Clinical impact of FDG PET-CT on management decisions in patients with cervical cancer

Objectives To review the clinical impact of FDG PET-CT in the management pathway of patients with cervical cancer.

Methods Consecutive patients with histologically-proven cervical cancer undergoing FDG PET-CT at a single large tertiary referral centre between January 2008 and May 2011 were retrospectively analyzed. Scan indication, findings on PET-CT compared to conventional imaging and impact on patient management was evaluated using information from clinico-radiological databases. Clinical impact was divided into (1) major - detection of occult nodal and/or metastatic disease or characterization of indeterminate lesion on conventional imaging; (2) minor - confirmation of suspected metastases found on conventional imaging; or (3) no impact.

Results 89 patients underwent 113 PET-CT scans during the study period (age range 26-78 yrs). 59 scans were performed for initial staging, 13 scans for re-staging and 41 scans for assessment of disease recurrence. Comparison was made with contemporary cross-sectional imaging. In 29 cases (26%) PET-CT had a major impact on subsequent management; 11 had unsuspected nodal involvement, 6 had occult metastatic disease and 4 had both; in a further 6 cases, lymph nodes or indeterminate findings on cross-sectional imaging were characterized as benign and 2 patients were found to have incidental synchronous primary cancers (breast and pancreatic). PET-CT had a minor impact in 10 cases (9%) confirming suspected nodal disease or local recurrence. No impact was found in 74 cases (65%).

Conclusions FDG PET-CT has a valuable role in the management pathway of patients with cervical cancer by detecting nodal and distant sites of metastatic disease and characterizing indeterminate lesions. FDG PET-CT can have a major influence on clinical decision-making in these patients and help to guide optimal treatment