Bhoil Amit, Mittal Bhagwant Rai, Bhattacharya Anish, Santhosh Sampath, Patel Firuza
Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Nucl Med. 2013 Oct;28(4):216-20. doi: 10.4103/0972-3919.121966.
Treatment of cervical cancer is usually surgery in the early stages and radiotherapy or chemoradiotherapy in more advanced stages of the disease. Recurrence may occur in multiple sites following primary treatment. Although recurrent metastatic disease is not curable, surgical treatment may be of great help if locoregional recurrence is detected early. Fluorine-18 Fluorodeoxyglucose positron emission tomography - computed tomography (F-18 FDG PET/CT) forms an important part of investigations in the diagnosis of clinically suspicious recurrent cervical cancer.
To assess the role of F-18 FDG PET/CT in diagnosing recurrence in patients with clinical suspicion of recurrent cervical cancer.
We retrospectively evaluated 53 histopathologically proved patients of cervical cancer. All the patients had been treated with either surgery/radiation therapy with or without chemotherapy. The standard PET/CT acquisition protocol, with delayed post void static pelvic images, wherever required, was followed in all patients. Significant uptake of FDG in the lymph nodes was considered to be a recurrence suggestive of metastasis. Para-aortic lymph nodal involvement was considered to be distant metastasis. Any significant uptake in the lung nodule on FDG PET was evaluated either by histological confirmation, by taking fine needle aspiration cytology (FNAC), or by a follow-up chest CT done after three months.
Of the 53 patients with clinically equivocal recurrence, FDG PET/CT suggested recurrence in 41 patients (local recurrence in 14 patients and distant recurrence/metastasis with or without local recurrence in 27 patients). It had a sensitivity of 97.5%, a specificity of 63.6%, positive predictive value of 90.9%, and negative predictive value of 87.5%.
PET/CT appears to have an important role in detecting recurrence following primary treatment of cervical cancer. The high positive and negative predictive values of PET/CT may be helpful in planning management of recurrent cervical cancer.
宫颈癌的治疗通常在疾病早期采用手术，在更晚期采用放疗或放化疗。初次治疗后复发可能发生在多个部位。尽管复发性转移性疾病无法治愈，但如果早期发现局部区域复发，手术治疗可能会有很大帮助。氟-18氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描（F-18 FDG PET/CT）是临床可疑复发性宫颈癌诊断检查的重要组成部分。
评估F-18 FDG PET/CT在临床怀疑复发性宫颈癌患者复发诊断中的作用。
我们回顾性评估了53例经组织病理学证实的宫颈癌患者。所有患者均接受了手术/放疗，部分接受了化疗。所有患者均遵循标准的PET/CT采集方案，必要时进行排尿后延迟静态盆腔图像采集。淋巴结中FDG的显著摄取被认为是提示转移的复发。腹主动脉旁淋巴结受累被认为是远处转移。FDG PET上肺结节的任何显著摄取通过组织学确认、细针穿刺细胞学检查（FNAC）或三个月后进行的胸部CT随访进行评估。
在53例临床复发情况不明确的患者中，FDG PET/CT提示41例复发（14例局部复发，27例远处复发/转移伴或不伴局部复发）。其敏感性为97.5%，特异性为63.6%，阳性预测值为90.9%，阴性预测值为87.5%。
PET/CT在宫颈癌初次治疗后复发的检测中似乎具有重要作用。PET/CT的高阳性和阴性预测值可能有助于规划复发性宫颈癌的管理。
