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Gynecologic

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PET-CT and PET-MRI in Oncology

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

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Abstract

This chapter reviews the current and evolving clinical roles of PET/PET in the diagnosis, staging, and restaging of gynecological malignancies. For endometrial and cervical carcinoma, PET has proven useful in both the staging of locally advanced cancer and restaging of the disease. PET plays a unique role assessing response to treatment and prognostication. In advanced ovarian carcinoma PET staging may be of value when chemotherapy is used as the primary treatment prior to surgery. When the serum CA-125 is elevated and conventional imaging is negative or equivocal, previously treated ovarian cancer patients benefit from PET/CT identification of disease. PET/CT aids the management of vulvar and vaginal squamous cell cancer, especially in the detection of nodal metastasis.

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References

  • Avril N, Sassen S, Schmalfeldt B et al (2005) Prediction of response to neoadjuvant chemotherapy by sequential F-18-fluorodeoxyglucose positron emission tomography in patients with advanced-stage ovarian cancer. J Clin Oncol 23:7445–7453

    Article  PubMed  Google Scholar 

  • Ben-Haim S, Ell P (2009) 18F-FDG PET and PET/CT in the evaluation of cancer treatment response. J Nucl Med 50:88–99

    Article  PubMed  Google Scholar 

  • Chung HH, Kang WJ, Kim JW et al (2007) Role of (18F) FDG PET/CT in the assessment of suspected recurrent ovarian cancer: correlation with clinical or histological findings. Eur J Nucl Med Mol Imaging 34:480–486

    Article  PubMed  Google Scholar 

  • Cohn DE, Dehdashti F, Gibb RK et al (2002) Prospective evaluation of positron emission tomography for the detection of groin node metastases from vulvar cancer. Gynecol Oncol 85:179–184

    Article  PubMed  Google Scholar 

  • Elit L, Bondy SJ, Paszat L et al (2002) Outcomes in surgery for ovarian cancer. Gynecol Oncol 87:260

    Article  PubMed  CAS  Google Scholar 

  • Esthappan J, Chaudhari S, Santanam L et al (2008) Prospective clinical trial of positron emission tomography/computed tomography image-guided intensity-modulated radiation therapy for cervical carcinoma with positive para-aortic lymph nodes. Int J Radiat Oncol Biol Phys 72:1134–1139

    Article  PubMed  Google Scholar 

  • Fagotti A, Fanfani F, Rositto C et al (2008) A treatment selection protocol for recurrent ovarian cancer patients: the role of FDG-PET/CT and staging laparoscopy. Oncology 75:152–158

    Article  PubMed  CAS  Google Scholar 

  • Fenchel S, Grab D, Nuessle K et al (2002) Asymptomatic adnexal masses: correlation of FDG PET and histopathologic findings. Radiology 223(3):780–788

    Article  PubMed  Google Scholar 

  • Goff BA, Mandel LS, Melancon CH et al (2004) Frequency of symptoms of ovarian cancer in women presenting to primary care clinics. JAMA 291:2705–2712

    Article  PubMed  CAS  Google Scholar 

  • Greenlee RT, Hill Harmon MB, Murray T, Thun M (2001) Cancer statistics, 2001. CA Cancer J Clin 51:15–36

    Article  PubMed  CAS  Google Scholar 

  • Grigsby PW (2002) Vaginal cancer. Curr Treat Options Oncol 3:125–130

    Article  PubMed  Google Scholar 

  • Horowitz NS, Dehdashti F, Herzog TJ et al (2004) Prospective evaluation of FDG-PET for detecting pelvic and para-aortic lymph node metastasis in uterine corpus cancer. Gynecol Oncol 95:546–551

    Article  PubMed  Google Scholar 

  • Iagaru AH, Mittra ES, McDougall IR et al (2008) 18F-FDG PET/CT evaluation of patients with ovarian carcinoma. Nucl Med Commun 29:1046–1051

    Article  PubMed  Google Scholar 

  • Irvin WP, Rice LW, Berkowitz RS (2002) Advances in the management of endometrial adenocarcinoma. J Reprod Med 47:173–190

    PubMed  Google Scholar 

  • Iyer VR, Lee SI (2010) MRI, CT, and PET/CT for ovarian cancer detection and adenexal lesion characterization. Am J Roentgenol 194:311–321

    Article  Google Scholar 

  • Jemal A, Siegel R, Ward E et al (2009) Cancer statistics, 2009. CA Cancer J Clin 59:225–249

