Performance of FDG-PET/CT for diagnosis of recurrent uterine cervical cancer

Abstract

The purpose is to evaluate the accuracy of integrated FDG-PET/CT, compared with PET alone, for diagnosis of suspected recurrence of uterine cervical cancer. Fifty-two women who had undergone treatment for histopathologically proven cervical cancer received PET/CT with suspected recurrence. PET-alone and integrated PET/CT images were evaluated by two different experienced radiologists by consensus for each investigation. A final diagnosis was confirmed by histopathology, radiological imaging, and clinical follow-up for over 1 year. Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/CT were 92.0% (23/25), 92.6% (25/27), and 92.3% (48/52), respectively, while for PET, the corresponding figures were 80.0% (20/25), 77.8% (21/27), and 78.8% (41/52), respectively. PET/CT resolved the false-positive PET results due to hypermetabolic activity of benign/inflammatory lesions and physiological variants, and was able to detect lung metastasis, local recurrence, peritoneal dissemination, para-aortic lymph node metastasis, and pelvic lymph node metastasis missed by PET alone. However, tiny local recurrence and lymph node metastasis could not be detected even by PET/CT. FDG-PET/CT is a useful complementary modality for providing good anatomic and functional localization of sites of recurrence during follow-up of patients with cervical cancer.

Usefulness of F-18 FDG PET/CT in Assessment of Recurrence of Cervical Cancer After Treatment

“…In other studies, sensitivities between 86 and 100%, specificities between 60 and 94%, and accuracies between 70 and 97% were reported [18][19][20][21][22]. As for the efficacy of PET/CT, the study by Chung et al reported a sensitivity of 90.3%, a specificity of 81%, and an accuracy of 86.5% [23], and in the study by Kitajima et al, PET/CT scored a sensitivity of 92%, a specificity of 93%, and an accuracy of 92% [24]. PET/CT also performed well in the present study, with a sensitivity of 97.3%, a specificity of 71.4%, a positive predictive value of 90%, a negative predictive value of 90.9%, and an accuracy of 90.2%.…”

Systematic review/Meta-analysis Positron emission tomography alone, positron emission tomography-computed tomography and computed tomography in diagnosing recurrent cervical carcinoma: a systematic review and meta-analysis

“…The status of the remaining 7 studies was not defined [10, 12, 20–23, 31]. Seven studies [13, 22, 24–26, 28, 31] enrolled patients in a consecutive manner, including three studies [21, 24, 27] in which the operator was blinded to prior test results. The TP, FN, FP, and TN results, as well as some features of each modality, are shown in Tables II–IV.…”

Clarifying the Diagnosis of Clinically Suspected Recurrence of Cervical Cancer: Impact of 18F-FDG PET

“…When a recurrence of cervical cancer was clinically suspected, 18 F-FDG PET had high accuracy in detecting and staging recurrence and was of major additional value in diagnostic understanding and treatment planning. Furthermore, the use of 18 F-FDG PET/CT (rather than 18 F-FDG PET) in these patients will likely reduce the number of diagnostic tests and help to identify biopsy sites, avoiding interpretation problems due to poor anatomic localization at 18 F-FDG PET alone (13,24).…”