Abstract
Purpose: To evaluate the diagnostic potential of PET/MRI with 18F-fluorodeoxyglucose (18F-FDG) in cervical cancer based on the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system. Materials and Methods: Seventy-two patients with biopsy-proven primary cervical cancer underwent pretreatment 18F-FDG PET/MRI, CT, and pelvic MRI. The diagnostic performance of 18F-FDG PET/MRI and MRI for assessing extent of the primary tumor and 18F-FDG PET/MRI and CT for assessing nodal and distant metastases was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. McNemar test was employed for statistical analysis. Results: Accuracy for the invasion of vagina, parametrium, side wall, and adjacent organs was 97.2%, 93.1%, 97.2%, and 100% for 18F-FDG PET/MRI; and 97.2%, 91.7%, 97.2%, and 100% for pelvic MRI, respectively (p > 0.05). Patient-based accuracy for metastasis to pelvic and paraaortic lymph nodes and distant organs was 95.8%, 98.6%, and 100% for 18F-FDG PET/MRI; and 83.3%, 95.8%, and 97.2% for CT, respectively; metastasis to pelvic lymph nodes was statistically significant (p < 0.01). Lesion-based sensitivity, specificity, and accuracy for lymph nodes were 83.3%, 95.9%, and 94.8% for 18F-FDG PET/MRI; and 29.2%, 98.9% and 93.1% for CT, respectively; sensitivity was statistically significant (p < 0.001). After excluding patients diagnosed by conization, accuracy for revised FIGO staging 2018 was significantly better for 18F-FDG PET/MRI (82.1%) than for CT and MRI (60.7%) (p < 0.01). Conclusions: 18F-FDG PET/MRI offers higher diagnostic value for revised 2018 FIGO staging, suggesting that 18F-FDG PET/MRI might provide an optimal diagnostic strategy for preoperative staging.
Highlights
Cervical cancer is the fourth most common cancer in women worldwide, with more than half a million cases diagnosed annually, even though prophylactic vaccines against human papillomavirus have reduced the occurrence of this disease [1]
Cervical cancer had been clinically staged based on the 2009 International Federation of Gynecology and Obstetrics (FIGO) classifications [2,3]
To the best of our knowledge, this is the first study to investigate the diagnostic value of 18F-FDG PET/MRI for cervical cancer based on the revised 2018 FIGO staging system in comparison with the conventional imaging modalities of MRI and CT. 18F-PET/MRI
Summary
Cervical cancer is the fourth most common cancer in women worldwide, with more than half a million cases diagnosed annually, even though prophylactic vaccines against human papillomavirus have reduced the occurrence of this disease [1]. Cervical cancer had been clinically staged based on the 2009 International Federation of Gynecology and Obstetrics (FIGO) classifications [2,3]. Preoperative assessment of disease is essential, the 2009 FIGO system did not yet include descriptions of imaging findings other than hydronephrosis and distant metastasis. The 2018 FIGO system highlighted the utility of imaging and permitted its use, when available, as part of clinical staging [4,5]. Compared with the 2009 classifications, the revised system better recognizes metastatic or recurrence risk by including a greater number of tumor size subdivisions (IB1, IB2, and IB3) and by taking into account the status of regional lymph nodes detected radiographically or pathologically (IIIC1 and IIIC2). The revised system has afforded a greater importance to imaging findings in the planning of optimal treatment
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