(18)F-FDG PET in stage IB/IIB cervical adenocarcinoma/adenosquamous carcinoma.
OBJECTIVE
The diagnostic and prognostic value of (18)F-FDG PET in cervical adenocarcinoma/adenosquamous carcinoma (AC/ASC) is unclear. The aim of this study was to assess the value of PET in the management of cervical AC/ASC.


METHODS
Patients with resectable FIGO stage IB/IIB cervical AC/ASC receiving a preoperative MRI scan and a PET or PET/CT scan before radical surgery were eligible. Diagnostic efficacy was compared by receiver operating characteristic (ROC) analysis. Correlations between clinicopathological parameters and outcome and maximum standardized uptake values (SUVmax) of FDG uptake were evaluated.


RESULTS
The study group comprised 83 patients (mean age 48.3 + or - 9.7 years) Five-year overall survival was 85.5%, with a median follow-up time of 38.6 months (range 2.8-87.2 months). Pelvic lymph node (PLN) and paraaortic lymph node (PALN) metastases were seen in 32.5% and 8.4% of patients, respectively. The difference in diagnostic efficacy in identifying metastatic PALN between PET and MRI was significant (PET versus MRI, area under the curve 0.832 versus 0.607, p=0.039). SUVmax in primary tumour was correlated with LN metastasis and deep stromal invasion. Overall survival was significantly related to FIGO stage, PLN metastasis, deep cervical stromal invasion, tumour size measured by MRI, and SUVmax of the primary cervical tumour.


CONCLUSIONS
PET provided significantly better diagnostic efficacy than MRI in detecting PALN metastasis. Poor prognostic factors in cervical AC/ASC were SUVmax of the primary cervical tumour >5.3, stage IIB, deep cervical stromal invasion, tumour size measured by MRI > or = 40 mm, and PLN metastasis.
Chou
Hung-Hsueh
HH
Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St. Kueishan, Taoyuan 333, Taiwan.
Chang
Hsiu-Ping
HP
Lai
Chyong-Huey
CH
Ng
Koon-Kwan
KK
Hsueh
Swei
S
Wu
Tzu-I
TI
Chen
Ming-Yu
MY
Yen
Tzu-Chen
TC
Hong
Ji-Hong
JH
Chang
Ting-Chang
TC
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D018196:Carcinoma, Adenosquamous / Q000000981:diagnostic imaging* / Q000401:mortality / Q000556:secondary / Q000601:surgery; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007091:Image Processing, Computer-Assisted; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging; D011379:Prognosis; D012372:ROC Curve; D011859:Radiography; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D047368:Tumor Burden; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery
D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18