Impact of positron emission tomography/computed tomography surveillance at 12 and 24 months for detecting head and neck cancer recurrence

BACKGROUND:

In head and neck cancer (HNC), 3‐month post‐treatment positron emission tomography (PET)/computed tomography (CT) reliably identifies persistent/recurrent disease. However, further PET/CT surveillance has unclear benefit. The impact of post‐treatment PET/CT surveillance on outcomes is assessed at 12 and 24 months.

METHODS:

A 10‐year retrospective analysis of HNC patients was carried out with long‐term serial imaging. Imaging at 3 months included either PET/CT or magnetic resonance imaging, with all subsequent imaging comprised of PET/CT. PET/CT scans at 12 and 24 months were evaluated only if preceding interval scans were negative. Of 1114 identified patients, 284 had 3‐month scans, 175 had 3‐ and 12‐month scans, and 77 had 3‐, 12‐, and 24‐month scans.

RESULTS:

PET/CT detection rates in clinically occult patients were 9% (15 of 175) at 12 months, and 4% (3 of 77) at 24 months. No difference in outcomes was identified between PET/CT‐detected and clinically detected recurrences, with similar 3‐year disease‐free survival (41% vs 46%, P = .91) and 3‐year overall survival (60% vs 54%, P = .70) rates. Compared with 3‐month PET/CT, 12‐month PET/CT demonstrated fewer equivocal reads (26% vs 10%, P < .001). Of scans deemed equivocal, 6% (5 of 89) were ultimately found to be positive.

CONCLUSIONS:

HNC patients with negative 3‐month imaging appear to derive limited benefit from subsequent PET/CT surveillance. No survival differences were observed between PET/CT‐detected and clinically detected recurrences, although larger prospective studies are needed for further investigation. Cancer 2013. © 2012 American Cancer Society.     

Characteristics of advantages of positron emission tomography over computed tomography for N-staging in lung cancer patients

OBJECTIVE: We analyzed the characteristics of advantages of positron emission tomography (PET) over computed tomography (CT) for N-staging in lung cancer patients. METHODS: Preoperative PET and CT scans were performed for 2057 lymph node stations in 205 patients with peripheral-type lung cancer. The advantages of PET over CT for N-staging were analyzed among lymph node locations and histological subtypes. RESULTS: The pathological N-stages were N0 in 143 patients, N1 in 31, N2 in 24 and N3 in 7. PET was able to diagnose N0, N2 and N3 diseases more accurately than CT (P=0.03, 0.01 and 0.02, respectively), but there was no significant difference between the two modalities for N1 disease. In the upper mediastinal lymph node stations, both false-negative and false-positive were significantly less frequent with PET than with CT (P=0.001). In the lower mediastinal and supra clavicle lymph nodes, PET showed a lower frequency of false-negative than CT (P=0.04 and 0.003, respectively), but there was no significant difference in the frequency of false-positive between the two modalities. Among histological types, PET could stage adenocarcinoma with less frequent false-negative and squamous cell carcinoma with less frequent false-positive than CT (P=0.02 and 0.005, respectively). CONCLUSION: For N-staging, PET was superior to CT for the following: (1) more accurate for N0, N2 and N3 diseases but not for N1; (2) lower frequency of false-positive in the upper mediastinal nodes; and (3) lower frequencies of false-negative in adenocarcinoma and false-positive in squamous cell carcinoma. Recognizing these advantages of PET could make the N-staging of lung cancer more accurate.     

Influence of 18F‐fluorodeoxyglucose‐positron emission tomography on computed tomography‐based radiation treatment planning for oesophageal cancer

The addition of positron emission tomography (PET) information to CT‐based radiotherapy treatment planning has the potential to improve target volume definition through more accurate localization of the primary tumour and involved regional lymph nodes. This case report describes the first patient enrolled to a prospective study evaluating the effects of coregistered positron emission tomography/CT images on radiotherapy treatment planning for oesophageal cancer. The results show that if combined positron emission tomography/CT is used for radiotherapy treatment planning, there may be alterations to the delineation of tumour volumes when compared to CT alone. For this patient, a geographic miss of tumour would have occurred if CT data alone were used for radiotherapy planning.     

