PET for cervical cancer – pro

For a initial staging, PET scan is of limited utility. While it can well assess known lymphadenopathy, it is not a sensitive staging tool. Many studies have reported low sensitivities for the detection of nodal metastases, ranging from 25–73%. Chao et al. concluded that PET/CT has a limited role in staging for patients with early-stage disease and should not replace lymphadenectomy for the detection of lymph node metastases. Many studies have reported low sensitivities for the detection of nodal metastases, ranging from 25–73%. Chao et al. concluded that PET/CT has a limited role in staging for patients with early-stage disease and should not replace lymphadenectomy for the detection of lymph node metastases.

In 2016, NCCN removed PET and MRI form its general algorithm to be explained in the section on imaging. There it says: “:Consider PET in in FIGO stage IB2.

Whole-body FDG-PET is a sensitive and specific tool for the detection of recurrent cervical cancer in patients who have clinical findings suspicious for recurrence. In one study,  11 patients with cervical carcinoma were investigated. Combined PET/CT identified additional lesions missed by CT and ultrasound alone in five patients (45%), all of whom had their treatment changed to address the additional areas of involvement.The sensitivity and specificity of FDG-PET for detecting recurrent cervical cancer are 85.7 and 86.7%, respectively. The positive and negative predictive values are 85.7 and 86.7%, respectively.InJanuary2005 the Center forMedicareservices(CMS) approved coverage of FDG-PETforstagingofcervical cancer patients.

N a recent study byElittet al, a randomized clinical trial, 44 of 112 patients receiving PET-CT compared with 14 of 56 patients receiving CT alone received more extensive chemotherapy and radiotherapy or palliative treatment, a nonsignificant difference. Five percent of patients in each group were treated with palliative intent. In this trial among women with locally advanced carcinoma of the cervix, there was no significant difference between PET-CT plus CT vs CT alone, possibly because the trial was underpowered. However, NCC now appears to accept it: “all body PET/CT preferred…”

 

 

Lorraine M. Elit et al, Effect of Positron Emission Tomography Imaging in Women With Locally Advanced Cervical CancerA Randomized Clinical Trial. JAMA Netw Open. 2018;1(5):e182081

 

Findings  In a randomized clinical trial, 44 of 112 patients receiving PET-CT compared with 14 of 56 patients receiving CT alone received more extensive chemotherapy and radiotherapy or palliative treatment, a nonsignificant difference. Five percent of patients in each group were treated with palliative intent.

Meaning  In this trial among women with locally advanced carcinoma of the cervix, there was no significant difference between PET-CT plus CT vs CT alone, possibly because the trial was underpowered.

Loft A, Berthelsen AK, Roed H et al.: The diagnostic value of PET/CT scanning in patients with cervical cancer: a prospective study. Gynecol. Oncol. 106(1),29–34 (2007).

Chao A, Ho KC, Wang CC et al.: Positron emission tomography in evaluating the feasibility of curative intent in cervical cancer patients with limited distant lymph node metastases. Gynecol. Oncol. 110(2),172–178 (2008).

Schwarz JK, Siegel BA, Dehdashti F, Grigsby PW. Association of posttherapy positron emission tomography with tumor response and survival in cervical carcinoma.JAMA. 2007 Nov 21;298(19):2289-95.

nccn.org, cervical, CERV-B, 1,   2019

 

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