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18F-FDG PET/CT in cervical cancer assessment
Poster Title: 18F-FDG PET/CT in cervical cancer assessment
Submitted on 14 Sep 2018
Author(s): A Rabone, S Hasso, A Jacques, S Natas, J Wilson, A Winship, G Cook, O Westerland
Affiliations: Guy's and St Thomas' NHS Foundation Trust
This poster was presented at BIR Annual Congress 2018
Poster Views: 462
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Poster Information
Abstract: Background:
18F-FDG PET/CT is a recognised useful tool in baseline staging/response assessment in locally advanced cervical cancer however, patient selection is important. The 2016 National Comprehensive Cancer Network (NCCN) cervical cancer guidelines recommend 18F-FDG-PET/CT in staging for FIGO stage IB2+ disease, with follow-up 18F-FDG-PET/CT at 3-6 months following treatment completion. 18F-FDG-PET/CT is also indicated in suspected recurrent/metastatic disease. We conducted an audit of 18F-FDG PET/CT utilisation by a tertiary gynae-oncology centre.
Weekly MDT lists between April 2017-March 2018 provided a cohort of cervical cancer patients who had received 18F-FDG-PET/CT. Electronic patient records, imaging requests and reports (pelvic MRI and staging CT where applicable) were reviewed and baseline clinical and imaging staging results recorded. 100% compliance with guidelines was sought.
24/32 (75%) 18F-FDG-PET/CT studies were compliant with guidelines. Most 18F-FDG-PET/CT scans were performed for baseline staging. Of those which were not compliant all were for staging of FIGO stage IB1 disease where there were additional concerns at MDT e.g. high-grade disease on biopsy, suspicious sub-centimetre lymph nodes or other concerning findings detected on initial staging CT /MRI. Of the non-compliant studies, 1/8 detected FDG avidity outside the cervix (synchronous lung adenocarcinoma where spiculate lung lesion was detected at baseline CT).
The importance of using 18F-FDG-PET/CT selectively is highlighted, to minimise unnecessary radiation exposures and avoid false negative results e.g. assessment of sub-centimetre lymph nodes. These results will be presented at local MDM audit meeting and adherence to NCCN guidelines recommended, with repeat audit in one year.
Summary: This was a single centre retrospective audit of compliance with National Comprehensive Cancer Network guidelines for PET/CT in cervical cancer. References: 1. Royal College of Radiologists. Evidence based indications for use of PET-CT in the United Kingdom, 2016.
2. Scottish Intercollegiate Guidelines Network Management of cervical cancer: A national clinical guideline. NHS, 2008.
3. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology, Version 1.2017, 2016.
4. Kitajima, K. et al. Accuracy of 18F-FDG PET/CT in Detecting Pelvic and Paraaortic Lymph Node Metastasis in Patients with Endometrial Cancer. American Journal of Roentgenology, 2008, Vol. 190. 1652-1658
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