Contribution of whole-body (18)FDG PET imaging in the management of cervical cancer

[en] OBJECTIVE: The objective of this study was to assess the contribution of [(18)F]fluoro-2-deoxy-D-glucose positron emission tomography ((18)FDG PET) imaging in the management of cervical cancer. METHODS: Fully corrected whole-body PET was performed in 60 patients (pts) with proven cervical cancer. In pretreatment staging, 22 pts underwent PET in addition to routine protocol including International Federation of Obstetrics and Gynecology (FIGO) staging and pelvic magnetic resonance imaging (MRI). Eighteen of them had pelvic lymphadenectomy. After treatment, PET was performed in 38 pts routinely followed up by clinical and radiological examinations. Results of PET and routine protocols were compared to final diagnoses, including histological findings in 31 pts and clinical outcomes in the other cases. Median follow-up time was 12 +/- 7.3 months. RESULTS: In all but 2 patients (FIGO stage IA), both PET and MRI detected the primary tumor. In 6 pts, MRI alone noted loco-regional tumor spread but PET localized 9 unsuspected extrapelvic nodal sites (6 para-aortic, 2 mediastinal, and 1 supra-clavicular). However, PET missed 8 microscopic pelvic nodal metastases. In 18% of the patients, PET staging significantly influenced the treatment choices. In follow-up, PET accurately diagnosed a recurrent disease in 13 pts with falsely negative or equivocal conventional imaging (CI). Ten patients with a negative PET were still in complete remission after a minimal follow-up time of 12 months. Overall, the agreement of PET with final diagnosis was significantly better than that of routine protocol (P < 0.05). CONCLUSIONS: Whole-body (18)FDG PET appears useful in the management of cervical cancer, in particular for staging extrapelvic metastases or optimally detecting a recurrence. MRI is better indicated for evaluating the loco-regional status of the disease.

Disciplines :

Oncology
Reproductive medicine (gynecology, andrology, obstetrics)

Author, co-author :

Belhocine, T.

Thille, Alain ; Centre Hospitalier Universitaire de Liège - CHU > Imagerie médicale

Fridman, Viviana ; Centre Hospitalier Universitaire de Liège - CHU > Anatomie pathologique

Albert, Adelin ; Université de Liège - ULiège > Département des sciences de la santé publique > Informatique médicale et biostatistique

Seidel, Laurence ; Université de Liège - ULiège > Département des sciences de la santé publique > Informatique médicale et biostatistique

Nickers, Philippe ; Université de Liège - ULiège > Département des sciences cliniques

Kridelka, Frédéric ; Université de Liège - ULiège > Département des sciences cliniques > Gynécologie et obstétrique

Rigo, Pierre ; Université de Liège - ULiège > Département des sciences de la motricité > Pathologie générale et médecine nucléaire

Language :

English

Title :

Contribution of whole-body (18)FDG PET imaging in the management of cervical cancer

Publication date :

October 2002

Journal title :

Gynecologic Oncology

ISSN :

0090-8258

eISSN :

1095-6859

Publisher :

Academic Press Inc Elsevier Science, San Diego, United States - California

Volume :

Issue :

Pages :

90-97

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 10 January 2013

Statistics

Number of views

63 (3 by ULiège)

Number of downloads

1 (1 by ULiège)

