The Role of PET/CT in the Management of Cervical Cancer

Mirpour, Sahar; Mhlanga, Joyce; Logeswaran, Prashanti; Russo, G.; Mercier, Gustavo; Subramaniam, Rathan M.

doi:10.2214/ajr.12.9830

Cited by 58 publications

(44 citation statements)

References 84 publications

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“…It has played a role in changing disease management, such as facilitating radiation planning 22. SUVmax, MTV and TLG are emerging as predictive markers and possible stratification tools for treating cervical cancer.…”

Section: Discussionmentioning

confidence: 99%

Relationship of ¹⁸F-Fdg Pet/Ct Metabolic, Clinical and Pathological Characteristics of Primary Squamous Cell Carcinoma of the Cervix

Xin

et al. 2016

Journal of Investigative Medicine

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The objectives of this retrospective study were to use preoperative fluoro-d-glucose (FDG) PET/CT in patients with primary cervical squamous cell carcinoma to explore the relationship between clinical, pathological and metabolic characteristics. Eighty consecutive patients with squamous cell carcinoma of cervix received FDG PET/CT scan before treatment. Metabolic tumor volume (MTV), total lesion glycolysis (TLG) and the peak standardized uptake value (SUVpeak) of the cervical tumors were calculated by an iterative adaptive algorithm. The association of these metabolic markers with serum squamous cell carcinoma antigen (SCC-ag), International Federation of Gynecology and Obstetrics (FIGO) stage, maximum tumor size and depth of cervical stromal invasion of the tumor was determined by the multivariate analysis. MTV and TLG were significantly higher in subjects with serum SCC-ag levels ≥3.95, with FIGO stage 1b2 and with a maximum tumor size of ≥4 cm (p≤0.009). Higher SUVpeak levels were associated with a maximum tumor size of ≥4 cm and with a cervical stromal invasion depth of ≥1/2 (p≤0.003). Multivariate analysis indicated that MTV was independently associated with FIGO stage Ib2 (p=0.041) and depth of cervical stromal invasion (p=0.020). TLG and SUVpeak were independently associated with maximum tumor size (p≤0.004) and depth of cervical stromal invasion (p≤0.013). Significant linear correlation was found between SUVpeak and tumor size; the Pearson correlation coefficient was 0.34 (p=0.002). Metabolic parameters such as MTV, TLG and SUVpeak are able to predict clinical and pathological status in preoperative cervical cancer.

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Section: Discussionmentioning

confidence: 99%

Relationship of ¹⁸F-Fdg Pet/Ct Metabolic, Clinical and Pathological Characteristics of Primary Squamous Cell Carcinoma of the Cervix

Xin

et al. 2016

Journal of Investigative Medicine

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“…However, due to technical advances, like the use of endovaginal coils and the wide implementation of magnetic resonance imaging (MRI) functional techniques [dynamic contrast enhanced (DCE) or diffusion weighted imaging (DWI) sequences] to conventional MRI protocols, even small (≤ 1 cm) cervical tumors may be detected [4] ; small tumors may be seen on MRI, as foci of enhancement on early arterial DCE images or as foci of restricted diffusion within the cervix [5] . Positron emission tomography/ computed tomography (PET/CT) may detect small FDGavid tumors 7 mm or less [6] ; PET/MRI, a new hybrid imaging method, may have the potential to improve imaging performance rate for detection of small cervical cancers, but more data is needed to establish clinical implementation.…”

Section: The Role Of Imaging In the Early Detection Of Cervical Cancermentioning

confidence: 99%

Current imaging strategies for the evaluation of uterine cervical cancer

Bourgioti

Chatoupis

Moulopoulos

2016

WJR

105

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Uterine cervical cancer still remains an important socioeconomic issue because it largely affects women of reproductive age. Prognosis is highly depended on extent of the disease at diagnosis and, therefore, accurate staging is crucial for optimal management. Cervical cancer is clinically staged, according to International Federation of Gynecology and Obstetrics guidelines, but, currently, there is increased use of cross sectional imaging modalities [computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-CT (PET-CT)] for the study of important prognostic factors like tumor size, parametrial invasion, endocervical extension, pelvic side wall or adjacent/distal organs involvement and lymph node status. Imaging indications also include cervical cancer follow-up, evaluation of tumor response to treatment and selection of suitable candidates for less radical surgeries like radical trachelectomy for fertility preservation. The preferred imaging method for local cervical cancer evaluation is MRI; CT is equally effective for evaluation of extrauterine spread of the disease. PET-CT shows high diagnostic performance for the detection of tumor relapse and metastatic lymph nodes. The aim of this review is to familiarize radiologists with the MRI appearance of cervical carcinoma and to discuss the indications of cross sectional imaging during the course of the disease in patients with cervical carcinoma.

