RT Journal Article SR Electronic T1 Clarifying the Diagnosis of Clinically Suspected Recurrence of Cervical Cancer: Impact of 18F-FDG PET JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP 1936 OP 1943 DO 10.2967/jnumed.108.055046 VO 49 IS 12 A1 Astrid A.M. van der Veldt A1 Marrije R. Buist A1 Marchien W. van Baal A1 Emile F. Comans A1 Otto S. Hoekstra A1 Carla F.M. Molthoff YR 2008 UL http://jnm.snmjournals.org/content/49/12/1936.abstract AB 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 < 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.