PET and CT Images Can Detect Distant Metastatic Disease in Cervical and Endometrial Cancers
Researchers in multicenter clinical trial recommend that PET/CT imaging be included in staging evaluation for these cancers.
Distant metastasis, which occurs when cancer that has spread from the primary tumor to distant organs or lymph nodes, has been associated with substantially poorer prognosis in patients with cervical and endometrial cancer. The detection of distant metastasis as early as possible can help guide treatment strategy to control spread of the disease and improve outcomes.
To this end, a recent multicenter clinical trial by the American College of Radiology Imaging Network and the Gynecology Oncology Group assessed the accuracy of staging PET/CT in detecting distant metastasis in patients with cervical and endometrial cancer. The results, published online in the journal Radiology, revealed that PET/CT can successfully identify the majority of patients with distant metastasis with few false positives.
The trial, known as ACRIN 6671/GOG 0233, originally aimed to assess PET/CT for detection of abdominal and pelvic lymph node metastasis. It included a total of 153 patients with cervical cancer and 203 patients with endometrial cancer enrolled from 28 sites. All patients underwent preoperative PET with a fluorine-18 fluorodeoxyglucose radiotracer and concurrent diagnostic CT imaging from the neck to upper thigh.
Three radiologists—one at the local institution and two independent central readers—evaluated the images for the presence of nonregional lymph node or hematogenous metastasis by using a confidence scale of 1 (definitely negative) to 6 (definitely positive). Distant metastasis was found in 13.7 percent of cervical cancer patients and 11.8 percent of endometrial cancer patients. Central readers showed significantly higher specificity and positive predictive value than the local institutional reviewer.
Overall, the authors conclude that using PET/CT has value in detecting distant metastasis and should be included in the staging evaluation for cervical and endometrial cancers.