Introduction Locally advanced cervical cancer (LACC) is a public health problem. Objectives: Determine importance of initiation of treatment of LACC in limited-resource settings. Evaluate the concordance between CT and PET/CT for FIGO 2018 staging.
Methods Retrospective analysis of 175 patients with LACC was performed in a national reference center. FIGO 2018 staging was stablished by clinical evaluation and CT scan. PET/CT was requested when CT was highly suspicious of more advanced disease or when initiation of treatment was delayed. Descriptive and inferential statistics, Cohen kappa index and ROC curve were performed.
Results Population analyzed was Mexican with median age at diagnosis 47 years. Most common FIGO stage by clinic evaluation was IIB (43%), by CT was IIIC1 (46%), and IIIC1 (43%) by PET/CT. Concordance of CT with PET/CT within 25 days of initial study was substantial (k=0.719, p = 0.0001) and after 25 days with moderate agreement (k = 0.468, p = 0.0001). Time to upstage was 25 days by ROC (AUC 0.763, p = 0.0001). FIGO IV was 9.2% with CT against 20.6% with PET/CT.
Conclusion/Implications Image studies make FIGO 2018 in cervical cancer more accurate. PET/CT in not accessible and is expensive for the general population in limited resource settings. According to our results, we can rely on the initial staging with CT within 25 days from diagnosis to initiation of treatment, after this period, upstage must be considered and a more accurate image study such as PET/CT might be recommended to reconsider the therapeutic plan and prognosis.
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