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

Tzu-Chen Yen, Koon-Kwan Ng, Shih-Ya Ma, Hung-Hsueh Chou, Chien-Sheng Tsai, Swei Hsueh, Ting-Chang Chang, Ji-Hong Hong, Lai-Chu See, Wuu-Jyh Lin, Jenn-Tzong Chen, Kuan-Gen Huang, Kar-Wai Lui, Chyong-Huey Lai

From the Department of Nuclear Medicine; Department of Radiology; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology; Department of Radiation Oncology; and Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University; Biostatistics Consulting Center/Department of Public Health, Chang Gung University; and Institute of Nuclear Energy Research, Taoyuan, Taiwan.

Address reprint requests to Chyong-Huey Lai, MD, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, 5 Fu-Shin St, Kueishan, Taoyuan 333, Taiwan; e-mail: sh46erry{at}ms6.hinet.net.

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.

Supported by NSC 91-2314-B-182A-163 from the National Science Council Taiwan and CTRP 016 from the Chang Gung Memorial Hospital and University.

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