PET/CT Evaluation of Cervical Cancer: Spectrum of Disease

Abstract

The prognosis of invasive cervical cancer is based on the stage, size, and histologic grade of the primary tumor and the status of the lymph nodes. Assessment of disease stage is essential in determining proper management in individual cases. In the posttherapy setting, the timely detection of recurrence is essential for guiding management and may lead to increased survival. However, the official clinical staging system of the International Federation of Gynecology and Obstetrics has inherent flaws that may lead to inaccurate staging and improper management. Combined positron emission tomography (PET)/computed tomography (CT) represents a major technologic advance, consisting of two integrated complementary modalities whose combined strength tends to overcome their respective weaknesses. PET/CT has higher sensitivity and specificity than do conventional anatomic modalities and is valuable in determining the extent of disease and detecting recurrent or residual tumor. The combination of 2-[fluorine-18]fluoro-2-deoxy-d-glucose PET with intravenous contrast material-enhanced high-resolution CT has proved useful for avoiding the interpretative weaknesses associated with either modality alone and in increasing the accuracy of staging or restaging. Nonetheless, accurate PET/CT interpretation requires a knowledge of the characteristics of disease spread or recurrence and an awareness of various imaging pitfalls if false interpretations are to be avoided.

The SUVmax (maximum standardized uptake value for F-18 fluorodeoxyglucose) and serum squamous cell carcinoma antigen (SCC-ag) function as prognostic biomarkers in patients with primary cervical cancer

“…Optimal management includes precise clinical staging and optimal treatment followed by deliberate posttherapy surveillance, early detection of recurrence and appropriate salvage therapy (Jao et al 2010). In the pretreatment setting, it is crucial to stage the tumor accurately and assess the prognostic factor precisely in order to determine the optimal treatment modality (Son et al 2010). Although LN assessment is not part of the FIGO clinical staging, it is generally performed during the initial workup of patients with cervical cancer as an important component of treatment planning, since the survival rates for patients with nodal metastases are significantly lower than those without nodal metastases (Chung et al 2010a;Ishikawa et al 1999;Lai et al 1999;Sakuragi et al 1999;Waggoner 2003;Haie-Meder et al 2010;Kidd et al 2010a).…”

Evaluating the Role of F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scanning in the Staging of Patients With Stage IIIB Cervical Carcinoma and the Impact on Treatment Decisions

“…This is because disease can exist in normal-sized lymph nodes, which will be reported as negative. 10 In this study, the accuracy of the PET/CT to determine para-aortic nodal metastases could not be proven because biopsies of the para-aortic lymph nodes were not done on all the patients who showed increased FDG uptake in paraaortic nodes.…”

“…Gynecological cancers and specifically ICC generally show high uptake of the glucose analog F-18 FDG due to the high cellular glucose metabolism and can therefore be detected by FDG PET/CT. 10 Cervical cancer, if confined to the lower pelvis can be cured by surgery or chemoradiation. The treatment of choice for locally advanced cervix cancer is radical chemoradiation with curative intent.…”

[18F]FDG-PET/CT and MRI for initial pelvic lymph node staging in patients with cervical carcinoma: The potential usefulness of [18F]FDG-PET/MRI

“…CC first spreads to the pelvic area along the external and internal iliac vascular system, as well as to the presacral space (14). The incidence of pelvic LNM in the early stages of CC ranges from 10.9-44.7% (15,16).…”