Chonnam Med J.  2013 Apr;49(1):20-26. 10.4068/cmj.2013.49.1.20.

Clinical Usefulness of 18F-FDG PET/CT in the Detection of Early Recurrence in Treated Cervical Cancer Patients with Unexplained Elevation of Serum Tumor Markers

• Chong A
• Ha JM
• Jeong SY
• Song HC
• Min JJ
• Bom HS
• Choi HS

• KMID: 2172172
• DOI: http://doi.org/10.4068/cmj.2013.49.1.20

Abstract

We investigated the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for restaging of treated uterine cervix squamous cell cancer with tumor maker elevation that was not explained by other conventional evaluation. We enrolled 32 cases who underwent PET/CT for the restaging of treated cervical cancer with tumor marker elevation that was not explained by recent conventional evaluation. All enrolled cases had squamous cell carcinoma. Increased tumor markers included squamous cell carcinoma antigen (SCC Ag) and carcinoembryonic antigen (CEA). PET/CT findings were determined by pathologic confirmation or clinical follow-up. We compared PET/CT accuracy and clinical parameters including normalization of tumor markers in both the SCC Ag elevation group and the CEA elevation group. The sensitivity, specificity, positive predictive value, and negative predictive value of PET/CT in detecting recurrence were 100%, 83.3%, 82.4%, and 100%, respectively. Accuracy was significantly different between the SCC Ag elevation group and the CEA elevation group (p=0.0169). PET/CT with SCC Ag elevation was more accurate (100%) than PET/CT with CEA elevation (66.7%). Normalization of tumor markers was observed more often in the SCC Ag elevation group than in the CEA elevation group (p=0.0429). PET/CT showed high negative predictive value and sensitivity in the restaging of cervical cancer with unexplained tumor marker elevation. PET/CT was more accurate in patients with SCC Ag elevation than in those with CEA elevation.

Keyword

Fluorodeoxyglucose F18; Positron-emission tomography and computed tomography; Recurrence

MeSH Terms

Antigens, Neoplasm
Carcinoembryonic Antigen
Carcinoma, Squamous Cell
Cervix Uteri
Electrons
Female
Fluorodeoxyglucose F18
Follow-Up Studies
Humans
Neoplasms, Squamous Cell
Positron-Emission Tomography and Computed Tomography
Recurrence
Sensitivity and Specificity
Serpins
Biomarkers, Tumor
Uterine Cervical Neoplasms
Antigens, Neoplasm
Carcinoembryonic Antigen
Fluorodeoxyglucose F18
Serpins

Figure

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  FIG. 1 Summary of 18F-FDG PET/CT findings and follow-up results in the 32 cases of tumor marker elevation of treated cervix malignancy. LN: lymph node.

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  FIG. 2 True-positive case (lymph node metastasis). A 72-year-old female had a cervical malignancy (squamous cell carcinoma) treated with chemoradiation therapy. Four months after the last treatment, serum SCC Ag was elevated (8.8 ng/ml). Pelvic CT (A) was done, but no metastatic lesions were detected. After 1 month, 18F-FDG PET/CT was done (B, C). Hypermetabolic lymph nodes with max SUV 5.0 were detected in the paraaortic area (B, C arrows). These lymph nodes were supposed to be benign lesions in the previous CT (A, arrow). Recurrence was clinically confirmed by follow-up CT studies and chemotherapy was done for this patient.

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  FIG. 3 True-positive case (splenic metastasis). A 54-year-old female had treated cervical cancer (squamous cell carcinoma). One year later, serum SCC Ag was elevated (from 1.4 to 3.2 ng/ml in 1 month). Contrast-enhanced abdomen CT (A) was done but recurrence of metastasis was not revealed. After 1 week, 18F-FDG PET/CT (B, C) detected a hypermetabolic lesion of max SUV 8.9 in the spleen (B, C arrows). Metastasis was confirmed by biopsy.

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