    Article  PubMed  Google Scholar 

  • Kang S, Kim SK, Chung DC et al (2010) Diagnostic value of (18)F-FDG PET for evaluation of paraaortic nodal metastasis in patients with cervical carcinoma: a metaanalysis. J Nucl Med 51(3):360–367

    Article  PubMed  Google Scholar 

  • Kaur H, Silverman PM, Iyer RB, Verschraegen CF, Eifel PJ, Charnsangavej C (2003) Diagnosis, staging, and surveillance of cervical carcinoma. Am J Roentgenol 180(6):1621–1631

    Google Scholar 

  • Kitajima K, Murakami K, Yamasaki E et al (2008) Accuracy of 18F-FDG PET/CT in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer. Am J Roentgenol 190(6):1652–1658

    Article  Google Scholar 

  • Kitajima K, Murakami K, Kaji Y, Sugimura K (2010) Spectrum of FDG PET/CT findings of uterine tumors. Am J Roentgenol 195(3):737–743

    Article  Google Scholar 

  • Kitajima K, Murakami K, Yamasaki E et al (2009) Accuracy of integrated FDG-PET/contrast-enhanced CT in detecting pelvic and paraaortic lymph node metastasis in patients with uterine cancer. Eur Radiol 19:1529–1536

    Article  PubMed  Google Scholar 

  • Kubik-Huch RA, Dörffler W, von Schulthess GK et al (2000) Value of (18F)-FDG positron emission tomography, computed tomography, and magnetic resonance imaging in diagnosing primary and recurrent ovarian carcinoma. Eur Radiol 10(5):761–767

    Article  PubMed  CAS  Google Scholar 

  • Kumar R, Alavi A (2004) PET imaging in gynecologic malignancies. Radiol Clin North Am 42:1155–1167

    Article  PubMed  Google Scholar 

  • Lamoreaux WT, Grigsby PW, Dehdashti F et al (2005) FDG-PET evaluation of vaginal carcinoma. Int J Radiat Oncol Biol Phys 62:733–737

    Article  PubMed  Google Scholar 

  • Lerman H, Metser U, Grisaru D, Fishman A, Lievshitz G, Even-Sapir E (2004) Normal and abnormal 18F-FDG endometrial and ovarian uptake in pre- and postmenopausal patients: assessment by PET/CT. J Nucl Med 45:266–271

    PubMed  Google Scholar 

  • Lin LL, Grigsby PW, Powell MA, Mutch DG (2005) Definitive radiotherapy in the management of isolated vaginal recurrences of endometrial cancer. Int J Radiat Oncol Biol Phys 63:500–504

    Article  PubMed  Google Scholar 

  • Lin LL, Mutic S, Low DA et al (2007) Adaptive brachytherapy treatment planning for cervical cancer using FDG-PET. Int J Radiat Oncol Biol Phys 67:91–96

    Article  PubMed  Google Scholar 

  • Ma SY et al (2003) Delayed 18F-FDG PET for detection of paraaortic lymph node metastatses in cervical cancer patients. J Nucl Med 44:1775–1783

    PubMed  Google Scholar 

  • Macdonald DM, Lin LL, Biehl K et al (2008) Combined intensity-modulated radiation therapy and brachytherapy in the treatment of cervical cancer. Int J Radiat Oncol Biol Phys 71:618–624

    Article  PubMed  Google Scholar 

  • Manfredi R, Mirk P, Maresca G et al (2004) Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology 231(2):372–378

    Article  PubMed  Google Scholar 

  • Mangili G, Picchio M, Sironi S (2007) Integrated PET/CT as a first-line re-staging modality in patients with suspected recurrence of ovarian cancer. Eur J Nucl Med Mol Imaging 34:658–666

    Article  PubMed  CAS  Google Scholar 

  • Nakamura K, Kodama J, Okumura Y et al (2010) The SUVmax of 18F-FDG PET correlates with histological grade in endometrial cancer. Int J Gynecol Cancer 20:110–115

    Article  PubMed  Google Scholar 

  • Oonk MH, de Hullu JA, van der Zee AG (2010) Current controversies in the management of patients with early-stage vulvar cancer. Curr Opin Oncol 22:481–486

    Article  PubMed  Google Scholar 

  • Pandharipande PV, Choy G, del Carmen MG, Gazelle GS, Russell AH, Lee SI (2009) MRI and PET/CT for triaging stage IB clinically operable cervical cancer to appropriate therapy: decision analysis to assess patient outcomes. Am J Roentgenol 192(3):802–814

    Article  Google Scholar 

  • Pandit-Taskar N (2005) Oncologic imaging in gynecologic malignancies. J Nucl Med 46:1842–1850

