Usefulness of 18F-fluorodeoxyglucose PET/CT in the diagnosis of local recurrence uterine or endometrial cancer: comparison with contrast enhanced CT and MR.

Background-Aim: To evaluate the accuracy of (18)F- fluorodeoxyglucose (FDG) PET/CT (PET/CT) in the diagnosis of suspected cervical uterine or endometrial cancer local recurrence after treatment (surgery, chemotherapy and/or radiotherapy) and to assess the impact of PET/CT findings on clinical management, compared with contrast enhanced CT alone and MR. Methods: We retrospectively studied 43 women (mean age 74 ? 6.3 years) who had undergone treatment for histopathologically proven uterine cervical or endometrial cancer. For the clinical-diag- nostic suspect of local cancer recurrence, all patients underwent PET/ CT examination at least 3 months from the end of treatment. PET/CT results were correlated to contrast enhanced CT alone and MR. Lesion status was determined on the basis of histopathology, radiological imaging and clinical follow-up for longer than 6 months. Differences among the three imaging modalities were tested using the Cochran Q test, followed by multiple comparisons using the McNemar test with Bonferroni adjustment. Results: Patient-based analysis showed that PET/CT confirmed a local disease relapse in 28 patients (65 %) out of 43. PET/CT data were confirmed by clinical-diagnostic and surgical follow-up. On the other hand CT alone showed a local recurrence of disease in 18 patients (41 %). On the other hand MR showed a relapse disease in 21 patients (48 %). The sensitivity, specificity, and accuracy of PET/CT were, respectively, 91, 93, and 92 %; whereas those of contrast en- hanced CT alone were, respectively, 68, 87, and 78 %. Finally, sensitivity, specificity and accuracy of MR were, respectively, 82, 91 and 90 %. PET/CT findings resulted in a change of management in 17 of 43 patients studied (39 %). Conclusion: PET/CT is a more accurate modality for assessing re- currence of uterine cancer and more appropriate than contrast enhanced CT alone in the restaging of patient with suspected uterine cancer recurrence. MR seems to be better then contrast enhanced CT for the restaging of local recurrence of uterine cancer but not per- forming like PET/CT. PET/CT done at least 3 months from the end of treatment allows to differentiate between after treatment local in- flammation and tumour recovery. The change of treatment management gives a better prognostic stratification and restraint of costs. Our data must be confirmed in a more wide casuistic.