More statistics

Scopus citations^®

112

Scopus citations^®
without self-citations

107

OpenCitations

OpenAlex citations

117

Bibliography

Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. Int J Cancer 2001;94:153-6.
Hricak H, Yu KK. Radiology in invasive cervical cancer. Am J Roentgenol 1996;167:1101-18.
Yu KK, Forstner R, Hricak H. Cervical carcinoma: Role of imaging. Abdom Imaging 1997;22:208-15.
Stehman FB, Bundy BN, DiSaia PJ, Keys HM, Larson JE, Fowler WC. Carcinoma of the cervix treated with radiation therapy. I. A multi-variate analysis of prognostic variables in the Gynecologic Oncology Group. Cancer 1991;67:2776-85.
Eifel PJ, Morris M, Oswald MJ, Wharton JT, Declos L. Adenocarcinoma of the uterine cervix: Prognosis and patterns of failure in 367 cases. Cancer 1990;65:2507-14.
Takeshima N, Yanoh K, Tabata T, Nagai K, Hirai Y, Hasumi K. Assessment of the revised International Federation of Gynecology and Obstetrics staging for early invasive squamous cervical cancer. Gynecol Oncol 1999;74:165-9.
Lagasse LD, Creasman WT, Shingleton HM, Ford JH, Blessing JA. Results and complications of operative staging in cervical cancer: Experience of the Gynecologic Oncology Group. Gynecol Oncol 1980;9:90-8.
Van Nagell JR Jr., Roddick JW Jr., Lowin DM. The staging of cervical cancer: Inevitable discrepancies between clinical staging and pathologic findings. Am J Obstet Gynecol 1971;110:973-8.
Kupets R, Covens A. Is the International Federation of Gynecology and Obstetrics staging system for cervical carcinoma able to predict survival in patients with cervical carcinoma? An assessment of clinimetric properties. Cancer 2001;92:796-804.
Grigsby PW, Perez CA, Chao KS, Herzog T, Mutch DG, Rader J. Radiation therapy for carcinoma of the cervix with biopsy-proven positive para-aortic lymph nodes. Int J Radiat Oncol Biol. Phys 2001;49:733-8.
Ansink A, de Barros Lopes A, Naik R, Monaghan JM. Recurrent stage IB cervical carcinoma: Evaluation of the effectiveness of routine follow up surveillance. Br J Obstet Gynaecol 1996;103:1156-8.
Hatano K, Sekiya Y, Araki H, Sakai M, Togawa T, Narita Y, Akiyama Y, Kimura S, Ito H. Evaluation of the therapeutic effect of radiotherapy on cervical cancer using magnetic resonance imaging. Int J Radiat Oncol Biol Phys 1999;45:639-644.
Ebner F, Kressel HY, Mintz MC, Carlson JA, Cohen EK, Schiebler M, Gefter W, Axel L. Tumor recurrence versus fibrosis in the female pelvis: Differentiation with MR imaging at 1.5 T. Radiology 1988;166:333-40.
Pras E, Willemse PH, Canrinus AA, de Bruijn HW, Sluiter WJ, ten Hoor KA, Aalders JG, Szabo BG, de Vries EG. Serum squamous cell carcinoma antigen and CYFRA 21-1 in cervical cancer treatment. Int J Radiat Oncol Biol Phys 2002;52:23-32.
Morris M, Eifel PJ, Lu J, Grigsby PW, Levenback C, Stevens RE, Rotman M, Gershenson DM, Mulch DG. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med 1999;340:1137-43.
Whitney CW, Sause W, Bundy BN, Malfetano JH, Hannigan EV, Fowler WC, Jr., Clarke-Pearson DL, Liao SY. Randomized comparison of flu-orouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: A Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol 1999;17:1339-48.
Keys HM, Bundy BN, Stehman FB, Muderspach LI, Chafe WE, Suggs CL, III, Walker JL, Gersell D. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 1999;340:1154-61.
Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, Clarke-Pearson DL, Insalaco S. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999;340:1144-53.
Peters WA, III, Liu PY, Barrett RJ, II, Stock RJ, Monk BJ, Berek JS, Souhami L, Grigsby P, Gordon W, Jr., Alberts DS. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 2000;18:1606-13.
Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group study. Gynecol Oncol 1999;73:177-83.
Varia MA, Bundy BN, Deppe G, Mannel R, Averette HE, Rose PG, Connelly P. Cervical carcinoma metastatic to para-aortic nodes: Extended field radiation therapy with concomitant 5-fluorouracil and cisplatin chemotherapy: A Gynecologic Oncology Group study. Int J Radiat Oncol Biol Phys 1998;42:1015-23.
Stryker JA, Mortel R. Survival following extended field irradiation in carcinoma of cervix metastatic to para-aortic lymph nodes. Gynecol Oncol 2000;79:399-405.
Delbeke D. Oncological applications of FDG PET imaging. J Nucl Med 1999;40:1706-15.