Positron emission tomography/computed tomography in the management of Hodgkin and B-cell non-Hodgkin lymphoma: An update

¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is now an integral part of lymphoma staging and management. Because of its greater accuracy compared with CT alone, PET/CT is currently routinely performed for staging and for response assessment at the end of treatment in the vast majority of FDG-avid lymphomas and is the cornerstone of response classification for these lymphomas according to the Lugano classification. Interim PET/CT, typically performed after 2 to 4 of 6 to 8 chemotherapy/chemoimmunotherapy cycles with or without radiation, is commonly performed for prognostication and potential treatment escalation or de-escalation early in the course of therapy, a concept known as response-adapted or risk-adapted treatment. Quantitative PET is an area of growing interest. Metrics, such as the standardized uptake value, changes (Δ) in the standardized uptake value, metabolic tumor volume, and total lesion glycolysis, are being investigated as more reproducible and potentially more accurate predictors of response and prognosis. Despite the progress made in standardizing the use of PET/CT in lymphoma, challenges remain, particularly with respect to its limited positive predictive value, emphasizing the need for more specific molecular probes. This review highlights the most relevant applications of PET/CT in Hodgkin and B-cell non-Hodgkin lymphoma, its strengths and limitations, as well as recent efforts at implementing PET/CT-based metrics as promising tools for precision medicine.     

Fluorodeoxyglucose positron emission tomography in the evaluation of germ cell tumours at relapse

Differentiation of active disease from fibrosis/mature teratoma in patients with residual masses or identifying of sites of recurrence in patients with raised markers following treatment of their testicular cancer remains a problem.(18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) has the potential to identify active disease and thereby influence further management in these patients. We performed a retrospective study of the use of FDG-PET in detecting residual/recurrent testicular carcinoma in 55 patients (seventy FDG-PET scans). Forty-seven scans were for the assessment of residual masses (18 had raised markers) and 23 scans were for the investigation of raised markers in the presence of normal CT scans. True positive results were based on positive histology or clinical follow-up. FDG-PET had a positive predictive value (PPV) of 96% and a negative predictive value (NPV) of 90% in patients with residual masses. This PPV was equivalent to that of markers (94%) but FDG-PET had the advantage of identifying the site of that recurrence. The NPV was higher than that of markers. In patients with raised markers alone the PPV of FDG-PET was 92% but the NPV was only 50%. However, subsequent FDG-PET imaging was frequently the first imaging modality to identify the site of disease. FDG-PET effected a management change in 57% of cases. FDG-PET scanning detected viable tumour in residual masses and identified sites of disease in suspected recurrence.     

Laparoscopic extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer: a prospective correlation of surgical findings with positron emission tomography/computed tomography findings

BACKGROUND:

Failure to detect metastasis to para‐aortic nodes in patients with locally advanced cervical cancer leads to suboptimal treatment. No previous studies have prospectively compared positron emission tomography (PET)/computed tomography (CT) with laparoscopic extraperitoneal staging in the evaluation of para‐aortic lymph nodes.

METHODS:

Sixty‐five patients were enrolled; 60 were available for analysis. Patients with stage IB2‐IVA cervical cancer without evidence of para‐aortic lymphadenopathy on preoperative CT or magnetic resonance imaging (MRI) were prospectively enrolled. All patients underwent preoperative PET/CT. Laparoscopic extraperitoneal lymphadenectomy was performed from the common iliac vessels to the left renal vein.

RESULTS:

The median age at diagnosis was 48 years (range, 23‐84). The median operative time was 140 minutes (range, 89‐252). The median blood loss was 22.5 mL (range, 5‐150). The median length of hospital stay was 1 day (range, 0‐4). The median number of lymph nodes retrieved was 11 (range, 1‐39). Fourteen (23%) patients had histopathologically positive para‐aortic nodes. Of the 26 patients with negative pelvic and para‐aortic nodes on PET/CT, 3 (12%) had histopathologically positive para‐aortic nodes. Of the 27 patients with positive pelvic but negative para‐aortic nodes on PET/CT, 6 (22%) had histopathologically positive para‐aortic nodes. The sensitivity and specificity of PET/CT in detecting positive para‐aortic nodes when nodes were negative on CT or MRI were 36% and 96%, respectively. Eleven (18.3%) patients had a treatment modification based on surgical findings.

CONCLUSIONS:

Laparoscopic extraperitoneal para‐aortic lymphadenectomy is safe and feasible. Surgical staging of patients with locally advanced cervical cancer should be considered before planned radiation and chemotherapy. Cancer 2011. © 2010 American Cancer Society.     

