Contribution of whole-body 18FDG PET imaging in the management of cervical cancer

OBJECTIVE: The objective of this study was to assess the contribution of [(18)F]fluoro-2-deoxy-D-glucose positron emission tomography ((18)FDG PET) imaging in the management of cervical cancer. METHODS: Fully corrected whole-body PET was performed in 60 patients (pts) with proven cervical cancer. In pretreatment staging, 22 pts underwent PET in addition to routine protocol including International Federation of Obstetrics and Gynecology (FIGO) staging and pelvic magnetic resonance imaging (MRI). Eighteen of them had pelvic lymphadenectomy. After treatment, PET was performed in 38 pts routinely followed up by clinical and radiological examinations. Results of PET and routine protocols were compared to final diagnoses, including histological findings in 31 pts and clinical outcomes in the other cases. Median follow-up time was 12 +/- 7.3 months. RESULTS: In all but 2 patients (FIGO stage IA), both PET and MRI detected the primary tumor. In 6 pts, MRI alone noted loco-regional tumor spread but PET localized 9 unsuspected extrapelvic nodal sites (6 para-aortic, 2 mediastinal, and 1 supra-clavicular). However, PET missed 8 microscopic pelvic nodal metastases. In 18% of the patients, PET staging significantly influenced the treatment choices. In follow-up, PET accurately diagnosed a recurrent disease in 13 pts with falsely negative or equivocal conventional imaging (CI). Ten patients with a negative PET were still in complete remission after a minimal follow-up time of 12 months. Overall, the agreement of PET with final diagnosis was significantly better than that of routine protocol (P < 0.05). CONCLUSIONS: Whole-body (18)FDG PET appears useful in the management of cervical cancer, in particular for staging extrapelvic metastases or optimally detecting a recurrence. MRI is better indicated for evaluating the loco-regional status of the disease.     

PET在监测宫颈癌复发中的应用

目的:评价全身2-18氟-2-去氧-D-葡萄糖(FDG)正电子发射断层显像(PET)在监测宫颈癌复发中的作用。方法:回顾分析北京协和医院2000年6月至2006年1月为评估宫颈癌是否复发行全身FDGPET检查的25例患者的临床资料,并将PET结果与手术病理和计算机断层扫描(CT)等进行比较。结果:25例患者共进行38次全身FDGPET检查。真阳性9例,真阴性27例,假阳性2例,无假阴性病例。本研究PET检测宫颈癌复发的敏感性和特异性分别为100%和93.1%。阳性和阴性预测值分别为81.8%和100%。结论:全身FDGPET是评估宫颈癌复发的一种敏感和特异的检测手段,是否可取代其他的影像学方法而成为检测宫颈癌复发的常规检测手段尚需大样本的前瞻性研究。     

The role of PET scanning in the detection of recurrent cervical cancer

OBJECTIVES: [(18)F] Fluoro-2-deoxyglucose positron emission tomography (FDG PET) has recently been established as a sensitive and specific method of detecting lymph node metastases in newly diagnosed cervical cancer. Little is known about the efficacy of PET for detecting recurrent disease. We evaluated the potential role of FDG PET in the context of suspected recurrent cervical cancer.METHODS: The records of patients undergoing PET scan to evaluate for cervical cancer recurrence between July 1998 and February 2002 were reviewed. Radiographic findings were classified as negative, suspicious, or equivocal. PET scan findings were compared to available clinical data to classify each PET result as a true positive, true negative, false positive, or false negative. Clinical proof of recurrence consisted of a tissue biopsy revealing recurrent cancer within 3 months of the PET scan. Clinical proof of no evidence of disease consisted of a negative tissue biopsy within 3 months or no clinical evidence of recurrence within 6 months after the PET scan. RESULTS: Twenty-eight patients underwent 37 PET scans. Twenty-nine cases among 22 patients were clinically evaluable for recurrence status. Median age was 42, and stage distribution was IB 1 (n = 3), IB2 (n = 4), IIA (n = 1), IIB (n = 10), IIIB (n = 9), IVB (n = 1). Histologic types included squamous (n = 23) adenocarcinoma (n = 4) and unknown (n = 1). There were 12 true positive PET scans, 13 true negatives, 2 false positives, and 2 false negatives. The sensitivity and specificity of FDG PET for detecting recurrent cervical cancer were 85.7 and 86.7%, respectively. The positive and negative predictive values were 85.7 and 86.7%, respectively. CONCLUSIONS: Whole-body FDG PET is a sensitive and specific tool for the detection of recurrent cervical cancer in patients who have clinical findings suspicious for recurrence. A larger prospective trial will determine whether this modality should be used routinely in conjunction with, or in lieu of, other imaging studies to detect recurrent disease in a broader population of cervical cancer patients.     

