FDG-PET in cervical cancer: staging, re-staging and follow-up

Correctly visualising the extent of the disease in cervical cancer is difficult with today's conventional imaging modalities. This paper presents the interim analysis of an on-going prospective study to evaluate the potential role of FDG-PET with software fusion with CT images in 3 different clinical settings of cervical cancer.

In Group 1, 10 patients with early stage cervical cancer underwent FDG-PET 6 months after surgery. Group 2 consisted of 17 patients with locally advanced cervical cancer who underwent FDG-PET as part of the staging procedure. In Group 3, 12 patients with verified relapse and 3 patients with a strong suspicion thereof underwent FDG-PET before starting any therapy. The FDG-PET results were compared with the results of the standard conventional work-up. All patients had a follow-up time of at least 6 months.

All FDG-PET scans in Group 1 were true negative. In Group 2, FDG-PET detected previously unknown locations of metastases in 4 patients, and a synchronous pulmonary carcinoma in 1 patient, resulting in a change in treatment plan for 4 patients. One false negative FDG-PET result was recorded. In Group 3, FDG-PET results led to a change in treatment plan for 3 patients.

We conclude that FDG-PET provides crucial information in the pre-treatment staging procedure in patients with locally advanced or relapsed cervical cancer. However, in the follow-up of early cervix cancer, FDG-PET 6 months post-operatively offered no clinical benefit in this small group of patients.