A prospective study of the accuracy of 18Fluorodeoxyglucose positron emission tomography (18FDG PET) in identifying sites of metastasis prior to pelvic exenteration.
OBJECTIVE
To determine the accuracy of (18)FDG PET in identifying sites of metastatic disease prior to pelvic exenteration or radical resection in patients (pts) with recurrent cervical or vaginal cancers.


METHODS
Pts with recurrent cervical or vaginal cancer being evaluated for surgical resection were enrolled in a prospective study approved by the institutional human subjects review board. All patients underwent (18)FDG PET scans as well as CT and/or MRI scans and were required to have pathologic confirmation of any sites suggestive of tumor recurrence.


RESULTS
Between 1998 and 2002 a total of 27 pts were enrolled on the study. Seven patients did not complete all study requirements and are excluded from further analysis. All pts had undergone prior pelvic radiation therapy and five patients had also received chemotherapy. CT/MRI scans identified three patients with possible metastatic disease in the following sites: (1) iliac nodes (2 pts) and (2) lungs (1 pt). After surgical and pathological evaluation, only one of these sites, the lungs, was confirmed to have metastatic disease. PET scans identified possible metastatic disease in nine patients and included the following sites: (1) pelvic nodes (4 pts), (2) para-aortic nodes (2 pts), (3) axillary node (1 pt), (4) bowel wall (1 pt) and (5) lungs (1 pt). After surgical and pathologic evaluation metastatic disease was identified in five of these pts at the following sites: iliac nodes, 2; para-aortic nodes, 1; bowel wall, 1; and lungs, 1. Of the sites identified by PET scan as areas of metastasis CT scan only identified the pulmonary metastasis.


CONCLUSIONS
(18)FDG PET was found to have a sensitivity of 100% and a specificity of 73% in detecting sites of extra-pelvic metastasis and may be the most accurate test to determine eligibility for pelvic exenteration.
Husain
Amreen
A
Stanford University School of Medicine, Div of Gynecologic Oncology and Memorial Sloan-Kettering Cancer Center, USA. ahusain@stanford.edu <ahusain@stanford.edu>
Akhurst
Timothy
T
Larson
Steven
S
Alektiar
Khaled
K
Barakat
Richard R
RR
Chi
Dennis S
DS
D000328:Adult; D000368:Aged; D005260:Female; D019788:Fluorodeoxyglucose F18; D005833:Genital Neoplasms, Female / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010385:Pelvic Exenteration; D049268:Positron-Emission Tomography / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014625:Vaginal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014846:Vulvar Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18