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The role of 18F-FDG-PET/CT in predicting the histopathological response in locally advanced cervical carcinoma treated by chemo-radiotherapy followed by radical surgery: a prospective study

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Abstract

Purpose

This prospective study aimed to evaluate whether 18F-FDG-PET/CT performed before, during and after neoadjuvant chemo-radiotherapy (CRT) could predict histopathological response in patients with locally advanced cervical cancer (LACC) treated with CRT followed by radical surgery.

Methods

Between October 2010 and June 2014, 88 patients with LACC were enrolled. For each patient, three 18F-FDG-PET/CT scans (baseline, early and final) were acquired and evaluated by qualitative and quantitative analysis. Maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured as absolute values and their percentage variation (delta) (early vs. baseline and final vs. baseline). The role of 18F-FDG-PET/CT in predicting lymph node (LN) residual disease was evaluated by qualitative analysis only. Histopathology was the reference standard.

Results

At histopathology, 40 patients had complete response (CR, pR0), 48 had partial response (PR: 21 microscopic [pR1] and 27 macroscopic [pR2]). At baseline, SUVmax and SUVmean were significantly higher in pR0 than in pR1–pR2 patients. At early evaluation, MTV and TLG were significantly higher in pR1–pR2 than in pR0 patients. At final evaluation, SUVmax, SUVmean and TLG were significantly higher in pR1–pR2 than in pR0 patients. Delta SUV parameters and delta TLG were significantly lower in PR group both during and after CRT. Delta MTV was significantly lower in patients with PR in the early phase only. In receiver operating characteristic (ROC) curve analysis, baseline SUVmean, early delta TLG, and final delta SUVmax better discriminated PR, providing 83.3%, 67.6% and 85% positive predictive value (PPV) and 60.3%, 90% and 70.8% negative predictive value (NPV), respectively. For LN assessment, high NPV was observed at early and final 18F-FDG-PET/CT (93.5% and 92.3%, respectively).

Conclusion

In LACC patients treated with CRT followed by surgery, early variations in metabolic parameters effectively discriminate histopathological PR of the primary tumor, suggesting the potential role of 18F-FDG-PET/CT in early personalized treatment. The high NPV of early and final PET/CT could enable “tailored surgery” by avoiding lymphadenectomy in selected patients.

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Acknowledgments

The authors thank Antonella Stefanelli M.D., Margherita Lorusso M.D. and Arnaldo Abbate for their contribution in data collection.

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Authors and Affiliations

  1. Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Rome, Italy

    Vittoria Rufini, Maria Lucia Calcagni, Valentina Fuoco & Alessandro Giordano

  2. Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Vittoria Rufini, Angela Collarino, Maria Lucia Calcagni, Guido Maria Meduri & Alessandro Giordano

  3. Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy

    Tina Pasciuto, Antonia Carla Testa, Gabriella Ferrandina & Giovanni Scambia

  4. Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Tina Pasciuto, Gabriella Ferrandina & Giovanni Scambia

  5. Institute of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy

    Maria Antonietta Gambacorta & Riccardo Manfredi

  6. Radiation Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Maria Antonietta Gambacorta & Maura Campitelli

  7. Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Benedetta Gui & Riccardo Manfredi

  8. Institute of Pathology, Università Cattolica del Sacro Cuore, Rome, Italy

    Gianfranco Zannoni

  9. Gynecopathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Gianfranco Zannoni

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  1. Vittoria Rufini
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  2. Angela Collarino
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Correspondence to Vittoria Rufini.

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Rufini, V., Collarino, A., Calcagni, M.L. et al. The role of 18F-FDG-PET/CT in predicting the histopathological response in locally advanced cervical carcinoma treated by chemo-radiotherapy followed by radical surgery: a prospective study. Eur J Nucl Med Mol Imaging 47, 1228–1238 (2020). https://doi.org/10.1007/s00259-019-04436-y

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