OBJECTIVES : To determine the impact of FDG-PET/CT in the initial staging of cervical cancer among
women with and without HIV and to determine the abilities of FDG-PET/CT metabolic
parameters in predicting the presence of distant metastasis.
METHODS : We reviewed the FDG-PET/CT images of women with FIGO stage IB2 to IVA carcinoma of
the cervix. We compared the FIGO stage before and after FDG-PET/CT. Maximum and
mean standardized uptake values (SUVmax and SUVmean), metabolic tumor volume
(MTV) and total lesion glycolysis (TLG) of the primary lesion were determined. We compared
these parameters between the HIV-infected and uninfected woman and also determined
their abilities to predict the presence of distant metastasis.
126 women, mean age 48.05 ± 11.80 years were studied. Seventy-three patients were HIV-infected.
The disease was upstaged in 65 patients, 32 of which were upstaged to stage IVB.
HIV-infected women were younger (43.36 ± 8.03 years versus 54.51 ± 13.12, p<0.001) and
had more advanced disease (p = 0.022) compared with HIV-uninfected. In a univariate logistic
regression adjusted for the FIGO stage of the disease, there were significant associations between MTV and TLG of the primary tumor and distant metastasis. SUVmax, SUVmean,
MTV and TLG performed well in predicting the presence of distant metastasis with areas
under the curves (AUCs) of 0.63, 0.66, 0.80 and 0.77 respectively. These performances improved after adjustment for the FIGO stage of the disease with AUCs of 0.80, 0.79, 0.84
and 0.82 for SUVmax, SUVmean, MTV and TLG respectively.
CONCLUSION : Inclusion of 18F-FDG-PET/CT in the pre-therapy assessment of cervical cancer improves
the accuracy of staging in about half of the patients. The metabolic parameters of the primary
tumor perform well in predicting the presence of distant metastases.