Comparative Diagnostic Value of 18F-FDG-PET-CT and Intraoperative Examination in Cervical Cancer Staging

Background and Objectives: The primary objective of this study is to assess the effectiveness of 18F-FDG-PET-CT in preoperative staging of cervical cancer, focusing on determining surgical operability and exploring the correlation between its quantitative parameters and clinicopathological characteristics. Materials and Methods: This retrospective study included 62 cervical cancer patients treated at the Department of Gynecology, Clinic for Operative Oncology at the Institute of Oncology Vojvodina between January 2016 and January 2020, where preoperative clinical examinations and 18F-FDG-PET-CT were performed to assess the extent of cancer, followed by intraoperative and pathohistological examinations of surgically removed specimens to provide a comprehensive evaluation. Results: The mean tumor size measured by 18F-FDG-PET-CT was slightly greater than that obtained through clinical examination (26.4 mm vs. 26.0 mm), with a strong linear correlation (r = 0.678, p < 0.001) observed between the two measurement methods. The overall prediction accuracy of 18F-FDG-PET-CT for primary tumors is 88.7% (55/62) [sensitivity 86.8%, specificity 100.0%, PPV 100.0%, NPV 56.2%] and for intraoperative examination is 88.7% (55/62) [sensitivity 98.1%, specificity 33.3%, PPV 89.7%, NPV 75.0%]. The agreement with histopathological examination was good for 18F-FDG-PET-CT and moderate for intraoperative examination for primary tumors. Regarding lymph nodes, the overall prediction accuracy of 18F-FDG-PET-CT is 82.2% (51/62) [sensitivity 53.8%, specificity 89.8%, PPV 58.3%, NPV 88.8%] and for intraoperative examination 66.1% (41/62) [sensitivity 76.9%, specificity 63.3%, PPV 35.7%, NPV 91.2%]. The agreement with histopathological examination was moderate for 18F-FDG-PET-CT and poor for intraoperative examination for lymph node metastasis, highlighting that the overall accuracy of 18F-FDG-PET-CT (82.1%) was significantly higher than that of intraoperative examination (66.1%) (p = 0.002). Conclusions: In conclusion, 18F-FDG-PET-CT provides high accuracy in detecting primary tumors and superior predictive value for lymph node metastases compared to intraoperative examination, highlighting the importance of incorporating this imaging modality into the preoperative evaluation process to enhance diagnostic precision and inform treatment decisions.