Improved Prognostic Value of 18F-FDG PET Using a Simple Visual Analysis of Tumor Characteristics in Patients with Cervical Cancer

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FIGURE 1.
On left is coronal image of patient with small, spherical, and homogeneous primary tumor and no lymph node disease (score = 0), who was alive without disease at 703 d. On right is coronal image of patient with large, nonspherical, and markedly heterogeneous primary tumor (score = 2 + 1 + 2 + 2, or 7), who was dead of her disease at 149 d. Patient on right also had paraaortic lymph node disease (not shown).
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FIGURE 2.
(A) PFS for scoring of observer 1. (B) OS for observer 1. Good Prognosis = patients with total score < 4; Bad Prognosis = patients with score ≥ 4.
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FIGURE 3.
(A) PFS superimposed for the 3 observers. (B) OS for the 3 observers. Good Prognosis = patients with total score < 4; Bad Prognosis = patients with score ≥ 4.
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FIGURE 4.
(A) PFS when only lymph node status was considered. (B) OS when only lymph node status was considered. LN negative = no lymph node disease; LN positive = disease at any site.
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FIGURE 5.
(A) PFS for scoring of observer 1 when only visual characteristics of tumor were considered. (B) OS for visual characteristic scoring of observer 1. Good Prognosis = patients with total score < 3; Bad Prognosis = patients with score ≥ 3.

TABLE 1

Scoring System

Size	Shape	Heterogeneity	Lymph nodes*
0 = small (<4 cm)	0 = spherical	0 = none	0 = none
1 = moderate (4–10 cm)	1 = nonspherical	1 = moderate (10%–30%)	1 = pelvic
2 = large (>10 cm)	—	2 = marked (>30%)	2 = paraaortic
—	—	—	3 = distant

TABLE 2

Patient Characteristics

Patient no.	Stage	Histology	Age (y)	Status	PFS (d)	OS (d)
1	IIb	Squamous	43	AWD	622	832
2	IIIb	Squamous	45	DOD	96	322
3	IIb	Squamous	61	DOD	151	342
4	IIb	Adenosq	44	DOD	95	466
5	IIb	Squamous	27	DOD	211	275
6	Ib2	Adenosq	56	DOD	337	397
7	IIIb	Squamous	52	DOD	103	384
8	Ib2	Squamous	24	DOD	188	270
9	IVb	Squamous	38	DOD	132	149
10	IIIb	Squamous	40	DOD	80	138
11	IIb	Squamous	67	DOD	196	252
12	IIIb	Squamous	47	DOD	55	55
13	IIb	Squamous	43	DOD	160	177
14	IIb	Squamous	52	DOD	213	239
15	Ib2	Squamous	45	DOD	265	730
16	IIIb	Squamous	34	DOD	99	334
17	IIIb	Squamous	48	DOD	345	429
18	IIb	Squamous	47	NED	1,017	1,017
19	Ib2	Squamous	28	NED	498	498
20	IIb	Squamous	28	NED	615	615
21	IIIb	Squamous	31	NED	616	616
22	IIIb	Squamous	47	NED	1,131	1,131
23	IIb	Squamous	54	NED	894	894
24	IIIb	Adenosq	49	NED	704	704
25	IIb	Squamous	58	NED	732	732
26	IIIb	Squamous	27	NED	752	752
27	Ib1	Squamous	47	NED	961	961
28	IIb	Squamous	55	NED	703	703
29	Ia1	Adeno	53	NED	968	968
30	IIb	Squamous	47	NED	643	643
31	IIb	Adeno	45	NED	883	1,040
32	IIb	Squamous	83	NED	661	661
33	IIb	Squamous	42	NED	571	571
34	Ib2	Squamous	47	NED	703	703
35	IIb	Squamous	48	NED	1,015	1,015
36	IIIb	Squamous	71	NED	596	596
37	Ib2	Squamous	29	NED	799	799
38	IIb	Squamous	43	NED	826	826
39	IIIb	Squamous	44	NED	761	761
40	IIb	Squamous	56	NED	830	830
41	IIb	Squamous	57	NED	730	730
42	IIb	Squamous	54	NED	614	614
43	Ib2	Squamous	60	NED	902	902
44	IIb	Squamous	87	NED	154	154
45	IIb	Squamous	63	NED	622	622
46	Ib1	Squamous	71	NED	788	788
47	Ib2	Squamous	36	NED	382	382

AWD = alive with disease; DOD = dead of disease; Adenosq = adenosquamous; NED = no evidence of disease; Adeno = adenocarcinoma.