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Impact of ~(18) F-FDG coincidence/CT imaging on the management of patients with gynecologic malignancies

ZHU Jia rui *, CHUAN Ling, ZHAO Wen rui, GAO Chun hua, XU Gen xiang, WEI Wei(Division of Nuclear Medicine, Navy General Hospital of PLA, Beijing 100037, China)  
Objective To investigate the impact of 18 F FDG coincidence/CT imaging on the management of patients with gynecologic malignancies. Methods Twenty two patients with gynecologic malignancies,including 9 cervical cancer, 4 endometrial cancer, 3 ovarian cancer, 3 vagina cancer and 3 leiomyosarcoma of uterus, underwent 18 F FDG coincidence imaging. The lesions were identified on fusion images of CT and FDG by two experenced physicians using visual and semiquantitative analysis. The results of FDG coincidence imaging were compared with that of dedicated CT and various serum tumor markers. Results The sensitivity, accuracy and positive predictive value of 18 F FDG coincidence/CT imaging were 90.5%, 91.3% and 100%, respectively,for detection of recurrence and metastasis of gynecologic malignancies. FDG coincidence/CT imaging found 64 lesions in 22 studies and CT found only 40 lesions(mean 3.2±3.2 vs 2.0±1.6, P =0.0298). FDG coincidence/CT imaging detected 24 more recurrent and metastastic lesions in 6 patients than dedicated CT. The stage of 7 patients were changed, in which 6 patients were upstaged and one were downstaged. The patient's management were changed in 7 cases (30.6%), resulted in a cancellation of second surgery because of the detection of previously unknown distant metastases (2 patients), additional lymph node metastases (2 patients), or the exclusion of active disease (1 patients). In another 2 patients, FDG PET results changed the curative treatment into palliative, because of extensive metastasis. Conclusion FDG coincidence imaging superiors to CT in staging of gynecologic malignancies. FDG coincidence imaging is useful to the clinicians to choose the optimal treatment ensuring the maximum probability of recovery and being cost effective as unnecessary medical interventions become avoidable.
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