PET/CT evaluation of cervical cancer at staging and restaging.

Learning Objectives 1. Review PET/CT characteristics of cervical cancer (CC) for primary tumor and local and distant metastases at staging.2. Review PET/CT features of localtumor recurrence and distant metastases. 3. Review PET/CT pitfalls at staging and in the post-therapy setting in CC.

Summary: The management of CC is based on FIGO stage, histopathologic grade and lymph node status. FIGO staging has inaccuracies and it does not assess lymph node metastasis. At staging, PET/CT complements both FIGO staging and CT, particularly, for lymph node evaluation with a better sensitivity and specificity. However, PET/CT may be limited in detection of parametrial spread and lung metastasis and differentiation of lymphoid hyperplasia from metastasis. About 85% of CC will recur locally or at distant sites (e,g.liver, lung,extrapelvic nodes) within 2 years of primary therapy. Timely and accurate detection of recurrence may have survival benefits. FDG/PET has an important role in identification of CC recurrence. However, fibrotic changes, fistulas, inflammation may cause pitfalls, particularly in surgically manipulated anatomic planes and after radiation. This presentation will review PET/CT findings in CC by disease spectrum, extent of involvement and metastatic patterns. PET/CT features of radiation induced and postsurgical abdominopelvic changes will be emphasized. Unusual cases will be presented along with contrast enhanced high resolution CT with recommendations to avoid false readings at both staging and restaging.