Molecular imaging in the management of cervical cancer

Abstract

Positron emission tomography (PET), magnetic resonance imaging (MRI), and integrated 18-fluorodeoxyglucose ((18)F-FDG) PET/computed tomography are valuable techniques for assessing prognosis, treatment response after the completion of concurrent chemoradiation, suspicious or documented recurrence, unexplained post therapy elevations in tumor markers, and the response to salvage treatment when managing cervical cancer. However, PET plays a limited role in the primary staging of MRI-defined node-negative patients. Currently, (18)F-FDG is still the only tracer approved for routine use, but several novel targeting PET compounds, high-Tesla MRI machines, diffusion-weighted imaging without contrast, and dynamic nuclear polarized-enhanced (13)C-MR spectroscopic imaging may hold promising applications.

The Role of Pretreatment FDG-PET in Treating Cervical Cancer Patients With Enlarged Pelvic Lymph Node(s) Shown on MRI: A Phase 3 Randomized Trial With Long-Term Follow-Up

“…In the past decade, many studies have demonstrated the role of 18 Ffluorodeoxyglucose positron emission tomography (FDG-PET or PET-CT) in cervical cancer (9,10). FDG-PET might be superior to CT or MRI in determining lymph node status and distant metastasis (11)(12)(13)(14).…”

Measuring Intratumoral Metabolic Heterogeneity by Positron Emission Tomography in Cervical Cancer–A Review

“…Positron Emission Tomography (PET), a functional imaging modality, which utilizes radiotracers, mainly 18F-fluorodeoxyglucose (18F-FDG), along or combined with CT or MRI, to detect metabolic processes, is beneficial in cervical cancer for evaluation of primary disease status, nodal metastasis, distant metastasis, prognosis, and recurrence [1,2]. Kidd et al reported that prognostic nomograms composed with pretreatment 18F-FDG PET LN status, cervical tumor maximum standardized uptake value (SUVmax), and tumor volume could be a predictive model for recurrence free survival (RFS), diseasespecific survival (DSS), and overall survival (OS) [3].…”

“…The prognosis is depended on International Federation of Gynecology and Obstetrics (FIGO) stage, histology, Lymph Node (LN) metastasis, lymphovascular space involvement, positive surgical resection margins [1]. Clinical staging by pelvic examination, imaging studies, mainly Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are widely used for pretreatment evaluation and detection of recurrences/ metastases.…”

Molecular imaging in the management of gynecologic malignancies

“…To date no adequate evidence has been provided by a large scale or prospective study partly because of rareness of uterine sarcoma. In cervical cancer, radiotracers other than FDG such as 64 Cu-labeled diacetylbis(N4-methylthiosemicarbazone) ( 64 Cu-ATSM) were used to demonstrate hypoxia and 11 C-choline for proliferative activity, yet have not gained popularity [14].…”

“…Generally, International Federation of Gynecology and Obstetrics [FIGO] stages IA1-IIA1 diseases can be treated with either primary surgery or radiotherapy (RT), while stages IB2 to IV (except IIA1) diseases can be treated with definitive radiation with concurrent platinum-based chemotherapy [14]. MRI was found useful to confirm the absence of residual tumor in the cervix after a cone biopsy with negative margins in selection of patients for fertility-sparing radical trachelectomy [15].…”