@article {Miller192, author = {Tom R. Miller and Edward Pinkus and Farrokh Dehdashti and Perry W. Grigsby}, title = {Improved Prognostic Value of 18F-FDG PET Using a Simple Visual Analysis of Tumor Characteristics in Patients with Cervical Cancer }, volume = {44}, number = {2}, pages = {192--197}, year = {2003}, publisher = {Society of Nuclear Medicine}, abstract = {In patients with cervical cancer, it is important to estimate prognosis at the time of diagnosis. This study using PET with 18F-FDG was undertaken to determine whether a simple and fast visual analysis of characteristics of the primary tumor before initiation of treatment could achieve this goal. Methods: Forty-seven patients with cervical cancer who were to be treated by combined radiation therapy and chemotherapy were imaged before beginning treatment. They were then followed for up to 3 y for evidence of recurrence or death. Images of the chest, abdomen, and pelvis were obtained 40{\textendash}90 min after administration of 370{\textendash}555 MBq (10{\textendash}15 mCi) 18F-FDG. Three observers then independently graded the primary tumor for size (0 = small, 1 = moderate, 2 = large), shape (0 = spherical, 1 = nonspherical), heterogeneity of uptake (0 = none, 1 = moderate, 2 = marked), and presence of lymph nodes (0 = none, 1 = pelvic, 2 = paraaortic, 3 = distant). The scores were summed to achieve a total score. A statistical calculation demonstrated that a score cutoff of 4 best separated patients with a good prognosis from patients with a bad prognosis. Kaplan-Meier analysis was used to compute progression-free survival and overall survival. Evaluation of lymph nodes alone was compared with the grading of tumor characteristics. Results: Observers 1 and 2 scored 26 patients as having a good prognosis and 21 as having a bad prognosis. Observer 3 scored 30 and 17, respectively, a statistically insignificant difference. Survival curves were almost identical for the 3 observers. For progression-free survival, approximately 12\% of patients with a good score had disease recurrence whereas approximately 75\% with a bad score had disease recurrence. For overall survival, approximately 10\% (good) and 80\% (bad) died. Evaluation of lymph nodes also separated the groups, but not as well as did visual analysis alone. The combination of the 2 was only slightly superior to visual assessment alone. Conclusion: A simple, rapid, and highly reproducible system is described for visual grading of characteristics of the primary tumor in patients with cervical cancer at the time of diagnosis. This approach separates patients with a poor prognosis from those who will do well, thus providing a new tool for accurate estimation of prognosis.}, issn = {0161-5505}, URL = {https://jnm.snmjournals.org/content/44/2/192}, eprint = {https://jnm.snmjournals.org/content/44/2/192.full.pdf}, journal = {Journal of Nuclear Medicine} }