    PubMed  Google Scholar 

  • Pannu HK, Corl FM, Fishman EK (2001) CT evaluation of cervical cancer: spectrum of disease. Radiographics 21(5):1155–1168

    PubMed  CAS  Google Scholar 

  • Park JY, Kim EN, Kim DY et al (2008) Clinical impact of positron emission tomography or positron emission tomography/computed tomography in the posttherapy surveillance of endometrial carcinoma: evaluation of 88 patients. Int J Gynecol Cancer 18(6):1332–1338

    Article  PubMed  Google Scholar 

  • Patel CN, Nazir SA, Khan Z, Gleeson FV, Bradley KM (2011) 18F-FDG PET/CT of cervical carcinoma. Am J Roentgenol 196(5):1225–1233

    Article  Google Scholar 

  • Pecorelli S (2009) Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105:103–104

    Article  PubMed  Google Scholar 

  • Permuth-Wey J, Sellers TA (2009) Epidemiology of ovarian cancer. Methods Mol Biol 472:413–437

    Article  PubMed  Google Scholar 

  • Peters WA, Liu PY, Barrett RJ et al (2000) Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 18:1606–1613

    PubMed  CAS  Google Scholar 

  • Petignat P, Vajda D, Joris F, Obrist R (2000) Surgical management of epithelial ovarian cancer at community hospitals: a population-based study. J Surg Oncol 75:119

    Article  Google Scholar 

  • Picchio M, Mangili G, Samanes Gajate AM et al (2010) High-grade endometrial cancer: value of (18F)FDG PET/CT in preoperative staging. Nucl Med Commun 31:506–512

    PubMed  Google Scholar 

  • Pilleron JP, Durand JC, Hamelin JP (1974) Prognostic value of node metastasis in cancer of the uterine cervix. Am J Obstet Gynecol 119:458

    PubMed  CAS  Google Scholar 

  • Rockall AG, Sohaib SA, Harisinghani MG et al (2005) Diagnostic performance of nanoparticle-enhanced magnetic resonance imaging in the diagnosis of lymph node metastases in patients with endometrial and cervical cancer. J Clin Oncol 23:2813–2821

    Article  PubMed  Google Scholar 

  • Roman LD, Muderspach LI, Stein SM et al (1997) Pelvic examination, tumor marker level, and gray-scale and Doppler sonography in the prediction of pelvic cancer. Obstet Gynecol 89:493

    Article  PubMed  CAS  Google Scholar 

  • Rose PG, Bundy BN, Watkins EB et al (1999) Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 340:1144–1153

    Article  PubMed  CAS  Google Scholar 

  • Rose PG, Nerenstone S, Brady MF et al (2004) Secondary surgical cytoreduction for advanced ovarian carcinoma. N Engl J Med 351:2489–2497

    Article  PubMed  CAS  Google Scholar 

  • Rustin GJ, Nelstrop AE, Tuxen MK, Lambert HE (1996) Defining progression of ovarian carcinoma during follow-up according to CA 125: a North Thames Ovary Group study. Ann Oncol 7:361–364

    Article  PubMed  CAS  Google Scholar 

  • Ryu SY, Kim MH, Choi SC, Choi CW, Lee KH (2003) Detection of early recurrence with 18F-FDG PET in patients with cervical cancer. J Nucl Med 44(3):347–352

    PubMed  Google Scholar 

  • Sala E, Kataoka M, Pandit-Taskar N et al (2010) Recurrent ovarian cancer: use of contrast-enhanced CT and PET/CT to accurately localize tumor recurrence and to predict patients’ survival. Radiology 257(1):125–134

    Article  PubMed  Google Scholar 

  • Schröder W, Zimny M, Rudlowski C, Büll U, Rath W (1999) The role of 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG PET) in diagnosis of ovarian cancer. Int J Gynecol Cancer 9(2):117–122

    Article  PubMed  Google Scholar 

  • Schutter EM, Sohn C, Kristen P et al (1998) Estimation of probability of malignancy using a logistic model combining physical examination, ultrasound, serum CA 125, and serum CA 72-4 in postmenopausal women with a pelvic mass: an international multicenter study. Gynecol Oncol 69:56–63

    Article  PubMed  CAS  Google Scholar 

  • Schwarz JK, Siegel BA, Dehdashti F, Grigsby PW (2007) Association of posttherapy positron emission tomography with tumor response and survival in cervical carcinoma. JAMA 298(19):2289–2295

    Article  PubMed  CAS  Google Scholar 

  • Sebastian S, Lee SI, Horowitz NS et al (2008) PET-CT vs CT alone in ovarian cancer recurrence. Abdom Imaging 33:112–118

