scholarly journals Positron emission tomography/computerised tomography imaging in detecting and managing recurrent cervical cancer: systematic review of evidence, elicitation of subjective probabilities and economic modelling

2013 ◽  
Vol 17 (12) ◽  
Author(s):  
C Meads ◽  
P Auguste ◽  
C Davenport ◽  
S Małysiak ◽  
S Sundar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Positron Emission Tomography ◽  
Emission Tomography ◽  
Economic Modelling ◽  
Subjective Probabilities ◽  
Computerised Tomography ◽  
Recurrent Cervical Cancer ◽  
Tomography Imaging ◽  
Positron Emission

Surveillance Procedures for Patients for Cervical Carcinoma: A Review of the Literature

2009 ◽  
Vol 19 (3) ◽  
pp. 306-313 ◽  
Author(s):  
Vanna Zanagnolo ◽  
Lucas Alfonso Minig ◽  
Angelo Gadducci ◽  
Tiziano Maggino ◽  
E. Sartori ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cervical Cancer ◽  
Positron Emission Tomography ◽  
Clinical Outcome ◽  
Cervical Carcinoma ◽  
Disease Free Survival ◽  
Emission Tomography ◽  
Recurrent Cervical Cancer ◽  
Positron Emission

Cervical cancer is still one of the most common malignancies in women. Treatment for cervical cancer is very successful, especially in early stage. However, some patients will experience recurrence. Primary purpose of follow-up programs is early detection of recurrence disease that should be more likely to be amenable to treatment, thereby improving the clinical outcome. Although, in the literature, most studies have shown that the surveillance programs did not improve the clinical outcome of patients with diagnosis of recurrence, this clinical practice is regarded as traditional management. The use of Papanicolaou tests to detect recurrent cervical cancer is not sufficiently justified. The assessment of tumor markers such as squamous cell carcinoma antigen could be useful. Imaging techniques are important for the detection and assessment of recurrent disease. The role of chest radiographs to detect asymptomatic recurrence in patients treated for cervical carcinoma remains controversial. Detection of a new abnormal mass or the changes in the size of a known lesion caused by cancer growth and the determination of the extent of recurrence with computed tomography and magnetic resonance imaging may provide clinical assistance in selection of optimal therapy. The fluoro-2-deoxy-glucose-positron emission tomography for surveillance only shows 80% of specificity and accuracy with negative predictive value of 100%. Integrated fluoro-2-deoxy-glucose-positron emission tomography/computed tomography provides precise anatomic localization of suspicious areas and therefore a better diagnostic interpretation with a possible impact on disease-free survival as well. In conclusion, our review confirms the need of prospective studies to compare the effectiveness of different follow-up regimens measuring as outcome overall survival and quality of life parameters.

Value of Dual-Phase 2-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography in Cervical Cancer

2003 ◽  
Vol 21 (19) ◽  
pp. 3651-3658 ◽  
Author(s):  
Tzu-Chen Yen ◽  
Koon-Kwan Ng ◽  
Shih-Ya Ma ◽  
Hung-Hsueh Chou ◽  
Chien-Sheng Tsai ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Characteristic Curve ◽  
Locally Advanced ◽  
Emission Tomography ◽  
Dual Phase ◽  
Recurrent Cervical Cancer ◽  
Metastatic Lesions ◽  
Positron Emission

Purpose: The role of positron emission tomography (PET) with fluorine-18–labeled fluoro-2-deoxy-d-glucose (FDG) in cervical cancer has not yet been well defined. We conducted a prospective study to investigate its efficacy in comparison with magnetic resonance imaging and/or computed tomography (MRI-CT). Materials and Methods: Patients with untreated locally advanced (35%) or recurrent (65%) cervical cancer were enrolled onto this study. In the first part of this study, 41 patients had a conventional FDG-PET (40 minutes after injection), and in the second part, 94 patients received dual-phase PET (at both 40 minutes and 3 hours after injection). The overall results of PET scans were compared with MRI-CT, and the two protocols of PET were also compared with each other. Lesion status was determined by pathology results or clinical follow-up. The receiver operating characteristic curve method with area under the curve (AUC) calculation was used to evaluate the discriminative power. Results: Overall (N = 135), FDG-PET was significantly superior to MRI-CT in identifying metastatic lesions (AUC, 0.971 v 0.879; P = .039), although the diagnostic accuracy was similar for local tumors. Dual-phase PET was also significantly better than the 40-minute PET (n = 94). The latter accurately recognized 70% of metastatic lesions and the former detected 90% (AUC, 0.943 v 0.951; P = .007). Dual-phase FDG-PET changed treatment of 29 patients (31%; upstaging 27% and downstaging 4%). Conclusion: This study shows that dual-phase FDG-PET is superior to conventional FDG-PET or MRI-CT in the evaluation of metastatic lesions in locally advanced or recurrent cervical cancer.

Role of [18F]fluoro-2-deoxy-D-glucose positron emission tomography in re-recurrent cervical cancer

2006 ◽  
Vol 16 (6) ◽  
pp. 1994-2003 ◽  
Author(s):  
C.-T. Lin ◽  
T.-C. Yen ◽  
T.-C. Chang ◽  
K.-K. Ng ◽  
C.-S. Tsai ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Scoring System ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Emission Tomography ◽  
Recurrent Cervical Cancer ◽  
Positron Emission

Cervical cancer patients with histologically documented re-recurrence after curative salvage therapy or unexplained tumor marker elevation (negative computed tomography and/or magnetic resonance imaging [CT-MRI]) proven to be a re-recurrence when a further attempt for cure (or control of cancer) appeared feasible were enrolled. Lesion status was determined from pathology or clinical follow-up for at least 12 months. Management decisions were recorded with CT-MRI alone and incorporating [18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), respectively. The benefits calculated were based on clinical impact because of the FDG-PET findings. Cox proportional hazards model was used to select independent prognostic covariates. Of the 26 patients who were eligible for analysis, 12 (46.2%) patients had positive impacts due to PET. Squamous cell carcinoma (SCC,P= 0.029), re-recurrence at distant metastasis only (P= 0.012), and level of SCC antigen ≤4 ng/mL (P= 0.005) were significantly associated with better survival. A scoring system using these covariates defined three distinct prognostic groups (P= 0.0001). Patients with score 0 had a 36-month cumulative survival rate of 80%. Using this prognostic scoring system, FDG-PET may facilitate selecting appropriate management for the individual patient with re-recurrent cervical cancer.

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