Preoperative staging of cervical cancer: Is 18-FDG-PET/CT really effective in patients with early stage disease?

Mauro Signorelli, Luca Guerra, Luca Montanelli, Cinzia Crivellaro, Alessandro Buda, Tiziana Dell'Anna, Maria Picchio, Rodolfo Milani, Robert Fruscio, Cristina Messa

Research output: Contribution to journalArticle

Abstract

Objective: Nodal status is one of the most important findings in patients with early-stage cervical cancer that requires post-surgical adjuvant therapies and influences prognosis of patients. The purpose of this study was to determine the diagnostic accuracy of 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG-PET/CT) in the detection of nodal metastases. Methods: From 2004 to 2010 women with Ib1-IIa <4 cm cervical cancer underwent 18F-FDG-PET/CT followed by radical hysterectomy and pelvic lymphadenectomy in our institution. 18F-FDG-PET/CT images were analyzed and histopathological findings served as the reference standard. Diagnostic performance of 18F-FDG-PET/CT in nodal disease detection was reported in terms of accuracy value. A sub analysis of women with tumor diameter <2 cm (group 1) or 2-4 cm (group 2) was performed in order to verify the efficacy of 18F-FDG-PET/CT in each group. Results: One hundred fifty-nine women were enrolled. 65% had squamous histotype and 51% had grade 3 disease. Median number of nodes dissected was 29 (range 11-61). 28/159 women (18%) showed nodal metastases. Overall patient-based sensitivity, specificity, positive and negative predictive value of 18F-FDG-PET/CT for detection of nodal disease were 32.1%, 96.9%, 69.2%and 87.0% respectively. Among the 97 (61%) women included in group 1, 8 had nodal metastases (8.2%) and 2 was discovered through 18F-FDG-PET/CT (25%), while 20/62 women of the group 2 (32.3%) had nodal involvement, of which 7 (35%) was detected by 18F-FDG-PET/CT. Conclusions: This study showed that 18F-FDG-PET/CT had low sensitivity and had a minimal clinical impact in the pretreatment planning of stage Ib1-IIa <4 cm cervical cancer.

Original languageEnglish
Pages (from-to)236-240
Number of pages5
JournalGynecologic Oncology
Volume123
Issue number2
DOIs
Publication statusPublished - Nov 2011

Keywords

  • 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography
  • Cervical cancer
  • Early stage

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Oncology

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    Signorelli, M., Guerra, L., Montanelli, L., Crivellaro, C., Buda, A., Dell'Anna, T., Picchio, M., Milani, R., Fruscio, R., & Messa, C. (2011). Preoperative staging of cervical cancer: Is 18-FDG-PET/CT really effective in patients with early stage disease? Gynecologic Oncology, 123(2), 236-240. https://doi.org/10.1016/j.ygyno.2011.07.096