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FDG PET-CT as an important diagnostic tool and prognostic marker in suspected recurrent cervical carcinoma after radiotherapy: comparison with MRI

Milica Stojiljkovic
Milica Stojiljkovic
, 
Dragana Sobic Saranovic
Dragana Sobic Saranovic
, 
Strahinja Odalovic
Strahinja Odalovic
, 
Marina Popovic
Marina Popovic
, 
Jelena Petrovic
Jelena Petrovic
, 
Nevena Rankovic
Nevena Rankovic
, 
Milos Veljkovic
Milos Veljkovic
 y 
Vera Artiko
Vera Artiko
   | 02 nov 2022
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Article Category: Research Article
Publicado en línea: 02 nov 2022
Páginas: 453 - 460
Recibido: 18 abr 2022
Aceptado: 15 sept 2022
DOI: https://doi.org/10.2478/raon-2022-0042
© 2022 Milica Stojiljkovic, Dragana Sobic Saranovic, Strahinja Odalovic, Marina Popovic, Jelena Petrovic, Nevena Rankovic, Milos Veljkovic, Vera Artiko, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

(A) A 51-year-old patient, with squamocellular carcinoma, presenting on FDG PET/CT with metastasis in left upper lung (blue arrow), and left iliac lymphadenopathy (red arrow). On MRI only left iliac disease was detected. (B) A 59-year-old patient, with adenocarcinoma, presenting on FDG PET/CT with active locoregional disease in pelvis (red arrow) also seen on MRI, and peritoneal deposit in front of the right liver lobe (blue arrow) which was missed by MRI.
(A) A 51-year-old patient, with squamocellular carcinoma, presenting on FDG PET/CT with metastasis in left upper lung (blue arrow), and left iliac lymphadenopathy (red arrow). On MRI only left iliac disease was detected. (B) A 59-year-old patient, with adenocarcinoma, presenting on FDG PET/CT with active locoregional disease in pelvis (red arrow) also seen on MRI, and peritoneal deposit in front of the right liver lobe (blue arrow) which was missed by MRI.

Figure 2

Kaplan-Meier survival curves showing progression free survival for patients with positive and negative magnetic resonance imaging; Log Rank, p = 0.003.
Kaplan-Meier survival curves showing progression free survival for patients with positive and negative magnetic resonance imaging; Log Rank, p = 0.003.

Figure 3

Kaplan-Meier survival curves showing progression free survival for patients with positive and negative fluorodeoxyglucose positron emission tomography/ computed tomography; Log Rank, p < 0.001.
Kaplan-Meier survival curves showing progression free survival for patients with positive and negative fluorodeoxyglucose positron emission tomography/ computed tomography; Log Rank, p < 0.001.

Figure 4

Kaplan-Meier survival curves showing progression free survival for patients with normal findings on fluorodeoxyglucose positron emission tomography/ computed tomography, locoregional recurrence, and presence of disseminated disease (with or without locoregional disease); Log Rank, p < 0.001.
Kaplan-Meier survival curves showing progression free survival for patients with normal findings on fluorodeoxyglucose positron emission tomography/ computed tomography, locoregional recurrence, and presence of disseminated disease (with or without locoregional disease); Log Rank, p < 0.001.

Multivariate Cox regression analysis of possible progression-free survival predictors in suspected recurrent cervical cancer (n = 84)

Predictor HR (95% confidence interval) p value
Age 0.995 (0.966–1.024) 0.727
Initial stage (IB/IIA vs. IIB/III/IV) 1.605 (0.520–4.957) 0.411
Histological type (squamocellular vs. other) 0.892 (0.419–1.898) 0.766
MRI (positive vs. negative) 1.959 (0.888–4.323) 0.096
PET-CT (positive vs. negative) 8.787 26.834(2.877) – < 0.001*

Univariate Cox regression analysis of possible progression-free survival predictors in suspected recurrent cervical cancer (n = 84)

Predictor HR (95% confidence interval) p value
Age 1.013 (0.987–1.040) 0.336
Initial stage (IB/IIA vs. IIB/III/IV) 2.024 (0.753–5.962) 0.155
Histological type (squamocellular vs. other) 1.245 (0.597–2.598) 0.558
Histological grade (1/2 vs. 3)* 0.831 (0.448–1.905) 0.831
MRI (positive vs. negative) 2.873 (1.370–6.027) 0.005†
PET-CT (positive vs. negative) 9.491 (3.302–27.274) < 0.001†

Patients’ characteristics

Characteristic Value
Age (years)
Mean ± sd 53 ± 11
Initial FIGO disease stage, n (%)
IB 9 (11%)
IIA 2 (2%)
IIB 38 (45%)
III 26 (31%)
IV 9 (11%)
Tumor histological type, n (%)
Squamous cell 70 (83%)
Adenocarcinoma 11 (14%)
Adenosquamous 2 (2%)
Small cell 1 (1%)
Tumor grade, n (%)
Low grade 6 (7%)
Intermediate grade 50 (60%)
High grade 10 (12%)
Unknown 18 (21%)
Previous treatment, n (%)
Surgery with (chemo)radiotherapy 11 (13%)
Radiotherapy only 10 (12%)
Radiotherapy with concurrent chemotherapy 49 (58%)
Primary (chemo)radiation with salvage hysterectomy 14 (17%)
MRI findings, n (%)
Positive 54 (64%)
Negative 30 (36%)
PET-CT findings, n (%)
Positive 57 (68%)
Negative 27 (32%)

Diagnostic performance of MRI and PET-CT

TP(n) TN(n) FP(n) FN(n) Sensitivity (%) Specificity (%) Accuracy (%)
MRI 34 22 20 8 80.1% 52.4% 66.7%
PET-CT 41 26 16 1 97.6% 61.9% 79.8%
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Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
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