.MethodsThe epidemiological and clinical data of patients with recurrent cervical cancer treated from March 2012 to April 2018 at a tertiary teaching hospital were retrospectively collected. The diagnostic methods and their reliability were compared across patients with various clinicopathological characteristics and were associated with survival outcomes.ResultsTwo hundred sixty-four patients with recurrent cervical cancer were included in the study, among which recurrence occurred in the first three years after the last primary treatment in 214 patients (81.06%). Half of the recurrence events (50.76%) occurred only within the pelvic cavity, and most lesions (78.41%) were multiple in nature. Among all recurrent cases, approximately half were diagnosed based on clinical manifestations (n=117, 44.32%), followed by imaging examinations (n=76, 28.79%), serum tumor markers (n=34, 12.88%), physical examinations (n=33, 12.50%) and cervical cytology with or without high-risk human papillomavirus (hrHPV) testing (n=4, 1.52%). The reliability of the diagnostic methods was affected by the stage (p<0.001), primary treatment regimen (p=0.001), disease-free survival (p=0.022), recurrence site (p=0.002) and number of recurrence sites (p=0.001). Primary imaging methods (sonography and chest X-ray) were not inferior to secondary imaging methods (computed tomography, magnetic resonance imaging and positron emission tomography-computed tomography) in the detection of recurrence. The chest X-ray examination only detected three cases (1.14%) of recurrence. Patients assessed with various diagnostic strategies had similar progression-free and overall survival outcomes.ConclusionsA meticulous evaluation of clinical manifestations might allow recurrence to be discovered in a timely manner in most patients with cervical cancer. Specific diagnostic methods for revealing recurrence were not associated with the survival outcomes.

PET‐CT versus MRI in the diagnosis of lymph node metastasis of cervical cancer: A meta‐analysis

“…However, the spatial resolution of PET is lower than that of CT or MRI (Chao et al, 2020), and the integrated PET-CT just solves this problem. It has both the anatomical details provided by CT and the functional and metabolic information of PET.…”

“…Studies (Chopra et al, 2020; Waller et al, 2020) have shown that PET using 18F‐FDG is more sensitive than MRI in detecting lymph node metastasis in patients with cervical cancer. However, the spatial resolution of PET is lower than that of CT or MRI (Chao et al, 2020), and the integrated PET‐CT just solves this problem. It has both the anatomical details provided by CT and the functional and metabolic information of PET.…”

Selection of Treatment Regimens for Recurrent Cervical Cancer

“…Based on surgical and/or imaging findings, the number of recurrent lesions was categorized as solitary (continuous nodules or masse) or multiple (separated lesions). The diagnostic methods used in this cohort are described elsewhere ( 16 ). In general, every 12 months, imaging assessment, including computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography-computed tomography (PET-CT) was performed according to the preference of the patient and the potential necessity for disease evaluation.…”

Giá Trị Của Cộng Hưởng Từ 1.5 Tesla Trong Chẩn Đoán Ung Thư Cổ Tử Cung Tái Phát Vùng

“…Khả năng sống sót đã được cải thiện với những tiến bộ trong việc quản lý những bệnh nhân tái phát bằng xạ trị bổ sung hoặc hóa trị với những bệnh nhân được phát hiện ở giai đoạn điều trị được, do đó việc phát hiện sớm ung thư cổ tử cung tái phát là điều bắt buộc 5 . Việc theo dõi sau điều trị thường được thực hiện bằng thăm khám lâm sàng và chẩn đoán hình ảnh (chụp cắt lớp vi tính (CLVT) hoặc chụp cộng hưởng từ (CHT)).…”