Heller PB, Malfetano JH, Bundy BN, Barnhill DR, Okagaki T. Clinical-pathologic study of stage IIB, III, and IVA carcinoma of the cervix: Extended diagnostic evaluation for paraaortic node metastasis - A Gynecologic Oncology Group study. Gynecol Oncol 1990;38:425-30.
Scheidler J, Hricak H, Yu KK, Subak L, Segal MR. Radiological evaluation of lymph node metastases in patients with cervical cancer: A meta-analysis. JAMA 1997;278:1098-101.
Rose PG, Adler LP, Rodriguez M, Faulhaber PF, Abdul-Karim FW, Miraldi F. Positron emission tomography for evaluating para-aortic nodal metastasis in locally advanced cervical cancer before surgical staging: A surgicopathologic study. J Clin Oncol 1999;17:41-5.
Reinhardt MJ, Ehritt-Braun C, Vogelgesang D, Ihling C, Hogerle S, Mix M, Moser E, Krause TM. Metastatic lymph nodes in patients with cervical cancer: Detection with MR imaging and FDG PET. Radiology 2001;218:776-82.
Grigsby PW, Dehdashti F, Siegel BA. FDG-PET evaluation of carcinoma of the cervix. Clin Positron Imaging 1999;2:105-9.
Sugawara Y, Eisbruch A, Kosuda S, Recker BE, Kison PV, Wahl RL. Evaluation of FDG PET in patients with cervical cancer. J Nucl Med 1999;40:1125-31.
Kerr IG, Manji MF, Powe J, Bakheet S, Al Suhaibani H, Subhi J. Positron emission tomography for the evaluation of metastases in patients with carcinoma of the cervix: A retrospective review. Gynecol Oncol 2001;81:477-80.
Umesaki N, Tanaka T, Miyama M, Kawabe J, Okamura T, Koyama K, Ochi H, Ogita S. The role of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET) in the diagnosis of recurrence and lymph node metastasis of cervical cancer. Oncol Rep 2000;7:1261-4.
Kühnel G, Horn LC, Fischer U, Hesse S, Seese A, Georgi P, Kluge R. 18F-FDG positron-emission-tomography in cervical carcinoma: Preliminary findings. Zentralbl Gynakol 2001;123:229-35.
Sun SS, Chen TC, Yen RF, Shen YY, Changlai SP, Kao A. Value of whole body 18F -fluoro-2-deoxyglucose positron emission tomography in the evaluation of recurrent cervical cancer. Anticancer Res 2000;21:2957-61.
Subak LL, Hricak H, Powell CB, Azizi L, Stern JL. Cervical carcinoma: Computed tomography and magnetic resonance imaging for preoperative staging. Obstet Gynecol 1995;86:43-50.
Hricak H, Powell CB, Yu KK, Washington E, Subak LL, Stern JL, Cisternas MG, Arenson RL. Invasive cervical carcinoma: Role of MR imaging in pretreatment work-up - Cost minimization and diagnostic efficacy analysis. Radiology 1996;198:403-9.
Narayan K, Hicks RJ, Jobling T, Bernshaw D, McKenzie AF. A comparison of MRI and PET scanning in surgically staged loco-regionally advanced cervical cancer: Potential impact on treatment. Int. J Gynecol Cancer 2001;11:263-71.
Grigsby PW, Siegel BA, Dehdashti F. Lymph node staging by positron emission tomography in patients with carcinoma of the cervix. J Clin Oncol 2001;19:3745-9.
Bodurka-Bevers D, Morris M, Eifel PJ, Levenback C, Bevers MW, Lucas KR, Wharton JT. Posttherapy surveillance of women with cervical cancer: An outcomes analysis. Gynecol Oncol 2000;78:187-93.
Nguyen HN, Nordqvist SR. Chemotherapy of advanced and recurrent cervical carcinoma. Semin Surg Oncol 1999;16:247-50.
Benedetti-Panici P, Maneschi F, Scambia G, Greggi S, Cutillo G, D'Andrea G, Rabitti C, Coronetta F, Capelli A, Mancuso S. Lymphatic spread of cervical cancer: An anatomical and pathological study based on 225 radical hysterectomies with systematic pelvic and aortic lymphadenectomy. Gynecol Oncol 1996;62:19-24.
Grigsby PW, Herzog TJ. Current management of patients with invasive cervical carcinoma. Clin Obstet Gynecol 2001;44:531-7.
Levenback C. Intraoperative lymphatic mapping and sentinel node identification: Gynaecologic applications. Rec Results Cancer Res 2000;157:150-8.
O'Boyle JD, Coleman RL, Bernstein SG, Lifshitz S, Muller CY, Miller DS. Intraoperative lymphatic mapping in cervix cancer patients undergoing radical hysterectomy: A pilot study. Gynecol Oncol 2000;79:238-43.
Verheijen RH, Pijpers R, van Diest PJ, Burger CW, Buist MR, Kenemans P. Sentinel node detection in cervical cancer. Obstet Gynecol 2000;96:135-8.
Dargent D, Martin X, Mathevet P. Laparoscopic assessment of the sentinel lymph node in early stage cervical cancer. Gynecol Oncol 2000;79:411-5.
Levenback C, Coleman RL, Burke TW, Lin WM, Erdman W, Deavers M, Delpassand ES. Lymphatic mapping and sentinel node identification in patients with cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy. J Clin Oncol 2002;20:688-93.