F18-FDG-PET/CT in the evaluation of patients with suspected recurrent or persistent locally advanced cervical carcinoma.

BACKGROUND

Cervical cancer (CC) represents the second most common neoplasm and the third cause of death by cancer among women. Recurrent or persistent disease depends on the clinical stage, but can be as high as 70%. Positron emission tomography/computed tomography (PET/CT) is an image study that can detect increased glucose uptake in tumor tissues.

MATERIAL AND METHODS

PET/CT was performed in patients with confirmed CC, who had been previously treated, who developed suspected symptoms of recurrence or persistent disease with or without evidence of disease on a CT scan. Sensitivity, specificity, predictive values from PET/CT, and CT scan were evaluated.

RESULTS

Sixteen patients with a mean age of 47.2 years were included in the study from April 2007 to June 2008. Thirteen patients (81.2%) were symptomatic. PET/CT was positive in 14/16 (85.7%), of these, 12 True positive (TP) and two, False positive (FP); meanwhile another two cases were True negative (TN) (12.5%). Cervix, retroperitoneal, iliac, obturator, and mediastinal lymph nodes were the most common anatomic sites detected by PET/CT. Mean number of anatomic sites with high Fluoro-deoxy-D-glucose (FDG) uptake was two sites (range 1-7 sites). PET/CT and CT scan had 100 and 91.7% sensitivity, respectively. Specificity for both was 50%. Positive predictive value (PPV) was 85.4 and 84.6%, respectively. Negative predictive value (NPV) was 100 and 66%, respectively, and accuracy was 88 vs. 81%, respectively.

CONCLUSIONS

PET/CT has the capability for detecting recurrent or persistent cervical cancer; it detects increased metabolic activity mainly in primary site or lymph nodes. Further PET/CT evaluation is required to confirm the real impact of this study on the early detection of CC recurrence.