title: Preoperative staging of cervical cancer: is 18-FDG-PET/CT really effective in patients with early stage disease?
abstract: OBJECTIVE
  Nodal status is one of the most important findings in patients with early-stage cervical cancer that requires post-surgical adjuvant therapies and influences prognosis of patients. The purpose of this study was to determine the diagnostic accuracy of 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG-PET/CT) in the detection of nodal metastases.
  
  
  METHODS
  From 2004 to 2010 women with Ib1-IIa <4cm cervical cancer underwent 18F-FDG-PET/CT followed by radical hysterectomy and pelvic lymphadenectomy in our institution. 18F-FDG-PET/CT images were analyzed and histopathological findings served as the reference standard. Diagnostic performance of 18F-FDG-PET/CT in nodal disease detection was reported in terms of accuracy value. A sub analysis of women with tumor diameter <2cm (group 1) or 2-4cm (group 2) was performed in order to verify the efficacy of 18F-FDG-PET/CT in each group.
  
  
  RESULTS
  One hundred fifty-nine women were enrolled. 65% had squamous histotype and 51% had grade 3 disease. Median number of nodes dissected was 29 (range 11-61). 28/159 women (18%) showed nodal metastases. Overall patient-based sensitivity, specificity, positive and negative predictive value of 18F-FDG-PET/CT for detection of nodal disease were 32.1%, 96.9%, 69.2%and 87.0% respectively. Among the 97 (61%) women included in group 1, 8 had nodal metastases (8.2%) and 2 was discovered through 18F-FDG-PET/CT (25%), while 20/62 women of the group 2 (32.3%) had nodal involvement, of which 7 (35%) was detected by 18F-FDG-PET/CT.
  
  
  CONCLUSIONS
  This study showed that 18F-FDG-PET/CT had low sensitivity and had a minimal clinical impact in the pretreatment planning of stage Ib1-IIa <4cm cervical cancer.
authors.affiliation: Department of Obstetrics and Gynecology, University of Milan-Bicocca, Milan, Italy. maurosignorelli@inwind.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Signorelli
authors.forename: Luca
authors.initials: L
authors.lastname: Guerra
authors.forename: Luca
authors.initials: L
authors.lastname: Montanelli
authors.forename: Cinzia
authors.initials: C
authors.lastname: Crivellaro
authors.forename: Alessandro
authors.initials: A
authors.lastname: Buda
authors.forename: Tiziana
authors.initials: T
authors.lastname: Dell'Anna
authors.forename: Maria
authors.initials: M
authors.lastname: Picchio
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Milani
authors.forename: Robert
authors.initials: R
authors.lastname: Fruscio
authors.forename: Cristina
authors.initials: C
authors.lastname: Messa
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18