ABSTRACT
For the past 50-60 years little changed in the initial evaluation of cervical cancer – until recently. Staging of cervical cancer has relied on clinical methods with a limited radiologic assessment based on the classification system of the International Federation of Gynecology and Obstetrics (FIGO). Multiple imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and lymphangiography, have been evaluated with intent to improve the staging, treatment planning, and prognostic accuracy of the initial tumor assessment, all with disappointing results. Over the past decade, molecular imaging has been rapidly changing the evaluation and management of cervical cancer. In this chapter, we will review the use of the only molecular imaging test currently approved by the US Center for Medicare and Medicaid Services: positron emission tomography (PET) with the glucose analog 2-[18F]- fluoro-2-deoxy-D-glucose (FDG). Patient preparation with a focus on unique features of imaging cervical cancer by PET will be discussed. In the past few years, PET combined with CT (image fusion) appears to also be a further step forward, and currently represents the molecular/anatomic imaging modality of choice. A clinician-focused review of
PET and PET/CT for staging, lymph node assessment, treatment planning, prognostication, response assessment, and disease surveillance will be presented. Other novel molecular imaging modalities (64Cu-ATSM-PET, [18F]fluoromisonidazole, [11C]choline, and nanoparticle-enhanced MRI) are under development to evaluate other important tumor biologic properties that may impact survival, and these will be briefly reviewed.
