Whole-body positron emission tomography with F-18 fluorodeoxyglucose for the detection of recurrence in uterine sarcomas

Abstract

We evaluated the usefulness of whole-body positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG-PET) for the detection of recurrence in follow-up patients after primary treatment of uterine sarcoma. Eight patients with pathologically proven uterine sarcoma underwent FDG-PET, computed tomography (CT), and ultrasonography (US). Final diagnoses of recurrence were established in five cases (three carcinosarcomas and two leiomyosarcomas). PET revealed recurrent sites in the intraperitoneum, liver, lung, bone, and retroperitoneal lymph nodes. However, the minimum size of the tumor detected by PET depended on the sites of recurrence. CT and US images showed two false-negative cases of intraperitoneal tumors. PET was able to detect a solitary small intraperitoneal tumor, which was very difficult to detect by CT and US. Positive PET findings did not affect the prognosis in three of the five recurrent patients; however, the remaining two patients consequently underwent the combination therapy consisting of surgery and chemotherapy and survived for more than 1 year after the positive FDG-PET results. Application of PET imaging for the early detection of recurrent sites was useful for the decision of treatment strategy for patients with recurrent uterine sarcoma.

Uterine Carcinosarcomas (Malignant Mixed Müllerian Tumours): A Review with Special Emphasis on the Controversies in Management

“…Though this modality appears to offer the possibility of earlier detection of metastases, there was no reported improvement in patient outcome data in this study [31]. Another study by Murakami et al suggests that in patients with recurrent uterine carcinosarcomas, FDG-PET may increase prolonged survival, especially in those with small tumours treated with combination therapy [50]. 18 F-PDG PET scans seem to have limited value in posttherapy surveillance or restaging after failure with recurrence [31].…”

PET in uterine malignancies

“…In fact, in this study, PET scan, show a very good accuracy (94,4%) in women with suspected recurrence and a good sensitivity (87,5%) in asymptomatic women and contribute to change the treatment in 1/3 of the population. The results of the few small reports are encouraging in this way, but not completely in agreement [72,76,77].…”

“…During the follow-up about one half of Stage I cases develop a recurrence [72]. In the management of sarcomas (soft tissues and bone sarcoma), the current literature evidences discordant data on the accuracy and the usefulness of 18 F-FDG-PET scan due to the small number and to the heterogeneity of the included cases; however, PET seems to be capable of differentiating between low and high grade sarcomas, and in the evaluation of residual disease after therapy [73].…”

Gynecologic Oncologic Imaging With PET/CT

“…[112][113][114][115] FDG-PET/CT has been reported to have a higher detection rate compared with CT alone for the detection of extrapelvic recurrence. The sensitivity of PET/CT was 100% compared with 85.7% for CT. 116,117 Park et al 118 evaluated 36 patients and found FDG-PET/CT to have a sensitivity, specificity, accuracy, PPV, and NPV of 92.9%, 100%, 94.4%, 100%, and 80%, respectively, in symptomatic patients and 87.5%, 95.5%, 93.3%, 87.5%, and 95.5%, respectively, in asymptomatic patients. They also found that FDG-PET/CT altered the treatment plan in 33.3% of the patients with suspected recurrence.…”