Article Figures & Data
Figures
- FIGURE 1.
18F-FDG PET of complete metabolic response in 52-y-old woman with newly diagnosed International Federation of Gynecology and Obstetrics stage IVA squamous cell cancer of cervix. (A) At initial staging, sagittal (top) and transaxial (bottom) CT (left), fused PET/CT (middle), and PET (right) demonstrate intense 18F-FDG uptake (SUV, 13.3) within large cervical mass. (B) Three months later, after concurrent radiochemotherapy, sagittal (top) and transaxial (bottom) CT (left), fused PET/CT (middle), and PET (right) demonstrate resolution of cervical mass and only mild, diffuse (similar to background [SUV, 2.0]) 18F-FDG uptake within cervix, consistent with complete metabolic response.
- FIGURE 2.
18F-FDG PET of partial metabolic response in 54-y-old woman with newly diagnosed International Federation of Gynecology and Obstetrics stage III squamous cell carcinoma of cervix. (A) At initial staging, sagittal (top) and transaxial (bottom) CT (left), fused PET/CT (middle), and PET (right) demonstrate intense 18F-FDG uptake (SUV, 15.3) within large cervical mass. (B) Three months later, after concurrent radiochemotherapy, sagittal (top) and transaxial (bottom) CT (left), fused PET/CT (middle), and PET (right) show that 18F-FDG uptake has improved but remains focally increased (SUV, 5.4) within residual cervical mass, consistent with partial metabolic response.
- FIGURE 3.
Kaplan–Meier curves showing survival outcome based on follow-up posttherapy 18F-FDG PET in 378 patients: 269 patients had complete metabolic response, 52 had persistent abnormal 18F-FDG uptake, and 57 had new sites of disease (log-rank P value < 0.0001 for all plots).
- FIGURE 4.
A 68-y-old woman presented with rising CA-125 levels and normal findings on CT. (A and B) At restaging, transaxial PET/CT slice through chest (A) demonstrates moderate (same as blood pool) 18F-FDG uptake in right hilum, corresponding to 1.6-cm lymph node, consistent with metastasis; transaxial PET/CT slice through focus of 18F-FDG uptake in right lower quadrant (B) demonstrates moderate 18F-FDG uptake in 0.5-cm right serosal implant, consistent with metastasis. This lesion was identified on CT retrospectively because of 18F-FDG uptake. (C and D) Three months after chemotherapy, transaxial PET/CT slice through chest (C) demonstrates more intense (greater than blood pool) 18F-FDG uptake in right hilar lymph node and slight increase in size, consistent with progressive disease; transaxial PET/CT slice through pelvis (D) demonstrates more intense 18F-FDG uptake in right serosal implant, consistent with progressive disease.
Tables
- TABLE 1
Cervical Cancer Staging System of the International Federation of Gynecology and Obstetrics
Carcinoma type Stage Description Preinvasive 0 Carcinoma in situ; intraepithelial carcinoma Invasive I Carcinoma strictly confined to cervix IA Invasive cancer identified only microscopically (all gross lesions, even with superficial staging, are stage IB cancers); invasion is limited to measured stromal invasion with maximum depth of 5.0 mm and no wider than 7.0 mm IA1 Measured invasion of stroma no greater than 3.0 mm in depth and no wider than 7.0 mm IA2 Measured invasion of stroma greater than 3.0 mm in depth but no greater than 5.0 mm and no wider than 7.0 mm IB Clinical lesions confined to cervix or preclinical lesions greater than stage IA IB1 Clinical lesions no larger than 4.0 cm IB2 Clinical lesions larger than 4.0 cm II Carcinoma extends beyond cervix but not to pelvic wall; carcinoma involves vagina but not lower third IIA No obvious parametrial involvement IIB Obvious parametrial involvement III Carcinoma has extended to pelvic wall; on rectal examination, there is no cancer-free space between tumor and pelvic wall; tumor involves lower third of vagina; all cases with hydronephrosis or nonfunctioning kidney are