TY - JOUR T1 - Clarifying the Diagnosis of Clinically Suspected Recurrence of Cervical Cancer: Impact of <sup>18</sup>F-FDG PET JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 1936 LP - 1943 DO - 10.2967/jnumed.108.055046 VL - 49 IS - 12 AU - Astrid A.M. van der Veldt AU - Marrije R. Buist AU - Marchien W. van Baal AU - Emile F. Comans AU - Otto S. Hoekstra AU - Carla F.M. Molthoff Y1 - 2008/12/01 UR - http://jnm.snmjournals.org/content/49/12/1936.abstract N2 - Clarifying the diagnosis of clinically suspected recurrence of cervical cancer can be challenging. The aim of this study was to investigate the clinical value of 18F-FDG PET in this context. Methods: The medical records of a cohort of 40 18F-FDG PET referrals in whom recurrence of cervical cancer was clinically suspected were reviewed. Two expert gynecologic oncologists assessed the level of pre-PET clinical doubt, quality of pre-PET work-up, and impact of 18F-FDG PET on diagnostic understanding and management using questionnaires. Results: In patients with clinically equivocal recurrence, 18F-FDG PET had a sensitivity of 92% and a specificity of 93% (prevalence, 65%). Before 18F-FDG PET, there was high disagreement about the adequacy of the conventional work-up (intraclass correlation coefficient [ICC], 0.25) and the presence of recurrence (ICC, 0.24). 18F-FDG PET increased experts' confidence (median increase, 14% and 25%; P &lt; 0.0001) and diagnostic agreement (from 68% to 98%; ICC, from 0.24 to 0.95). When 18F-FDG PET was positive for recurrence, the median overall survival was 13 mo. For patients with negative 18F-FDG PET findings, the median survival was not reached (log rank, 15.50, P = 0.0001). When the treatment plan was categorized as local therapy, systemic therapy, and expectative management, 18F-FDG PET changed the treatment plan in half of all cases. The 2 experts reported that 18F-FDG PET led to a better diagnosis and a beneficial change in management in, respectively, 60% and 65% of cases. Conclusion: 18F-FDG PET can help to clarify the diagnosis of clinically suspected recurrence of cervical cancer. In this patient population, 18F-FDG PET had significant value in diagnostic understanding and management of recurrent cervical cancer, facilitating decision making and treatment planning. Therefore, 18F-FDG PET should be part of the diagnostic work-up in detection of recurrent cervical cancer. The high positive predictive value of 18F-FDG PET in these patients suggests that inclusion in intervention trials might be based on a positive 18F-FDG PET scan. ER -