Characterization of surgically transposed ovaries in integrated PET/CT scan in patients with cervical cancer

BACKGROUND: The purpose of this study was to determine the ovarian findings on integrated positron emission tomography/computed tomography scans during follow-up in cervical cancer patients with ovarian transposition. METHOD: We retrospectively reviewed the clinical data and integrated 18F-fluorodeoxyglucose positron emission tomography/computed tomography of women with ovarian transposition during radical hysterectomy for cervical cancer between December 2003 and March 2006. RESULTS: Eighty-four premenopausal women had ovarian transposition performed during the study period. Twelve positron emission tomography/computed tomography scans from 11 patients were registered for the current study and three women were diagnosed with metastasis: two in lung and one in pelvis. Two patients complained of menopausal symptoms during follow-up, and the hormonal tests were consistent with it. In the current study, an integrated positron emission tomography/computed tomography scan detected one patient with right lower abdominal mass with increased 18F-fluorodeoxyglucose uptake, which was identified as a transposed right ovary. Clinical information of ovarian transposition was helpful in interpretation of the lesion. In the patient, transposed ovary was associated with increased fluorodeoxyglucose uptake, with standard uptake values ranging from 3.7 to 5.5. Other positron emission tomography/computed tomography scans did not show abnormal uptake of 18F-fluorodeoxyglucose. CONCLUSIONS: Transposed ovary in premenopausal women may appear on integrated positron emission tomography/computed tomography scan as a mass with increased 18F-fluorodeoxyglucose uptake, which may be associated with preserved ovarian function. Clinical information regarding transposition should be noted in order not to interpret these as recurrent or metastatic lesions.     

Diagnosis of recurrent uterine cervical cancer: PET versus PET/CT: a systematic review and meta-analysis

Objective

The aim of this work was to assess and compare the overall value of stand-alone FDG PET and PET/CT in diagnosing recurrent cervical cancer with a meta-analysis.

Methods

All the English published studies which addressed the use of PET whether interpreted with or without the use of CT for the diagnosis of recurrent cervical cancer were collected. Methodological quality of the included studies was evaluated. Pooled sensitivity and specificity were calculated, summary receiver operating characteristics (SROC) curve analysis was used to compare the diagnostic ability of stand-alone PET and PET/CT.

Result

A total of 18 studies were included in this meta-analysis, with a total of 762 subjects. Pooled sensitivity and specificity of PET and PET/CT were 0.91 (95 % CI 0.87–0.94) and 0.94 (95 % CI 0.89–0.97), and 0.92 (95 % CI 0.91–0.94) and 0.84 (95 % CI 0.74–0.91), respectively. The areas under the SROC curve (AUCs) of PET and PET/CT were 0.9610 and 0.9491, respectively. There was no statistical significance between the AUC of PET and PET/CT (P > 0.05).

Conclusion

Both PET and PET/CT have good performance in the detection of recurrent cervical cancer. However, interpreted CT images may have limited additional value on PET in detecting recurrent cervical cancer.     

A syndrome characterized by recurrent symptomatic functional ovarian cysts in young women.

A syndrome characterized by the persistent recurrence of symptomatic functional ovarian cysts, elevated plasma estradiol levels, and infertility in four young patients is described. Two of the patients experienced recurring ovarian cysts following total abdominal hysterectomy and bilateral salpingo-oophorectomy. Pathologic findings confirmed the presence of ovarian tissue in all cysts. Recurrent cysts formation is attributed to either an increased production of gonadotropins or a hypersensitive response to normal gonadotropins. The development of recurrent cysts following bilateral oophorectomy indicates that some ovarian or "ovarian-like" tissue is present within the pelvic cavity, anatomically unrelated to the normally positioned ovaries. This extraovarian tissue may become sensitive to circulating gonadotropin levels in the absence of normal ovarian tissue. The source of this extraovarian tissue is discussed from an embryologic standpoint.     

Management of recurrent cervical cancer

Treatment for cervical cancer is very successful, especially in early stages. However, most patients presenting in late stages of disease will experience recurrence. The prognosis of recurrent disease is very poor and treatment options are limited. The diagnosis of recurrence may be apparent or difficult, but determining the extent of disease is always complex. Routine follow-up of asymptomatic patients has other objectives and is not a reliable way to detect recurrences. Symptomatic patients require extensive investigation to detect the extent of the disease. For patients with central pelvic recurrences, exenteration offers the prospect of survival in more than one-third of cases. Newer developments include laterally extended endopelvic resection that may become an option for patients with more extensive pelvic recurrence. For patients with recurrences of cervical cancer, the roles of second-time radiotherapy or postradiation chemotherapy are very limited. Palliative treatment is important for all patients with untreatable disease. Pain relief forms a central part of palliative care. Caregivers also experience emotional feelings and probably function best in a system offering strong colleageal support.     