    Article  PubMed  Google Scholar 

  • Sedlis A, Bundy BN, Rotman MZ et al (1999) A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a gynecologic oncology group study. Gynecol Oncol 73:177–183

    Article  PubMed  CAS  Google Scholar 

  • Shah CA, Goff BA, Lowe K, Peters WA 3rd, Li CI (2009) Factors affecting risk of mortality in women with vaginal cancer. Obstet Gynecol 113:1038–1045

    PubMed  Google Scholar 

  • Signorelli M, Guerra L, Buda A et al (2009) Role of the integrated FDG PET/CT in the surgical management of patients with high risk clinical early stage endometrial cancer: detection of pelvic nodal metastases. Gynecol Oncol 115:231–235

    Article  PubMed  Google Scholar 

  • Simcock B, Neesham D, Quinn M (2006) The impact of PET/CT in the management of recurrent ovarian cancer. Gynecol Oncol 103:271–276

    Article  PubMed  Google Scholar 

  • Sironi S, Buda A, Picchio M et al (2006) Lymph node metastasis in patients with clinical early-stage cervical cancer: detection with integrated FDG PET/CT. Radiology 238(1):272–279

    Article  PubMed  Google Scholar 

  • Sironi S, Messa C, Mangili G et al (2004) Integrated FDG PET/CT in patients with persistent ovarian cancer: correlation with histological findings. Radiology 233:433–440

    Article  PubMed  Google Scholar 

  • Son H, Kositwattanarerk A, Hayes MP et al (2010) PET/CT evaluation of cervical cancer: spectrum of disease. Radiographics 30(5):1251–1268

    Article  PubMed  Google Scholar 

  • Sugiyama T, Nishida T, Ushijima K et al.(1995) Detection of lymph node metastasis in ovarian carcinoma and uterine corpus carcinoma by preoperative computerized tomography or magnetic resonance imaging. J Obstet Gynaecol (Tokyo 1995) 21:551–556

    Google Scholar 

  • van der Burg ME, van Lent M, Buyse M et al (1995) The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. Gynecological Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer. N Engl J Med 332:629–634

    Article  PubMed  Google Scholar 

  • van der Veldt AA, Buist MR, van Baal MW, Comans EF, Hoekstra OS, Molthoff CF (2008) Clarifying the diagnosis of clinically suspected recurrence of cervical cancer: impact of 18F-FDG PET. J Nucl Med 49(12):1936–1943

    Article  PubMed  Google Scholar 

  • Woelber L, Kock L, Gieseking F, Petersen C, Trillsch F, Choschzick M, Jaenicke F, Mahner S (2011) Clinical management of primary vulvar cancer. Eur J Cancer 47:2315–2321

    Article  PubMed  Google Scholar 

  • Wu X, Matanoski G, Chen VW, Saraiya M, Coughlin SS, King JB, Tao XG (2008) Descriptive epidemiology of vaginal cancer incidence and survival by race, ethnicity, and age in the United States. Cancer 113(10):2873–2882

    Article  PubMed  Google Scholar 

  • Yen TC, See LC, Lai CH et al (2004a) 18F-FDG uptake in squamous cell carcinoma of the cervix is correlated with glucose transporter 1 expression. J Nucl Med 45(1):22–29

    PubMed  CAS  Google Scholar 

  • Yen TC, See LC, Chang TC et al (2004b) Defining the priority of using 18F-FDG PET for recurrent cervical cancer. J Nucl Med 45(10):1632–1639

    PubMed  Google Scholar 

  • Yoshida Y, Kurokawa T, Kawahara K et al (2004) Incremental benefits of FDG positron emission tomography over CT alone for the preoperative staging of ovarian cancer. Am J Roentgenol 182(1):227–233

    Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

    Patrick J. Peller

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  1. Patrick J. Peller
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Correspondence to Patrick J. Peller .

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Editors and Affiliations

  1. Rochester, 55901, Minnesota, USA

    Patrick Peller

  2. , Division of Neuroradiology, Boston University School of Medicine, Boston, 02493, Massachusetts, USA

    Rathan Subramaniam

  3. Dept. Radiology, Boston University Medical Center, E. Newton St. 88, Boston, 02118, Massachusetts, USA

    Ali Guermazi

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© 2012 Springer-Verlag Berlin Heidelberg

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Peller, P.J. (2012). Gynecologic. In: Peller, P., Subramaniam, R., Guermazi, A. (eds) PET-CT and PET-MRI in Oncology. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2012_621

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  • DOI: https://doi.org/10.1007/174_2012_621

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-01138-2

  • Online ISBN: 978-3-642-01139-9

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