title: Comparative benefits and limitations of 18F-FDG PET and CT-MRI in documented or suspected recurrent cervical cancer.
abstract: OBJECTIVE
  The purpose of this study was to assess the comparative benefits and limitations of (18)F-fluorodeoxyglucose (FDG) PET and CT-MRI in documented or suspected recurrence of cervical cancer after primary treatment.
  
  
  METHODS
  Three patient groups were enrolled. Group A patients had biopsy-documented recurrent or persistent cervical cancer. Group B patients had suspicion of recurrent tumour on CT-MRI without biopsy proof and were potentially curable. Group C patients were in complete remission after previous definitive treatment for histologically confirmed cervical carcinoma but had elevated serum squamous cell carcinoma antigen (tumour marker) levels despite negative CT-MRI. Clinical management decisions were recorded with CT-MRI alone and with additional FDG PET. Discordances and concordances between CT-MRI and FDG PET results were identified and related to final diagnosis as based on histopathology or follow-up.
  
  
  RESULTS
  A total of 150 patients (ten regions per patient) were eligible for analysis, with 58 in group A, 52 in group B and 40 in group C. For the 149 discordant regions, 126 (84.6%) had final diagnoses. Of these final diagnoses, there was additional benefit from FDG PET over CT-MRI in 73.8% (93/126), with FDG PET correcting false negatives (FNs) on CT-MRI in 74.2% (69/93) and correcting false positives (FPs) on CT-MRI in 25.8% (24/93). Among lesions confirmed by FDG PET, 75.4% (52/69) were extra-pelvic. There was additional benefit of CT-MRI compared with FDG PET in 26.2% (33/126): in nine (27.3%) CT-MRI results were shown to be true positive (TP) whereas FDG PET yielded FN results, while in 24 (72.7%) CT-MRI corrected FP results on FDG PET. Among the nine FNs on FDG PET that were identified by CT-MRI, four were extra-pelvic. Among the FPs on FDG PET that were excluded by CT-MRI, 79.2% (19/24) were extra-pelvic.
  
  
  CONCLUSIONS
  For recurrent cervical cancer, the benefits of FDG PET exceed those of CT-MRI owing to the ability of FDG PET to identify extra-pelvic metastases and its higher sensitivity and specificity.
authors.affiliation: Department of Nuclear Medicine and Molecular Image Center, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University Medical College, Taoyuan, Taiwan.
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Yen
authors.forename: Chyong-Huey
authors.initials: CH
authors.lastname: Lai
authors.forename: Shih-Ya
authors.initials: SY
authors.lastname: Ma
authors.forename: Kuan-Gen
authors.initials: KG
authors.lastname: Huang
authors.forename: Huei-Jean
authors.initials: HJ
authors.lastname: Huang
authors.forename: Ji-Hong
authors.initials: JH
authors.lastname: Hong
authors.forename: Swei
authors.initials: S
authors.lastname: Hsueh
authors.forename: Wuu-Jyh
authors.initials: WJ
authors.lastname: Lin
authors.forename: Koon-Kwan
authors.initials: KK
authors.lastname: Ng
authors.forename: Ting-Chang
authors.initials: TC
authors.lastname: Chang
mesh_terms: D000951:Antigens, Neoplasm / Q000097:blood; D004282:Documentation; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods*; D012008:Recurrence; D016879:Salvage Therapy; D012680:Sensitivity and Specificity; D015843:Serpins / Q000097:blood; D014057:Tomography, X-Ray Computed / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control / Q000628:therapy
chemical_list: D000951:Antigens, Neoplasm; D015843:Serpins; C051072:squamous cell carcinoma-related antigen; D019788:Fluorodeoxyglucose F18