复发性宫颈癌的治疗

宫颈癌是世界范围内最常见的女性生殖系统恶性肿瘤,严重威胁女性的生命。在发展中国家占女性癌症死亡率的第二位。宫颈癌治疗失败的主要原因是局部复发和远处转移。复发性宫颈癌患者预后差、5年生存率低。因此,复发性宫颈癌的治疗成为临床关注的重点。     

Vaginal colonization by Candida in asymptomatic women with and without a history of recurrent vulvovaginal candidiasis

OBJECTIVE: The asymptomatic carriage of Candida in the vagina of women with a history of recurrent vulvovaginal candidiasis was compared with that of women with no such history. METHODS: Vaginal swabs from 50 women with a history of recurrent vulvovaginal candidiasis and 45 women with one or fewer episodes of candidal vaginitis within the past 12 months were evaluated for Candida by wet mount/Gram stain, culture, and polymerase chain reaction (PCR). All women were asymptomatic for at least 30 days. RESULTS: Candida was identified in 28 women by PCR, in 14 women by culture, and in 13 women by wet mount/Gram stain. Candida was identified by PCR in a similar proportion of patients with previous recurrent vulvovaginal candidiasis (30%) and in controls (28.8%). However, Candida was identified by culture in more women with previous recurrent vulvovaginal candidiasis (22%) than in controls (6.6%, P = .04); it also was identified by wet mount/Gram stain in more women with recurrent vulvovaginal candidiasis (22%) than in controls (4.4%, P = .01). For the recurrent vulvovaginal candidiasis patients, culture and wet mount/Gram stain had a sensitivity of 66.6% compared with PCR. For the controls, the sensitivity of the two former assays relative to PCR was only 15.3%. CONCLUSION: Women with a history of recurrent vulvovaginal candidiasis have more easily detectable Candida in their vagina, even when asymptomatic, than do other women. A relative inefficiency in regulating the proliferation of Candida in the vagina may increase susceptibility to periodic symptomatic recurrences.     

The value of FDG PET/CT, ultrasound and CT in diagnosing recurrent ovarian carcinoma

The diagnosis of recurrent ovarian cancer can be complicated and variable sensitivities, specificities and accuracies have been reported for integrated positron emission tomography and computed tomography (PET/CT). The aim of the study was to evaluate the sensitivity, specificity and accuracy of PET/CT, ultrasound and CT in the diagnosing recurrent ovarian cancer. MATERIALS AND METHODS: 27 women in the follow-up after cytoreductive surgery and chemotherapy of ovarian cancer, underwent ultrasound, CT and PET/CT to assess for possible recurrence. RESULTS: Recurrence of ovarian cancer was detected in 22 patients (laparotomy or cytology of ascites or pleural effusion). 5 disease-free patients were followed-up for 8-14 months. FDG-PET, ultrasound and CT had sensitivities of 81,82%, 45,45%, 55.56%, specificities of 60%, 60%, 60% and accuracies 77,78%, 48,15%, 52,17% respectively. CONCLUSIONS: 1. FDG PET/CT is a useful technique to in diagnosing recurrent ovarian cancer. 2. PET/CT depicts/detects recurrent ovarian cancer with higher diagnostic accuracy comparing to the standard imaging and provides the chance to detect disease at an earlier stage during follow-up.     

Clonidine raises the sweating threshold in symptomatic but not in asymptomatic postmenopausal women

OBJECTIVE: To determine the effects of clonidine, which reduces central sympathetic activation, on the sweating threshold in postmenopausal women with and without hot flashes. DESIGN: Laboratory physiologic study. SETTING: University medical center. PATIENT(S): 12 healthy postmenopausal women reporting frequent hot flashes and 7 reporting none. INTERVENTION(S): In two separate sessions, participants received a blind intravenous injection of clonidine HCl (2 microg/kg of body weight) or placebo, followed by body heating. MAIN OUTCOME MEASURE(S): Core body temperature, mean skin temperature, sweat rate, sternal skin conductance level, and blood pressure. RESULT(S): Symptomatic women had significantly lower core body temperature sweating thresholds than asymptomatic women after receiving placebo. Clonidine significantly increased this threshold in symptomatic women but lowered it in asymptomatic women. CONCLUSION(S): These results support the hypothesis that elevated brain norepinephrine levels reduce the sweating threshold in symptomatic women, thereby contributing to the initiation of menopausal hot flashes.     

Chemotherapy in recurrent and advanced cervical cancer.

