Clinical Value of Combining 18F-FDG PET/CT and Routine Serum Tumor Markers in The Early Detection of Recurrence Among Follow-up Patients Treated for Cervical Squamous Cell Carcinoma

Rajiv Rai Sookha; Wenhua Zhi; Yanxia Shen; Cordelle Lazare; Ling Wang; Yifan Meng; Canhui Cao; Junbo Hu; Peng Wu

doi:10.7150/jca.27206

Clinical Value of Combining ¹⁸F-FDG PET/CT and Routine Serum Tumor Markers in The Early Detection of Recurrence Among Follow-up Patients Treated for Cervical Squamous Cell Carcinoma

J Cancer. 2018 Aug 6;9(17):3101-3108. doi: 10.7150/jca.27206. eCollection 2018.

Authors

Rajiv Rai Sookha¹, Wenhua Zhi¹, Yanxia Shen², Cordelle Lazare¹, Ling Wang¹, Yifan Meng¹, Canhui Cao¹, Junbo Hu¹, Peng Wu¹

Affiliations

¹ The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
² Department of Nuclear medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China.

Abstract

Objective: The purpose of this retrospective study was to investigate the role of 18F-Fluorodeoxyglucose Positron Emission Tomography (¹⁸F-FDG PET/CT) and evaluate if combined elevated serum tumor markers levels improve the accuracy of ¹⁸F-FDG PET/CT in detecting recurrence of cervical squamous cell carcinoma. Methods: A total number of 42 patients who were treated for cervical squamous cell carcinoma and had underwent ¹⁸F-FDG PET/CT for suspected recurrence of cervical cancer were retrospectively reviewed in this study and their clinical, pathological and serological data were collected and analyzed. The clinical value of combining ¹⁸F-FDG PET/CT with serum tumor markers was investigated. Results: Among the 42 patients, ¹⁸F-FDG PET/CT was true positive in 25 (59.5%), false positive in 5 (11.9%), true negative in 12 (28.5%) and false negative in none. The overall patient-based sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ¹⁸F-FDG PET/CT in detecting recurrent cervical cancer were 100%, 70.6, 88.1%, 83.3%, and 100%, respectively. The accuracy of ¹⁸F-FDG PET/CT with combined squamous cell carcinoma antigen (SCC Ag) and carcinoembryonic antigen (CEA) elevation was 100% compared to only SCC Ag elevation and only CEA elevation, 90% and 33.3%, respectively. The positive predictive value of a positive ¹⁸F-FDG PET/CT with combined SCC Ag and CEA elevation was 100% for detection of recurrent cervical cancer. Also, the negative predictive value of a negative ¹⁸F-FDG PET/CT combined with normal SCC Ag and CEA levels was 100%. Conclusion:¹⁸F-FDG PET/CT is highly sensitive in the diagnosis of recurrent cervical cancer. When ¹⁸F-FDG PET/CT is associated with both SCC Ag and CEA elevation or only SCC Ag elevation, the accuracy is increased but not when associated with only CEA elevation. Positive ¹⁸F-FDG PET/CT associated with both tumor markers elevation can precisely predict recurrence. Moreover, normal levels of both tumor markers with a negative ¹⁸F-FDG PET/CT result may clinically reassure that a recurrence is absent.

Keywords: 18F-FDG PET/CT; Cervical cancer; carcinoembryonic antigen; recurrence; squamous cell carcinoma antigen.