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“…Our criterion for MRNM was ≥5 mm for CT and MRI,25 which has been frequently used in the past but has a sensitivity of 68% and a specificity of 78% 26 27. For PET, a standardized uptake value cut-off point of 2.5 was used 28. Pelvic node metastasis was detected in 45.1% of our cases.…”

Section: Discussionmentioning

confidence: 99%

Incidence of mesorectal node metastasis in locally advanced cervical cancer: its therapeutic implications

Cordero-Gallardo

Burnett

McNamara

et al. 2019

Int J Gynecol Cancer

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ObjectiveTo evaluate the incidence and risk factors for mesorectal node metastasis (MRNM) in locally advanced cervical cancer.Methods/MaterialsWe performed an observational retrospective cohort study of 122 patients with cervical cancer who received definitive chemo-radiation treatment between December 2013 and June 2017 to evaluate the incidence of MRNM. Three diagnostic radiologists assessed all available pre-treatment images. In this study, the pelvic node metastasis was defined as ≥ 1.0 cm and MRNM as ≥ 0.5 cm for CT and MRI scans and as a maximum standardized uptake value of > 2.5 for PET/CT. The relationship of MRNM with FIGO stage, pelvic node metastasis, and mesorectal fascia involvement was evaluated.ResultsThe incidence of MRNM in all 122 patients was 8 (6.6%). However, in advanced stage (III– IV) patients, MRNM occurred in 4 of 39 (10.3%) compared with 4 of 83 (4.8%) in early stage (IB1–IIB) patients (p = 0.27). In patients with a positive pelvic node, MRNM occurred in 7 of 55 (12.7%) and 1 of 67 (1.5%) in those with negative pelvic node (p = 0.02). In addition, the incidence of MRNM was 3 of 9 (33.3%) in the presence of mesorectal fascia involvement and 5 of 113 (4.4%) among those without mesorectal fascia involvement (p = 0.013).ConclusionThis study indicates that pelvic node metastasis and mesorectal fascia involvement are high-risk factors for MRNM. Therefore, vigilance of reviewing images in the mesorectum for MRNM is necessary for high-risk patients.

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The Role of PET/CT in the Management of Cervical Cancer

Cited by 58 publications

References 84 publications

Relationship of ¹⁸F-Fdg Pet/Ct Metabolic, Clinical and Pathological Characteristics of Primary Squamous Cell Carcinoma of the Cervix

Relationship of ¹⁸F-Fdg Pet/Ct Metabolic, Clinical and Pathological Characteristics of Primary Squamous Cell Carcinoma of the Cervix

Current imaging strategies for the evaluation of uterine cervical cancer

Incidence of mesorectal node metastasis in locally advanced cervical cancer: its therapeutic implications

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The Role of PET/CT in the Management of Cervical Cancer

Cited by 58 publications

References 84 publications

Relationship of 18F-Fdg Pet/Ct Metabolic, Clinical and Pathological Characteristics of Primary Squamous Cell Carcinoma of the Cervix

Relationship of 18F-Fdg Pet/Ct Metabolic, Clinical and Pathological Characteristics of Primary Squamous Cell Carcinoma of the Cervix

Current imaging strategies for the evaluation of uterine cervical cancer

Incidence of mesorectal node metastasis in locally advanced cervical cancer: its therapeutic implications

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Product

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Relationship of ¹⁸F-Fdg Pet/Ct Metabolic, Clinical and Pathological Characteristics of Primary Squamous Cell Carcinoma of the Cervix

Relationship of ¹⁸F-Fdg Pet/Ct Metabolic, Clinical and Pathological Characteristics of Primary Squamous Cell Carcinoma of the Cervix