Magnetic Resonance Imaging/Positron Emission Tomography Provides a Roadmap for Surgical Planning and Serves as a Predictive Biomarker in Patients With Recurrent Gynecological Cancers Undergoing Pelvic Exenteration

Vargas, Hebert Alberto; Burger, Irene A.; Donati, Olivio F.; Andikyan, Vaagn; Lakhman, Yulia; Goldman, Debra A.; Schöder, Heiko; Dennis, S.; Sala, Evis; Hricak, Hedvig

doi:10.1097/igc.0b013e3182a41e61

Cited by 29 publications

(18 citation statements)

References 20 publications

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“…not enough for precise T-staging [19]) or MRI-only (whole-body protocol staging not yet established and ability to detect recurrence is inferior to PET/MRI [20,21]). …”

Section: Introductionmentioning

confidence: 98%

PET/MRI and PET/CT in advanced gynaecological tumours: initial experience and comparison

et al. 2015

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“…not enough for precise T-staging [19]) or MRI-only (whole-body protocol staging not yet established and ability to detect recurrence is inferior to PET/MRI [20,21]). …”

Section: Introductionmentioning

confidence: 98%

PET/MRI and PET/CT in advanced gynaecological tumours: initial experience and comparison

et al. 2015

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“…The discrepancy between intra-operative metastatic nodal findings and pre-operative PET/CT findings may be due to the limitations of PET/CT in detection of small volume metastatic disease. Combined PET and MRI is an emerging technology that has the increased soft tissue contrast while reducing ionizing radiation exposure 16. It integrates morphological and structural information afforded by MRI with functional information from PET 17.…”

Section: Discussionmentioning

confidence: 99%

Utility of 18F-FDG-PET/CT imaging in patients with recurrent gynecological malignancies prior to pelvic exenteration

Kim

Lee²,

Brar³

et al. 2019

International Journal of Gynecological Cancer

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BackgroundIn patients with recurrent gynecologic malignancies isolated to the pelvis, pelvic exenteration is a potential option. 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), is often used to confirm no evidence of metastatic disease.ObjectiveTo assess the impact of PET/CT on clinical management of patients with recurrent gynecologic malignancies being considered for pelvic exenteration.MethodsPatients with recurrent gynecological malignancies who underwent PET/CT imaging between 2011 and 2014 were identified. All were considered for pelvic exenteration and underwent conventional imaging with CT +/- pelvic MRI. Patient anthropometric data, disease sites, histology, stage, treatment received, and treatment plan based on PET/CT findings were extracted.ResultsA total of 40 patients met inclusion criteria. In 15 (37.5%) of these patients, results of PET/CT changed the original plan of pelvic exenteration owing to metastatic disease/unresectability (11/15) or no evidence of disease on PET/CT imaging (4/15). Twenty-five (62.5%) patients had their planned surgery after PET/CT with 19 (76%) patients undergoing a completed exenteration procedure. Six (24%) patients with PET/CT indicating isolated pelvic recurrence ultimately had intra-operative findings of extra-pelvic metastasis or nodal disease and therefore the planned surgery was aborted.ConclusionIn nearly 40% of patients with recurrent gynecologic malignancies being considered for radical salvage surgery, PET/CT can significantly alter the originally intended treatment and hence may reduce the number of futile surgical procedures.

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“…Recent research suggests that fused MR imaging/ PET may serve as a predictive biomarker and yield greater diagnostic accuracy and better interobserver agreement than either MR imaging or FDG PET/ CT alone (66). With wider adoption and greater availability of hybrid whole-body PET/MR imaging, this novel technique may become a valuable diagnostic tool for patients with treatment-resistant gynecologic malignancies.…”

Section: Future Perspectivementioning

confidence: 97%

Role of MR Imaging and FDG PET/CT in Selection and Follow-up of Patients Treated with Pelvic Exenteration for Gynecologic Malignancies

Lakhman¹,

Nougaret²,

Miccò³

et al. 2015

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Pelvic exenteration (PE) is a radical surgical procedure used for the past 6 decades to treat locally advanced malignant diseases confined to the pelvis, particularly persistent or recurrent gynecologic cancers in the irradiated pelvis. The traditional surgical technique known as total PE consists of resection of all pelvic viscera followed by reconstruction. Depending on the tumor extent, the procedure can be tailored to remove only anterior or posterior structures, including the bladder (anterior exenteration) or rectum (posterior exenteration). Conversely, more extended pelvic resection can be performed if the pelvic sidewall is invaded by cancer. Preoperative imaging evaluation with magnetic resonance (MR) imaging and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is central to establishing tumor resectability and therefore patient eligibility for the procedure. These imaging modalities complement each other in diagnosis of tumor recurrence and differentiation of persistent disease from posttreatment changes. MR imaging can accurately demonstrate local tumor extent and show adjacent organ invasion. FDG PET/CT is useful in excluding nodal and distant metastases. In addition, FDG PET/CT metrics may serve as predictive biomarkers for overall and disease-free survival. This pictorial review describes different types of exenterative surgical procedures and illustrates the central role of imaging in accurate patient selection, treatment planning, and postsurgical surveillance.

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Magnetic Resonance Imaging/Positron Emission Tomography Provides a Roadmap for Surgical Planning and Serves as a Predictive Biomarker in Patients With Recurrent Gynecological Cancers Undergoing Pelvic Exenteration

Abstract: In patients with recurrent gynecological cancers undergoing pelvic exenteration, fused MRI/PET served as a predictive biomarker and yielded greater diagnostic confidence and interreader agreement than either MRI or PET/CT.

Cited by 29 publications

References 20 publications

PET/MRI and PET/CT in advanced gynaecological tumours: initial experience and comparison

PET/MRI and PET/CT in advanced gynaecological tumours: initial experience and comparison

Utility of 18F-FDG-PET/CT imaging in patients with recurrent gynecological malignancies prior to pelvic exenteration

Role of MR Imaging and FDG PET/CT in Selection and Follow-up of Patients Treated with Pelvic Exenteration for Gynecologic Malignancies

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