Nuclear medicine techniques in gynaecological malignancy: a review of best practice

Gynaecological malignancies are increasing in incidence in the UK, primarily driven by a rise in cases of endometrial cancer. The most common in order of prevalence thereafter are ovarian, cervical, vulval and vaginal cancers. Imaging is fundamental to their diagnosis, staging, response assessment and surveillance; and has significant implications in management by guiding local, regional or systemic treatment strategies. Advanced nuclear medicine imaging modalities, in particular [¹⁸F]-fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography (PET)/computed tomography (CT), have an evolving role in combining anatomical and functional data, resulting in superior sensitivity and specificity for detection of sites of disease compared to conventional techniques. Sentinel node lymphoscintigraphy using [^99mTc]-labelled nanocolloids is also integral to management pathways in selected cases, notably in patients with cervical and vulval cancer, to detect microscopic nodal disease and potentially avoid more extensive procedures which carry morbidity. This article provides a contemporary, evidence-based, overview of nuclear medicine imaging practice in gynaecological malignancy, separated by primary tumour location. It makes reference to current international guidelines and highlights key studies evidencing their utility, in addition to describing strengths and limitations compared to alternative modalities. Future advances on the horizon are also discussed, including novel radiopharmaceuticals and technological developments.