Comparative Analysis of FDG-PET Versus CT/MRI in Staging and Management of Advanced-stage Cervical Cancer

Accurate staging is critical for optimizing treatment in advanced-stage cervical cancer (FIGO stage IB3 and above). This study evaluated the added value of ^18F-fluorodeoxyglucose positron emission tomography (FDG-PET) compared to magnetic resonance imaging (MRI) and computed tomography (CT) in improving staging accuracy and guiding management decisions.

A retrospective review was conducted of patients with advanced cervical cancer treated at Derby Gynaecological Cancer Centre (2016-2023) who underwent MRI, CT, and FDG-PET. Differences in staging and management before and after FDG-PET were analyzed using McNemar's test with Yates' correction.

DG-PET led to a change in FIGO stage in 13 of 45 cases (29%; p=0.00087). It upstaged 11 cases (24%) - primarily due to previously undetected nodal metastases - and downstaged 2 cases (4%) due to false-positive findings on CT/MRI. Occult nodal disease was identified in 20% of patients. FDG-PET altered management in five cases (11%; p=0.044), most commonly through para-aortic nodal radiotherapy boost adjustments.

FDG-PET appears to enhance staging accuracy and impact treatment planning in advanced cervical cancer, particularly by detecting occult nodal metastasis. However, its utility may be limited in cases where nodal involvement is already evident on MRI/CT.