included IIIA No extension to pelvic wall IIIB Extension to pelvic wall or hydronephrosis or nonfunctioning kidney IV Carcinoma has extended beyond true pelvis or has clinically involved mucosa of bladder or rectum; bullous edema does not permit a case to be allotted to stage IV IVA Spread of growth to adjacent organs IVB Spread to distant organs Author Year Number of patients Criteria for response on PET Outcome measure Design P Avril (39) 2005 33 20% decrease in SUV after first cycle Overall survival Prospective study 0.008 55% decrease in SUV after third cycle Overall survival 0.005 Nishiyama (40) 2008 21 SUV after completion, <3.8 Detection of responders: sensitivity 90%, specificity 64%, accuracy 76% Retrospective study <0.005 >65% change in SUV between baseline and after completion Detection of responders: sensitivity 90%, specificity 82%, accuracy 86% Author Year Number of Patients Modality Sens Spec Acc PPV NPV Design Outcome P Rose (42) 2001 22 with complete clinical response PET: lesion-based 10% 42% NA NA NA Prospective: compared with second-look surgery NA NA Cho (43) 2002 21 PET + CT Retrospective: compared with second-look surgery NA NA Lesion-based 58% 99% 92% 97% 92% Patient-based 100% 92% 95% 92% 100% PET Lesion-based 36% 100% 89% 95% 88% Patient-based 81% 90% 86% 90% 82% CT Lesion-based 54% 100% 82% 97% 92% Patient-based 100% 90% 95% 92% 100% Sironi (44) 2004 31 (15 patients with CA-125 > 35 U/mL) PET/CT: lesion-based 78% 75% 77% 89% 57% Prospective study NA NA PET/CT: patient-based 53% 86% Kim (45) 2004 55 PET NA NA NA NA NA Randomized: 18F-FDG PET vs. second-look surgery Progression-free survival NS Kurosaki (46) 2006 18 PET ± CA-125 high/normal NA NA NA NA NA Retrospective study 2-y survival 0.025 Sens = sensitivity; Spec = specificity; Acc = accuracy; PPV = positive-predictive value; NPV = negative-predictive value; NA = not available; NS = not significant.
Author Year Number of patients Modality Sens Spec Acc PPV NPV Design Change of management Smith (57) 1999 Simulation study PET NA NA NA NA NA Simulation analysis of cost with and without PET Decrease of unnecessary surgery from 70% to 5% Bristow (51) 2003 22 with rising CA-125 and equivocal CT PET/CT for detection of tumor > 1 cm 83% NA 82% 94% Prospective study Complete cytoreduction to no gross residual tumor: 72% Havrilesky (47) 2005 10 studies between 1966 and 2003 PET 90% 86% NA NA NA Review NA CT 68% 58% PET when CA-125 high 94% 80% NA NA NA NA PET when CA-125 normal 54% 73% NA NA NA NA Ruiz (49) 2005 17 studies between 1972 and 2003 PET 94% 65% NA NA NA Metaanalysis NA Simcock (52) 2006 55 for surveillance or suspicion of relapse PET/CT NA NA NA NA NA Prospective 58% Garcia (50) 2007 80 for suspicion of relapse PET 87% 79% 85% 92% 68% Retrospective study NA CT 53% 82% 61% 89% 39% CA-125 58% 94% 67% Mangili (53) 2007 32 for suspicion of relapse PET/CT; CT NA NA NA NA NA Retrospective study 44% Chung (54) 2007 77 PET/CT 93% 97% 94% 98% 91% Retrospective study 25% Kitajama (56) 2008 132 PET/contrast-enhanced CT 79% 91% 85% NA NA Retrospective study 39% PET/unenhanced CT 74% 91 83% NA NA NA Contrast-enhanced CT 61% 85% 73% NA NA NA Soussan (55) 2008 29 PET/CT NA NA NA NA NA Questionnaire 33% Sens = sensitivity; Spec = specificity; Acc = accuracy; PPV = positive-predictive value; NPV = negative-predictive value; NA = not available.
Jump to section
Related Articles
Cited By...
- Repeatability of 18F-FDG PET Radiomic Features in Cervical Cancer
- 89Zr-anti-{gamma}H2AX-TAT but not 18F-FDG Allows Early Monitoring of Response to Chemotherapy in a Mouse Model of Pancreatic Ductal Adenocarcinoma
- 18F-FDG PET/CT for Therapy Control in Vascular Graft Infections: A First Feasibility Study
- Pathway-Specific Analysis of Gene Expression Data Identifies the PI3K/Akt Pathway as a Novel Therapeutic Target in Cervical Cancer
- Assessing Tumor Response to Therapy