Abstract
Clarifying the diagnosis of clinically suspected recurrence of cervical cancer can be challenging. The aim of this study was to investigate the clinical value of (18)F-FDG PET in this context. The medical records of a cohort of 40 (18)F-FDG PET referrals in whom recurrence of cervical cancer was clinically suspected were reviewed. Two expert gynecologic oncologists assessed the level of pre-PET clinical doubt, quality of pre-PET work-up, and impact of (18)F-FDG PET on diagnostic understanding and management using questionnaires. In patients with clinically equivocal recurrence, (18)F-FDG PET had a sensitivity of 92% and a specificity of 93% (prevalence, 65%). Before (18)F-FDG PET, there was high disagreement about the adequacy of the conventional work-up (intraclass correlation coefficient [ICC], 0.25) and the presence of recurrence (ICC, 0.24). (18)F-FDG PET increased experts' confidence (median increase, 14% and 25%; P < 0.0001) and diagnostic agreement (from 68% to 98%; ICC, from 0.24 to 0.95). When (18)F-FDG PET was positive for recurrence, the median overall survival was 13 mo. For patients with negative (18)F-FDG PET findings, the median survival was not reached (log rank, 15.50, P = 0.0001). When the treatment plan was categorized as local therapy, systemic therapy, and expectative management, (18)F-FDG PET changed the treatment plan in half of all cases. The 2 experts reported that (18)F-FDG PET led to a better diagnosis and a beneficial change in management in, respectively, 60% and 65% of cases. (18)F-FDG PET can help to clarify the diagnosis of clinically suspected recurrence of cervical cancer. In this patient population, (18)F-FDG PET had significant value in diagnostic understanding and management of recurrent cervical cancer, facilitating decision making and treatment planning. Therefore, (18)F-FDG PET should be part of the diagnostic work-up in detection of recurrent cervical cancer. The high positive predictive value of (18)F-FDG PET in these patients suggests that inclusion in intervention trials might be based on a positive (18)F-FDG PET scan.
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