Distant metastasis of prostate cancer: early detection of recurrent tumor with dual-phase carbon-11 choline positron emission tomography/computed tomography in two cases

Several types of recurrence may be detected by radiologic assessment after treatment in patients with prostate cancer. However, early detection of distant metastasis using positron emission tomography has so far never been published. We report two patients who underwent hormone therapy or surgical resection for prostate cancer. They developed distant metastases which were detected on whole body [C-11] choline positron emission tomography/computed tomography with significant elevation of serum PSA level. In one patient, recurrent tumor of the supraclavicular node (6 mm) diminished in size after subsequent hormone therapy. Surgical resection of recurrent tumor of the lung (12 mm) was performed in the other patient, the pathology of which confirmed the metastatic adenocarcinoma derived from the prostate. The recurrent tumor can be correctly detected by dual-phase whole body [C-11] choline positron emission tomography/computed tomography.     

Imaging tumour hypoxia with positron emission tomography

Hypoxia, a hallmark of most solid tumours, is a negative prognostic factor due to its association with an aggressive tumour phenotype and therapeutic resistance. Given its prominent role in oncology, accurate detection of hypoxia is important, as it impacts on prognosis and could influence treatment planning. A variety of approaches have been explored over the years for detecting and monitoring changes in hypoxia in tumours, including biological markers and noninvasive imaging techniques. Positron emission tomography (PET) is the preferred method for imaging tumour hypoxia due to its high specificity and sensitivity to probe physiological processes in vivo, as well as the ability to provide information about intracellular oxygenation levels. This review provides an overview of imaging hypoxia with PET, with an emphasis on the advantages and limitations of the currently available hypoxia radiotracers.     

Standardized uptake value by positron emission tomography/computed tomography as a prognostic variable in metastatic breast cancer

BACKGROUND:

In this retrospective, single‐institution study, the authors examine the maximum standardized uptake value (SUVmax) on positron emission tomography/computed tomography (PET/CT) images as a prognostic variable in patients with newly diagnosed metastatic breast cancer (MBC).

METHODS:

Patients with ≥1 metastatic lesion on PET/CT images that were obtained within 60 days of their MBC diagnosis between January 1, 2001 and December 31, 2008 were included. Patients were excluded if they had received chemotherapy ≤30 days before the PET/CT images were obtained. Electronic medical reports were reviewed to determine the SUVmax and overall survival. Because of intraindividual variation in the SUV by body site, separate analyses were conducted by metastatic site. Relationships between site‐specific PET/CT variable tertiles and overall survival were assessed using Cox regression; hazard ratios for the highest tertile versus the lowest tertile were reported.

RESULTS:

In total, 253 patients were identified, and their median age was 57 years (range, 27‐90 years). Of these, 152 patients (60%) died, and the median follow‐up was 40 months. On univariate analysis, SUVmax tertile was strongly associated with overall survival in patients who had bone metastases (N = 141; hazard ratio, 3.13; 95% confidence interval, 1.79‐5.48; P < .001). This effect was maintained on multivariate analysis (HR = 3.19; 95% confidence interval, 1.64‐6.20, P = .002) after correcting for known prognostic variables. A greater risk of death was associated with SUVmax tertile in patients who had metastases to the liver (N = 46; hazard ratio, 2.07; 95% confidence interval, 0.90‐4.76), lymph nodes (N = 149; hazard ratio, 1.1; 95% confidence interval, 0.69‐1.88), and lung (N = 62; hazard ratio, 2.2; 95% confidence interval, 0.97‐4.95), although these results were not significant (P = .18, P = .31, and P = .095, respectively).

CONCLUSIONS:

The current results indicate that PET/CT has value as a prognostic tool in patients with newly diagnosed MBC to bone. Cancer 2012. © 2012 American Cancer Society.     

Value of integrated positron emission tomography revised using a phantom study to evaluate malignancy grade of lung adenocarcinoma

BACKGROUND:

The malignant biological behavior of small‐sized lung adenocarcinomas remains obscure, although understanding this feature is important for selecting appropriate treatment. In the current study, the authors evaluated malignancy grades of small adenocarcinomas using fluorodeoxyglucose‐positron emission tomography/computed tomography (PET/CT) in addition to high‐resolution CT (HRCT) and pathological analysis in a multicenter setting.

METHODS:

A total of 201 patients with clinical T1N0M0 adenocarcinoma underwent PET/CT and HRCT followed by complete surgical resection. Associations between components of bronchioloalveolar carcinoma (BAC) in specimens and maximum standardized uptake values (maxSUV) on PET/CT and ground‐glass opacity (GGO) ratios and tumor disappearance rate (TDR) on HRCT were analyzed, as well as associations between these findings and pathological features of the tumors. Variations in maxSUV among institutions and the underestimations derived from small tumors, which are limitations of PET performed in multicenter studies, were adjusted using a phantom study.

