Usefulness of FDG-PET to detect recurrent cervical cancer based on asymptomatically elevated tumor marker serum levels--a preliminary report.

This study was to evaluate the clinical impact of whole body positron emission tomography (PET) with 18F-fluoro-2-deoxyglucose (FDG) to detect recurrent cervical cancer based on asymptomatically elevated tumor marker levels. Whole-body FDG-PET was performed in 20 patients with suspected recurrent squamous cell carcinoma (SCC) of the cervix and asymptomatic tumor marker of SCC antigen increased serum levels but negative or equivocal other imaging modality results. All of these 20 asymptomatic patients have serum levels of SCC antigen > 1.5 ng/mL. The final diagnosis of recurrent cervical cancer was established by operation/biopsy histopathological findings or clinical follow-up after more than 1 year by additional morphological imaging techniques. Among the 20 patients, the final diagnosis of recurrent cervical cancer was established in 81 lesions of 19 patients. The FDG-PET accurately detected 78/81 lesions. With asymptomatically elevated SCC antigen serum levels, the diagnostic sensitivity and accuracy of FDG-PET to detect recurrent cervical cancer lesions were 97.5% and 94.0%, respectively. The FDG-PET is a useful technique to detect recurrent cervical cancer for patients with asymptomatically elevated SCC antigen serum levels.

Usefulness of (18)F-fluorodeoxyglucose positron emission tomography to detect para-aortic lymph nodal metastasis in advanced cervical cancer with negative computed tomography findings.

OBJECTIVE: In advanced cervical cancer, it has been reported that progression-free survival is significantly related to para-aortic lymph node metastasis. Computed tomography (CT) has been widely used for clinical staging, but its sensitivity for lymph nodal metastasis is low. Therefore, this prospective study was undertaken to evaluate (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) in detecting para-aortic lymph nodal metastasis in patients with locally advanced cervical carcinoma when CT findings were negative. METHODS: Fifty women with advanced cervical cancer confined to the pelvis with negative abdominal CT findings were included in this study. After 10 mCi of FDG was administered intravenously, the abdomens were scanned by PET. Para-aortic lymph node metastases were diagnosed as present or absent according to a standardized staging procedure. RESULTS: Retroperitoneal surgical exploration revealed 14 patients with para-aortic lymph nodal metastasis. Two patients had false-negative FDG-PET findings and the other two patients had false-positive FDG-PET findings. CONCLUSION: Overall, FDG-PET imaging had a sensitivity of 85.7%, a specificity of 94.4%, and an accuracy of 92%. When abdominal CT findings are negative, the use of FDG-PET can accurately detect para-aortic lymph nodal metastatis in patients with advanced cervical cancer.