Use of PET/CT for staging locally advanced cervical cancer in limited resource settings (439)

Abstract

Objectives: To determine the utility of PET/CT in staging locally advanced cervical cancer (LACC) in limited-resource settings. Methods: A cross-sectional observational study of 536 records of patients with clinically proven LACC from January 2020 to June 2021 at a reference center was performed. Eighty cases suitable for analysis included a physical exam, CT, and PET/CT. CT had simple and IV contrast images; PET/CT was performed using 18-F-fluorodeoxyglucose (FDG) and simple CT images. In this specific group of individuals, PET/CT was requested because CT was consistent with advanced disease. The variables included in the evaluation were age, clinical stage, CT stage, and PET / CT stage. Descriptive statistics, Chi-square, and Cohen Kappa were performed. Results: The mean age of cases at the time of diagnosis was 48.13 years (SD ± 14). The most common stage by clinical exam was IIB (46.3%), IIIC1 (43.8%), and IIIC1 (40%) by CT and PET/CT, respectively. When comparing clinical staging and PET/CT, concordance was observed in 12% of cases and 36.2% when CT and PET were compared (k=0.352). The use of PET/CT in patients with stages IIIC1 and IIIC2 and suspicious CT upstaged 14% of cases, which was statistically significant (p=0.0001) but was not statistically useful when a CT was considered conclusive (p=0.18). Conclusions: Imaging studies are required by FIGO 2018 staging of cervical cancer. A significant difference between the use of PET/CT and CT for upstage was demonstrated in patients with stages IIIC1 and IIIC2; therefore, PET/CT as an initial study can improve the accuracy of diagnosis of patients with clinically stage III but not in other stages of LACC. However, since it occurs in a low percentage of cases, it can be omitted in limited-resource settings and replaced by CT. Clinical evaluation, even though is useful, should not be used as the only method for staging patients with LACC, and image studies must be included in the evaluation to establish an appropriate therapeutic plan and prognosis. Objectives: To determine the utility of PET/CT in staging locally advanced cervical cancer (LACC) in limited-resource settings. Methods: A cross-sectional observational study of 536 records of patients with clinically proven LACC from January 2020 to June 2021 at a reference center was performed. Eighty cases suitable for analysis included a physical exam, CT, and PET/CT. CT had simple and IV contrast images; PET/CT was performed using 18-F-fluorodeoxyglucose (FDG) and simple CT images. In this specific group of individuals, PET/CT was requested because CT was consistent with advanced disease. The variables included in the evaluation were age, clinical stage, CT stage, and PET / CT stage. Descriptive statistics, Chi-square, and Cohen Kappa were performed. Results: The mean age of cases at the time of diagnosis was 48.13 years (SD ± 14). The most common stage by clinical exam was IIB (46.3%), IIIC1 (43.8%), and IIIC1 (40%) by CT and PET/CT, respectively. When comparing clinical staging and PET/CT, concordance was observed in 12% of cases and 36.2% when CT and PET were compared (k=0.352). The use of PET/CT in patients with stages IIIC1 and IIIC2 and suspicious CT upstaged 14% of cases, which was statistically significant (p=0.0001) but was not statistically useful when a CT was considered conclusive (p=0.18). Conclusions: Imaging studies are required by FIGO 2018 staging of cervical cancer. A significant difference between the use of PET/CT and CT for upstage was demonstrated in patients with stages IIIC1 and IIIC2; therefore, PET/CT as an initial study can improve the accuracy of diagnosis of patients with clinically stage III but not in other stages of LACC. However, since it occurs in a low percentage of cases, it can be omitted in limited-resource settings and replaced by CT. Clinical evaluation, even though is useful, should not be used as the only method for staging patients with LACC, and image studies must be included in the evaluation to establish an appropriate therapeutic plan and prognosis.