RESULTS:

The maxSUV, BAC ratio, TDR, and GGO ratio (in that order) reflected the grade of tumor invasiveness and lymph node metastasis. The maxSUV and BAC ratio were found to be significant prognostic predictors derived from disease‐free survival curves. Although the BAC ratio was found to be significantly associated with preoperative radiographic parameters, the maxSUV, GGO ratio, and TDR (all P < .0001), the degree of correlation with maxSUV (correlation coefficient [R²] = 0.1699) was much weaker than that reported with the GGO ratio (R² = 0.5860) or TDR (R² = 0.5082).

CONCLUSIONS:

Phantom studies can overcome the difficulties of multicenter studies using PET. A higher maxSUV appears to reflect aggressive malignant behavior in clinical T1N0M0 adenocarcinomas, independent of BAC components. Preoperative PET/CT assessment in addition to HRCT could be used to construct hypotheses for a future clinical study of strategies for the treatment of patients with small lung adenocarcinoma. Cancer 2010. © 2010 American Cancer Society.     

Unsuspected bone and soft tissue lesions identified at cancer screening using positron emission tomography

BACKGROUND: [F-18]-fluorodeoxy-D-glucose (18FDG) positron emission tomography (PET) is a sensitive modality for detecting malignant lesions. The purpose of the present study was to describe unknown bone and soft tissue lesions in adults identified at cancer screening using PET. METHODS: A total of 4283 individuals of more than or equal to 40 years of age were enrolled. All individuals underwent scans from the base of the skull to proximal thigh. The images were reviewed and a consensus was reached by two board-certified radiologists and a nuclear medicine specialist for the diagnoses. Diagnoses of the lesions were confirmed by histological examination, typical radiologic findings, obvious progression in number and/or size of the lesion on follow-up examinations, and medical examination of interview. RESULTS: Unsuspected focal abnormality in the bone and soft tissue were found in 62 individuals (1.4%). The mean size of the lesion was 26 mm (range, 6-155 mm). There were 29 bone lesions (47%) and 33 soft tissue lesions (53%). A malignant lesion was found in one case (1.6%) and histologic diagnosis was primary non-Hodgkin lymphoma of the vertebra. Other major diagnoses were healing bone (n = 11, 18%) and benign cystic lesions of bone and soft tissue (n = 9, 15%), and brown fat of soft tissue (n = 4, 6%). CONCLUSION: Unsuspected bone and soft tissue lesions of a wide variation of pathologic and clinical diagnoses were encountered at cancer screening using PET. Correlation with clinical history and other imaging findings is essential in the differential diagnosis.     

The diagnostic and prognostic utility of positron emission tomography/computed tomography‐based follow‐up after radiotherapy for head and neck cancer

BACKGROUND:

The detection of subclinical head and neck cancer recurrence or a second primary tumor may improve survival. In the current study, the authors investigated the clinical value of a follow‐up program incorporating serial ¹⁸F?fluorodeoxyglucose?positron emission tomography integrated with computed tomography (PET/CT) in the detection of recurrent disease in patients with head and neck cancer.

METHODS:

A total of 240 PET/CT scans were reviewed in 80 patients with head and neck cancer who were treated with radiotherapy (RT) from July, 2005 through August, 2007. All patients were followed with clinical examination, PET/CT, and correlative imaging for a minimum of 11 months (median follow?up, 21 months).

RESULTS:

The sensitivity, specificity, and positive and negative predictive values of PET/CT‐based follow‐up for detecting locoregional recurrence were 92%, 82%, 42%, and 98%, respectively. Corresponding values for distant metastases or second primary tumors were 93%, 96%, 81%, and 98%, respectively. Eight patients (10%) developed disease recurrences or second primary tumors that were amenable to salvage surgery with negative surgical margins. The 2‐year progression‐free survival and 2‐year overall survival rates were significantly different between patients who had a negative and those with a positive PET/CT result within 6 months of the completion of RT (93% vs 30% [P<.001] and 100% vs 32% [P<.001], respectively).

CONCLUSIONS:

Although post‐therapy follow‐up using PET/CT is reportedly associated with a high false‐positive rate in the irradiated head and neck, PET/CT appears to be a highly sensitive technique for the detection of recurrent disease. Furthermore, negative PET/CT results within 6 months of the completion of RT offer significant prognostic value. Cancer 2009. © 2009 American Cancer Society.     

