title: Clinical impact of ¹⁸F-FDG PET/CT in the pretreatment evaluation of patients with locally advanced cervical carcinoma.
abstract: OBJECTIVE
  The aim of this study was to evaluate the impact of F-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) on the pretreatment evaluation of patients with locally advanced cervical carcinoma.
  
  
  METHODS
  Forty-seven patients with stage 2b-4a cervical carcinoma underwent F-FDG PET/CT for initial staging and pretreatment evaluation. Concomitant pelvic/abdominal MRI was performed in 38 patients. The contribution of PET/CT to treatment planning was evaluated, and the prognostic performance of PET/CT was compared with that of MRI. Lymph node (LN) status on PET/CT was correlated with patient follow-up data.
  
  
  RESULTS
  PET/CT detected hypermetabolic LNs in 39/47 patients. In 24/39 patients (62%), PET/CT was found to be superior to MRI. In 13/24 patients (54%), PET/CT detected para-aortic ± pelvic LNs, which were not found on MRI. PET/CT successfully detected distant metastases in 10 patients and peritonitis carcinomatosa in one patient; these patients were upstaged clinically. Overall, PET/CT has led to modifications in the extent of the radiotherapy field in 34% of patients and to major alterations in treatment plans in 23% of patients with widespread disease. The frequency of PET-positive LNs was significantly lower in patients who were alive without disease at the time of last follow-up (60%) compared with patients with persistent disease and nonsurvivors (100%, P=0.012).
  
  
  CONCLUSIONS
  The presence of PET-positive LNs has prognostic significance in patients with cervical carcinoma. PET/CT has the potential to show both lymphatic and distant metastases, which results in modifications to the chemoradiotherapeutic regimen. The use of PET/CT must be included in the initial workup of patients with locally advanced cervical carcinoma.
authors.affiliation: Department of Nuclear Medicine, Ankara Oncology Research and Training Hospital, Ankara, Turkey. burcuesen@yahoo.com
authors.forename: Burcu E
authors.initials: BE
authors.lastname: Akkas
authors.forename: Busra B
authors.initials: BB
authors.lastname: Demirel
authors.forename: Gulin U
authors.initials: GU
authors.lastname: Vural
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*
chemical_list: D019788:Fluorodeoxyglucose F18