The role of positron emission tomography in the diagnosis and management of gynecologic malignancies

Kang, Soon Beom

Abstract

The utility of positron emission tomography (PET) in gynecologic malignancy has been increased rapidly in recent years. PET scans are mostly performed using 18-fluorodeoxyglucose (FDG-PET). It is valuable for primary staging of untreated advanced cervical cancer, for evaluating unexplained tumor marker elevation after treatment and for restaging of potentially curable recurrent cervical cancer. Its value in early-stage cervical cancer is limited. In ovarian cancer, sequential imaging predicts both response to neoadjuvant chemotherapy and survival. It also provides benefits when serum CA-125 was elevated or computed tomography/magnetic resonance imaging defined recurrence is noted but biopsy deemed infeasible. A few studies have shown that FDG-PET may facilitate optimal management of endometrial cancer, especially for post-therapy surveillance and after salvage therapy. FDG-PET is potentially useful in selected gestational trophoblastic neoplasia by monitoring response and localizing viable tumors after chemotherapy. Scanty studies have been reported in vulvar and vaginal cancer. The methodology and prospects of using integrated PET/computed tomography (PET-CT) in the management of gynecological cancer are discussed. The role of PET or PET-CT has evolved from a diagnostic tool into a potential indicator of both response to treatment and prognosis. Evaluating this tool by clinical impact is an attractive end point.