Detection of Recurrent Cervical Cancer by Whole-Body FDG PET Scan in Asymptomatic and Symptomatic Women

Abstract

The authors reviewed the medical records of 44 patients who had been previously treated for cervical carcinoma. In these women, a total of 47 examinations with whole-body [18F]fluoro-2-deoxyglucose (FDG) positron emissiontomography (PET) scans were performed to detect recurrent disease. Twenty-one PET scans were performed in women who had symptoms of recurrence and 26 were in asymptomatic women. In the surveillance group, the time to posttreatment PET scans ranged from 2 to 40 months. In symptomatic women, posttreatment scans were performed from 3 to 80 months after treatment (P = 0.02 for difference). Recurrent disease was detected in 8 (30.8%) asymptomatic and 14 (66.7%) symptomatic patients (P = 0.01). Two asymptomatic women had false-negative PET scans. One patient, whose scan was negative for the presence of disease 3 months after treatment, had persistent disease detected in a cervical biopsy taken at the same time. Another developed a recurrence 4 months after a negative PET scan. A diagnosis of recurrent disease 13 months after a negative scan was not considered a false-negative. The sensitivity of PET scan for detection of recurrent disease among asymptomatic patients was 80.0%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 88.9%. There were 15 positive PET scans reported among symptomatic women. Fourteen of these were confirmed by biopsy or computed tomography (CT), but no disease was found in 1 patient whose PET scan indicated vaginal recurrence. Repeat PET scan at 4 months was negative for disease. Another patient had a pelvic mass detected by PET scan and CT, but because it did not appear to exceed surrounding areas in the FDG uptake, she was not considered positive for recurrence. She was found to have adherent bowel at laparotomy and had no evidence of recurrent disease. All negative findings by PET scan in symptomatic women were confirmed by clinical examination, biopsy, or CT. The sensitivity of PET scan for detection of recurrent disease in symptomatic patients was 100%, specificity was 85.7%, positive predictive value was 93.3%, and negative predictive value was 100%.