Computed tomography and 18F-FDG positron emission tomography for therapy control of Hodgkin's and non-Hodgkin's lymphoma patients: when do we really need FDG-PET?

BACKGROUND: The aim of this study was to evaluate the accuracy of computed tomography (CT) and [(18)F]fluoro-deoxy-d-glucose positron emission tomography (FDG-PET) for prediction of progression-free survival of Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) patients after completion of therapy. PATIENTS AND METHODS: CT and FDG-PET were performed in 40 HD, 17 indolent NHL and 44 aggressive NHL patients (29 women, 72 men; aged 41+/-14 years) in a median of 2 months after therapy. Progression-free survival was evaluated using the Kaplan-Meier method. Independent prognostic factors were identified by means of Cox proportional hazards model. RESULTS: CT imaging results were progressive disease (PD) in five, stable disease (SD) in 57, and partial response (PR) or complete remission (CR) in 39 patients. FDG-PET suggested residual lymphoma in 24 patients. Three-year progression-free survival rates after exclusion of five PD patients were: 100% (PET negative; CT: PR or CR), 81% (PET negative; CT: SD), 21% (PET positive; CT: SD) and 0% (PET positive; CT: PR). FDG-PET (P<0.0001) and bulky disease (P <0.05) were identified as independent prognostic variables. CONCLUSIONS: Among lymphoma patients with PR and SD on CT, FDG-PET discriminated those destined to progress into a low risk of < or =20% and a high risk for recurrence of > or =80%.     

Detection of occult bone metastases of lung cancer with Fluorine‐18 fluorodeoxyglucose positron emission tomography

Accurate staging of cancer has a critical role in optimal patient management. Fluorine‐18 fluorodeoxyglucose positron emission tomography (FDG PET) is superior to CT in the detection of local and distant metastases in patients with non‐small cell lung cancer. Although Tc‐99 m methylene diphosphonate (MDP) bone scanning is well established in the evaluation of bone metastases, there are conflicting reports on the use of FDG PET in the evaluation of skeletal metastases. We report on a patient with locally advanced lung carcinoma in whom FDG PET accurately identified previously unsuspected widespread asymptomatic bone metastases (bone scan and X‐rays negative, confirmed on MRI). Assessment of glucose metabolism with FDG PET might represent a more powerful tool to detect bone metastases in lung cancer compared with conventional bone scans.     

Prognostic significance of metabolic tumor burden by positron emission tomography/computed tomography in patients with relapsed/refractory diffuse large B‐cell lymphoma

The aim of the present study was to investigate the feasibility of measuring metabolic tumor burden using [F‐18] fluorodeoxyglucose (¹⁸F‐FDG) positron emission tomography/computed tomography (PET/CT) in patients with relapsed or refractory diffuse large B‐cell lymphoma (DLBCL) treated with bendamustine–rituximab. Because the standardized uptake value is a critical parameter of tumor characterization, we carried out a phantom study of ¹⁸F‐FDG PET/CT to ensure quality control for 28 machines in the 24 institutions (Japan, 17 institutions; Korea, 7 institutions) participating in our clinical study. Fifty‐five patients with relapsed or refractory DLBCL were enrolled. The ¹⁸F‐FDG PET/CT was acquired before treatment, after two cycles, and after the last treatment cycle. Treatment response was assessed after two cycles and after the last cycle using the Lugano classification. Using this classification, remission was complete in 15 patients (27%) and incomplete in 40 patients (73%) after two cycles of therapy, and remission was complete in 32 patients (58%) and incomplete in 23 patients (42%) after the last treatment cycle. The percentage change in all PET/CT parameters except for the area under the curve of the cumulative standardized uptake value–volume histogram was significantly greater in complete response patients than in non‐complete response patients after two cycles and the last cycle. The Cox proportional hazard model and best subset selection method revealed that the percentage change of the sum of total lesion glycolysis after the last cycle (relative risk, 5.24; P = 0.003) was an independent predictor of progression‐free survival. The percent change of sum of total lesion glycolysis, calculated from PET/CT, can be used to quantify the response to treatment and can predict progression‐free survival after the last treatment cycle in patients with relapsed or refractory DLBCL treated with bendamustine–rituximab.     

