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Detection of Early Recurrence with ¹⁸F-FDG PET in Patients with Cervical Cancer

¹ Department of Obstetrics & Gynecology, Korea Cancer Center Hospital, Seoul, Korea
² Department of Nuclear Medicine, Korea Cancer Center Hospital, Seoul, Korea

This study investigated the feasibility of PET with ¹⁸F-FDG to evaluate retrospectively early recurrence in patients with cervical cancer. Methods: From September 1997 to March 2000, 249 patients with no evidence of cervical cancer after treatment were investigated with ¹⁸F-FDG PET. ¹⁸F-FDG PET scanning, beginning 50 min after injection of 370–555 MBq ¹⁸F-FDG, was performed. ¹⁸F-FDG uptake other than physiologic uptake was evaluated with the standardized uptake value and was analyzed by 2 observers who were unaware of CT or MRI data. CT or MRI and needle biopsies were performed to evaluate the positive lesions on ¹⁸F-FDG PET, and all patients were monitored closely for 6 mo for recurrence. Results: Of the 249 patients, 80 patients (32.1%) showed positive lesions with ¹⁸F-FDG PET, and 28 patients (11.2%) were clinically or histologically confirmed as having recurrences. Eighty-two percent of recurrence was detected within 6–18 mo after diagnosis, and 89% of recurrence occurred in Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) stage IIb and stage III patients. The sensitivity and specificity of ¹⁸F-FDG PET for detection of early recurrence were 90.3% and 76.1%, respectively. The sensitivity of ¹⁸F-FDG PET was high in mediastinal, hilar, and scalene lymph nodes, spine, and liver; however, the sensitivity was relatively low in lung, retrovesical lymph nodes, and paraaortic lymph nodes. Three false-negative cases were detected in lung, retrovesical lymph nodes, and paraaortic lymph nodes. Conclusion: ¹⁸F-FDG PET was effective in detecting early recurrences in cervical cancer patients with no evidence of disease. ¹⁸F-FDG PET may be a useful follow-up method for cervical cancer, thereby providing the patients with early opportunities for sophisticated treatments.

Key Words: ¹⁸F-FDG PET • cervical cancer • recurrence

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