Twenty-five patients, ranging from 21 to 61 years of age (median = 45 years), with histologically proven recurrent and advanced cervical cancer were treated with chemotherapy using a combination of bleomycin, ifosfamide, and cis-platinum (BIP). Twenty-one patients were evaluable for response. Ninety percent of patients achieved a subjective response. An objective response was noted in 14 of 21 (66.6%) patients: complete in 4 (19%) and partial in 10 (47.6%). Side effects were mainly nausea/vomiting, alopecia, myelosuppression, reversible encephalopathy, and impaired renal function. One patient died from the toxic effects of chemotherapy. These results indicate that BIP is an active combination in recurrent cervical cancer with acceptable toxicity.     

复发性及转移性宫颈癌的化疗

在发达国家,由于宫颈筛查的应用,宫颈癌的发病率及死亡率已经大幅度下降.然而,约80%的宫颈癌发生在发展中国家,且相当一部分仍然是晚期病例.早期宫颈癌治疗后的5年生存率可高达91.7%,而中晚期宫颈癌约35%在治疗后会出现复发.复发性或转移性宫颈癌,5年生存率不超过20%[1].     

Invasive cervical cancer in young women

Between 1970 and 1979, 103 women below 35 years of age with invasive cervical cancer were treated at the First Obstetrics and Gynaecology Clinic of the University of Milan. Nine patients were pregnant or less than 3 months postpartum. Estimated 10-year disease-free survival, determined by the life-table method, was 100% in stage IA (37 patients), 79% in stage IB (45 patients), 67% in stage II (15 patients), 0% in stages III (5 patients) and IV (1 patient). Prognosis was also strongly associated with lymph-node involvement, 10-year actuarial survival decreasing from 93% in lymph-node-negative to 44% in lymph-node-positive patients (P less than 0.001). The prognostic relevance of the clinical stage decreased after adjustment for lymph-node involvement, but the statistical significance of lymph-node involvement was unaffected when stage was allowed for. In the present series, the estimated 10-year disease-free survival was 80% in patients treated by radical hysterectomy compared with 62% in the group treated by total hysterectomy (stage IB to IV patients only); this difference, however, was not statistically significant when the data were adjusted for clinical stage (P = 0.10). None of the 20 patients with recurrent disease could be managed successfully.     

Use of tamoxifen in asymptomatic patients with recurrent small-volume ovarian cancer

OBJECTIVES: Tamoxifen, a well-tolerated oral hormonal agent with biological activity in ovarian cancer, is a potentially attractive option in asymptomatic patients with recurrent disease. Unfortunately, the clinical utility of the drug in this specific setting has not been well documented. PATIENTS AND METHODS: A retrospective review was conducted of patients with cancers of the ovary, fallopian tube, and primary cancer of the peritoneum at the Cleveland Clinic who experienced recurrence of the malignancy, in the absence of large volume disease (by physical exam and radiographic evaluation) or any cancer-related symptoms, and who received tamoxifen (20 mg [most patients] or 40 mg/day) before re-initiation of cytotoxic chemotherapy. RESULTS: Fifty-six patients (45 after primary chemotherapy; 12 after second-line treatment) satisfied the criteria noted above. The median duration of treatment was 3 months (range 1-30 months), with 42% and 19% of patients remaining on tamoxifen for >/=6 and >/=12 months, respectively. Reasons for discontinuation were equally divided between three causes: (a) continued rise in CA-125 antigen level without symptoms or other objective signs of cancer; (b) evidence of progressive disease by physical exam or radiographic evaluation in the absence of symptoms; and (c) development of cancer-related symptoms. CONCLUSION: In the absence of data from a randomized controlled trial which defines optimal management of the asymptomatic ovarian cancer patient with documented recurrent disease, tamoxifen is a rational management option, although it remains unknown if the delay in subsequent administration of chemotherapy in some individuals for periods greater than 6-12 months results from a direct effect of this agent or simply reflects the natural history of disease in a subset of patients in this clinical setting.     

Invasive cervical cancer in young women

Summary. Between 1970 and 1979, 103 women below 35 years of age with invasive cervical cancer were treated at the First Obstetrics and Gynaecology Clinic of the University of Milan. Nine patients were pregnant or less than 3 months postpartum. Estimated 10–year disease–free survival, determined by the life–table method, was 100% in stage IA (37 patients), 79% in stage IB (45 patients), 67% in stage 11 (15 patients), 0% in stages III (5 patients) and IV (1 patient). Prognosis was also strongly associated with lymph–node involvement, 10–year actuarial survival decreasing from 93% in lymph–node–negative to 44% in lymph–node– positive patients ( P 相似文献