Predictive role of post-treatment [18F]FDG PET/CT in patients with uterine cervical cancer.

OBJECTIVE: To evaluate the efficacy of post-treatment positron emission tomography (PET)/computed tomography (CT) for identification of tumor recurrence, and to determine whether [(18)F]fluorodeoxyglucose (FDG) uptake measured as the maximum standardized uptake value (SUV(max)) has predictive role regarding survival in patients with uterine cervical cancer.

METHODS: Medical records from 276 women with uterine cervical cancer who had post-treatment [(18)F]FDG PET/CT performed were retrospectively reviewed. Results of PET/CT scans were compared with histological or clinical examination.

RESULTS: Ninety-five (34.4%) of the 276 patients had documented recurrence by either surgical biopsy or clinical and imaging follow-up. Median duration from treatment to PET/CT scan was 24 months (range, 6-307). The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of post-treatment PET/CT were 94.7%, 87.8%, 80.4%, 97%, and 90.2%, respectively. The PET/CT scan modified both the diagnostic or treatment plan in 67 patients (24.3%). Patients were divided into two groups according to cut-off SUV(max) established on the basis of ROC analysis (<5.25 vs. ≥5.25), and there was a significant difference in OS between groups (p=0.001). In addition, the 5-year progression-free survival (PFS) and OS rates of patients with a negative PET/CT scan for recurrence were significantly better than those with a positive PET/CT (98.62% vs. 17.83%, p<0.0001 for PFS, 99.31% vs. 85.38%, p=0.0015 for OS).

CONCLUSION: Post-treatment PET/CT scan is a sensitive and accurate surveillance modality, and provides prognostic information in uterine cervical cancer. Furthermore, it may allow individualization of patient care.