Post-treatment (not interim) positron emission tomography-computed tomography scan status is highly predictive of outcome in mantle cell lymphoma patients treated with R-HyperCVAD

BACKGROUND:

Although convincing data exist regarding the prognostic utility of positron emission tomographic (PET)‐computed tomographic (CT) imaging in Hodgkin lymphoma and diffuse large B‐cell lymphoma, its prognostic utility both during treatment and immediately after treatment have not been systematically evaluated in a large mantle cell lymphoma (MCL) patient cohort to support its use in clinical practice.

METHODS:

The authors conducted a retrospective cohort study to examine the prognostic utility of PET‐CT imaging in a uniform MCL patient cohort undergoing dose‐intensive chemotherapy (R‐HyCVAD) in the frontline setting. The primary study endpoints were progression‐free survival (PFS) and overall survival (OS). PET‐CT images were centrally reviewed for the purposes of this study using standardized response criteria.

RESULTS:

Fifty‐three patients with advanced stage MCL with PET‐CT data were identified. With median follow‐up of 32 months, 3‐year PFS and OS estimates were 76% (95% confidence interval [CI], 64%‐84%) and 84% (95% CI, 72%‐90%), respectively. Interim PET‐CT status was not associated with PFS (hazard ratio [HR], 0.9; 95% CI, 0.3‐2.7; P = .8) or OS (HR, 0.6; 95% CI, 0.1‐2.9; P = .5). Post‐treatment PET‐CT status was statistically significantly associated with PFS (HR, 5.2; 95% CI, 2.0‐13.6; P = .001) and trended toward significant for OS (HR, 2.8; 95% CI, 0.8‐9.6; P = .07).

CONCLUSIONS:

These data do not support the prognostic utility of PET‐CT in pretreatment and interim treatment settings. A positive PET‐CT after the completion of therapy identifies a patient subset with an inferior PFS and a trend toward inferior OS. Cancer 2012;3565–3570. © 2011 American Cancer Society.     

Current status of positron emission tomography in oncology

Positron emission tomography (PET) has emerged as a powerful diagnostic tool in oncology patients. There is evidence of the superior utility over conventional imaging methods of the principal PET tracer ¹⁸F‐fluoro‐2‐deoxy‐glucose in the staging of a range of cancers and monitoring disease recurrence, as well as changing patient management to more appropriate therapy. The methods for evaluating the evidence for PET remain complex, particularly as the standard evidence‐based approach of randomized controlled trials is not generally applicable to imaging technologies. PET has the potential to dramatically improve our ability to manage patients with cancer and is also making major contributions to the development of new therapies. (Intern Med J 2000; 31 : 27–36)     

A study on the clinical value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography combined with serum squamous cell carcinoma antigen in diagnosing recurrence/metastases in patients with early metaphase cervical cancer

Cervical cancer (CC) is the most common female genital tract malignancy, with repercussions on the psychophysiological health of female patients. Patients with CC are faced with a high risk of postoperative recurrence and metastases. The present study aimed to evaluate the clinical value of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) combined with serum squamous cell carcinoma antigen (SCC-Ag) in the diagnosis of postoperative recurrence/metastases in patients with early stage CC. This was a prospective follow-up study on 246 patients who received surgery for early stage CC. The results of clinical follow-up and pathological examination were taken as the gold standard. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and area under the receiver operating characteristic (ROC) curve were calculated for PET/CT, serum SCC-Ag determination and the combined PET/CT and serum SCC-Ag method. Results demonstrated that 90.11% patients completed the follow-up, and the median follow-up time was 22 months (range, 7–42 months). Tumor recurrence or metastasis was confirmed in a total of 137 patients (55.7%), including 18 deaths. The diagnostic sensitivity of PET/CT scan combined with serum SCC-Ag determination for postoperative metastases/recurrence in patients with early stage CC was 93.43% (95% CI, 0.875–0.967). The specificity was 92.67% (95% CI, 0.856–0.965), the positive predictive value was 94.12% (95% CI, 0.884–0.972), the negative predictive value was 91.81% (95% CI, 0.846–0.959) and the area under the ROC curve was 0.930±0.019 (95% CI, 0.893–0.968; P<0.001). The results also revealed that the serum SCC-Ag level was positively correlated with SUVmax (r=0.458; P<0.001). The results from the present study demonstrated that for patients with early metaphase CC, PET/CT scan combined with serum SCC-Ag determination during the follow-up was capable of earlier, more comprehensive and more accurate detection of recurrence/metastatic lesions, which is of high clinical application value.