Original articleFDG-PET Evaluation of Carcinoma of the Cervix
Introduction
Carcinoma of the uterine cervix is the most common gynecologic neoplasm in the world. Its incidence is decreasing in developed countries but is increasing in underdeveloped countries. Women with early clinical stage disease may be treated with surgery or with radiotherapy. Those with advanced stage disease and those with known lymph node metastasis are treated with radiotherapy.
The diagnosis of cervical cancer is established by obtaining biopsies of the cervix. Clinical staging of carcinoma of the cervix is defined by the International Federation of Obstetrics and Gynecology (FIGO) Staging System1 and includes a pelvic examination, a general history and physical examination, and selected imaging studies (chest radiography, excretory urography, and radiographic skeletal survey). These studies are not capable of evaluating lymph node status. Carcinoma of the cervix spreads by local extension within the pelvis and by lymphatic spread to the pelvic, para-aortic, and supraclavicular lymph nodes. Metastasis to lung, bone, brain, and liver may then occur. Lymph node status does not alter clinical staging but the presence of positive lymph nodes significantly alters therapy (i.e., radiotherapy versus surgery). The presence of distant metastasis may alter the intent of therapy (i.e., palliative versus curative).
Conventional imaging methods [lymphangiography, computed tomography (CT), and magnetic resonance imaging (MRI)] are utilized to determine lymph node status and sites of distant metastasis. There are major limitations to these studies, especially in the evaluation of lymph node metastasis.
Positron emission tomography with the glucose analogue 2-[18F] fluoro-2-deoxy-d-glucose (FDG) yields physiologic information that provides a means for diagnosing sites of metastatic cancer based on altered tissue metabolism. This imaging modality takes advantage of the principle that biochemical changes often precede or are more specific than the structural changes that are visualized by conventional imaging studies.
On the basis of the results of FDG-PET in pretreatment staging of a wide variety of malignant neoplasms, we have used this technique clinically in patients with newly diagnosed cervical cancer and in patients with suspected recurrent disease as an aid in planning additional diagnostic studies and treatment.2 We have retrospectively assessed the performance of FDG-PET in this clinical setting and have compared the results of PET with those of CT and lymphangiography and with the pathologic findings (when available) in these patients.
Section snippets
Methods
We studied 23 patients with carcinoma of the uterine cervix by FDG-PET between January 1998 and May 1998; 11 of these were imaged as part of their pretreatment evaluation and 12 were imaged for evaluation of clinically suspected recurrent disease. The clinical stages of the 11 patients with newly diagnosed disease were as follows: Ia2 in one; Ib1 in one; Ib2 in four; IIb in one; IIIb in three; IVb in one. Histologic confirmation of the primary tumor was obtained in all patients with primary
Newly Diagnosed Cancer
Table 1 shows the clinical data, CT findings, LAG findings, and PET findings for 11 patients listed by increasing clinical stage, with newly diagnosed carcinoma of the uterine cervix.
Discussion
Carcinoma of the cervix metastasizes from the cervix in a predictable pattern. Tumor usually spreads from the primary cervical lesion to the pelvic lymph nodes, to the para-aortic lymph nodes, to the supraclavicular lymph nodes, and then to non-nodal metastatic sites such as lung, bone, and liver. Staging for carcinoma of the cervix is a clinically based system. The presence of lymph node metastasis does not alter the clinical stage but it is a significant finding that does alter the method of
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Accurate segmenting of cervical tumors in PET imaging based on similarity between adjacent slices
2018, Computers in Biology and MedicineFDG-PET-based prognostic nomograms for locally advanced cervical cancer
2012, Gynecologic OncologyCitation Excerpt :For this study, we aimed to create a PET-based prognostic model for cervical cancer. Recently, positron emission tomography (PET) with the glucose analogue F-18 fluorodeoxyglucose (FDG) has been shown to be a useful diagnostic tool in the evaluation of patients with cervical cancer, aiding in identifying the extent of the primary cervical tumor, lymph node involvement, and distant disease [6–9]. Additionally, FDG-PET has helped further define new prognostic factors for cervical cancer.
The role of FDG-PET/CT in cervical cancer: Diagnosis, staging, radiation treatment planning and follow-up
2010, PET ClinicsCitation Excerpt :A prognostic value of SUVmax measurements has also been reported for other malignancies, such as lung and head and neck cancers.56–61 FDG-PET has a superior ability to detect regional and distant metastatic disease in patients with cervical cancer as compared with CT and MR imaging (Fig. 1).10,40,47,62–64 In a retrospective analysis of 59 subjects with Stage IA-IIA disease, Wright and colleagues65 reported that FDG-PET before definitive surgery had a sensitivity and specificity of 53% and 90% respectively for detection of metastases.
Clinical Outcomes of Definitive Intensity-Modulated Radiation Therapy With Fluorodeoxyglucose-Positron Emission Tomography Simulation in Patients With Locally Advanced Cervical Cancer
2010, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :Some have suggested cervical cancer is particularly difficult to treat with IMRT because IMRT requires specific target volume definition and cervical tumors are difficult to distinguish from surrounding tissue using computed tomography (CT) (15). Positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) has good sensitivity for detecting sites of disease in cervical cancer and, at our institution, we have significant experience in using FDG-PET to aid radiation treatment planning in patients with cervical cancer (16, 17). In addition, we have found, in a prospectively validated study, that treatment response in cervical cancer, as evaluated on the 3-month post-therapy FDG-PET, predicts overall survival (18).
Additional value of MR/PET fusion compared with PET/CT in the detection of lymph node metastases in cervical cancer patients
2009, European Journal of CancerThe role of PET/CT in the management of patients with cervical cancer: Practice patterns of the members of the Society of Gynecologic Oncologists
2009, Gynecologic OncologyCitation Excerpt :PET uses the glucose analogue [18F]-fluoro-2-deoxy-d-glucose (FDG) and relies on increased metabolism of cancer cells and thus increased glucose uptake. Substantial evidence has now emerged documenting the important value of PET/CT in the management of cervical cancer patients, not only at the time of initial diagnosis, but also at post-treatment follow-up visits and for routine surveillance [4,6–12]. The use of PET/CT has been shown to detect recurrences in otherwise asymptomatic women, improve survival after recurrence, and provide important prognostic information for women post-therapy that may alter treatment plans [11,12,16,17].