Ramesh C. Verma MD, Presenter: Nothing to Disclose

Seyed Abdolmajid Rooholamini MD, Abstract Co-Author: Nothing to Disclose

Christine Holschneider MD, Abstract Co-Author: Nothing to Disclose

Manju P Gan MD, Abstract Co-Author: Nothing to Disclose

Gail Hansen MD, Abstract Co-Author: Nothing to Disclose

Javad Rahimian PhD, Abstract Co-Author: Nothing to Disclose

This study was conducted to evaluate the role of CT and PET scans in preoperative staging of patients with initial diagnosis of carcinoma of the cervix (CaCx).

Retrospective analysis of medical records was performed on 26 patients (ages 32-66 years) with CaCx who had undergone a pelvic/abdominal CT and a whole body PET/FDG scan followed by surgery within a 3-month period. The CT scans were obtained on a Picker PQ5000 Spiral CT scanner using conventional technique with oral and intravenous contrast. The whole body PET scans were obtained on a Siemens ECAT ART scanner one hour following 5-7 mCi of F-18-FDG I.V. Histopathology was available on all FNA and surgically excised lesions.

Each patient was assigned a FIGO (International Federation of the Gynecology and Obstetrics) stage for CT, PET, and surgical pathology findings. The distribution of the 26 patients by surgical pathology stage were 3, 14, 1, 5, and 3 in stages 0, I, II, III, and IV respectively. CT stage was concordant with surgical stage in 17 of 26 patients (65.3%). Surgery upstaged CT in 7 and downstaged in 2 cases. CT and PET stages were concordant in 15 of 26 (57.7%). CT upstaged PET in 5 and downstaged in 6 cases (one from each was confirmed at surgery). PET stage was concordant with surgical staging in 12 of 26 (46.2%). Surgery upstaged PET in 9 cases (5 lesions under 6 mm) and downstaged PET in 5 cases. Both CT and PET staging was discordant with surgical stage in 7 cases (26.9%). The 5 PET scans that were upstaged by surgery consisted of 3 with pelvic and 1 with parametrial and 1 with supraclavicular nodes.

CT scans demonstrated higher (65%) concordance with surgical findings than PET (46%). Both CT and PET demonstrated high degree of discordance with surgery (27% of the cases). Most patients with CaCx are detected early on Pap smears and such sub-centimeter primary lesions and metastases in lymph nodes are missed both on CT and PET. Overall, PET imaging demonstrates limited value over CT scans in initial evaluation of patients with CaCx.

Verma, R, Rooholamini, S, Holschneider, C, Gan, M, Hansen, G, Rahimian, J, Role of CT and PET Imaging in Preoperative Staging of Carcinoma of Cervix.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4415784.html