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Clarifying the Diagnosis of Clinically Suspected Recurrence of Cervical Cancer: Impact of ¹⁸F-FDG PET

¹ Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, The Netherlands; ² Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands; and ³ Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands

Correspondence: For correspondence or reprints contact: Astrid A.M. van der Veldt, VU University Medical Center, Department of Nuclear Medicine and PET Research, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. E-mail: aam.vanderveldt{at}vumc.nl

Clarifying the diagnosis of clinically suspected recurrence of cervical cancer can be challenging. The aim of this study was to investigate the clinical value of ¹⁸F-FDG PET in this context. Methods: The medical records of a cohort of 40 ¹⁸F-FDG PET referrals in whom recurrence of cervical cancer was clinically suspected were reviewed. Two expert gynecologic oncologists assessed the level of pre-PET clinical doubt, quality of pre-PET work-up, and impact of ¹⁸F-FDG PET on diagnostic understanding and management using questionnaires. Results: In patients with clinically equivocal recurrence, ¹⁸F-FDG PET had a sensitivity of 92% and a specificity of 93% (prevalence, 65%). Before ¹⁸F-FDG PET, there was high disagreement about the adequacy of the conventional work-up (intraclass correlation coefficient [ICC], 0.25) and the presence of recurrence (ICC, 0.24). ¹⁸F-FDG PET increased experts' confidence (median increase, 14% and 25%; P < 0.0001) and diagnostic agreement (from 68% to 98%; ICC, from 0.24 to 0.95). When ¹⁸F-FDG PET was positive for recurrence, the median overall survival was 13 mo. For patients with negative ¹⁸F-FDG PET findings, the median survival was not reached (log rank, 15.50, P = 0.0001). When the treatment plan was categorized as local therapy, systemic therapy, and expectative management, ¹⁸F-FDG PET changed the treatment plan in half of all cases. The 2 experts reported that ¹⁸F-FDG PET led to a better diagnosis and a beneficial change in management in, respectively, 60% and 65% of cases. Conclusion: ¹⁸F-FDG PET can help to clarify the diagnosis of clinically suspected recurrence of cervical cancer. In this patient population, ¹⁸F-FDG PET had significant value in diagnostic understanding and management of recurrent cervical cancer, facilitating decision making and treatment planning. Therefore, ¹⁸F-FDG PET should be part of the diagnostic work-up in detection of recurrent cervical cancer. The high positive predictive value of ¹⁸F-FDG PET in these patients suggests that inclusion in intervention trials might be based on a positive ¹⁸F-FDG PET scan.

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

COPYRIGHT © 2008 by the Society of Nuclear Medicine, Inc.

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