The impact and value of [18F]-FDG PET-CT on management of patients with cervical cancer with service evaluation audited against national evidence-based PET-CT guidelines

PURPOSE: First, to assess the diagnostic value of fluorine-18-fluorodeoxyglucose PET-computed tomography ([18F]-FDG PET-CT) compared with conventional MRI and/or CT. Second, to audit the clinical indications for referring patients with cervical cancer for [18F]-FDG PET-CT against the 2022 guidelines published by the Royal College of Radiologists and the Royal College of Physicians. Finally, to evaluate the impact of [18F]-FDG PET-CT on management plans. METHODS: A retrospective cohort study of 49 patients with histologically proven cervical cancer across the Sussex Cancer Network underwent 59 [18F]-FDG PET-CT between 1 November 2020 and 31 October 2022. Scans were compared with the most recent CT and MRI scan conducted within 4 months of the [18F]-FDG PET-CT. Scan indications were categorized as either 'in accordance' or 'outside' the guidelines. Those in accordance fell into one of four groups: staging, response assessment, suspected recurrence, or staging when considering exenterative surgery. A questionnaire investigating the impact of the [18F]-FDG PET-CT on the management plan of each patient was answered by one clinical oncology consultant. RESULTS: [18F]-FDG PET-CT identified new metastatic sites in 16/59 (27.1%) scans. The remaining scans were concordant with the CT and MRI. The majority, 57/59 (96.6%), of the scans were performed in accordance with the guidelines. The management plan was changed by 5/59 scans (8.4%), confirmed by 48/59 (81.4%) and was not impacted with 6/59 (10.2%) scans. CONCLUSION: [18F]-FDG PET-CT is superior to conventional imaging and enhances the management plan. Future cohort studies with larger patient numbers involving multicentric studies are needed to fully assess its impact on cervical cancer management and prognosis.