You are here

  • Home
  • Online First
  • PET-MRI for evaluation of response to radiochemotherapy in patients with locally advanced cervical cancer

Article Text

Article menu

other Versions

Download PDFPDF
Original research
PET-MRI for evaluation of response to radiochemotherapy in patients with locally advanced cervical cancer
  1. Ariane Weyl1,
  2. Charlotte Chollet1,
  3. Erwan Gabiache2,
  4. Valérie Cancès-Lauwers1,
  5. Franklin Gallo3,
  6. Alejandra Martinez4,
  7. Frederic Courbon2,
  8. Pierre Leguevaque5,
  9. Isabelle Brenot Rossi6,
  10. Aurélie Jalaguier6,
  11. Eric Lambaudie7,
  12. Elodie Chantalat8 and
  13. Stephanie Motton8
  1. 1Gynecologic Surgery, CHU Toulouse, Toulouse, Occitanie, France
  2. 2Nuclear Medicine, Cancer University Institute Toulouse Oncopole, Toulouse, Languedoc-Roussillon-Midi, France
  3. 3Radiology, IUCT Oncopole, Toulouse, Occitanie, France
  4. 4Institute Claudius Regaud, Toulouse, Occitanie, France
  5. 5Clinique Pasteur, Toulouse, Midi-Pyrénées, France
  6. 6Paoli-Calmettes Institute, Marseille, Provence-Alpes-Côte d'Azu, France
  7. 7Institut Paoli-Calmettes, Marseille, France
  8. 8Gynecologic Surgery, Centre Hospitalier Universitaire de Toulouse, Toulouse, Midi-Pyrénées, France
  1. Correspondence to Dr Ariane Weyl, CHU Toulouse, Toulouse, Occitanie, France; ariane.weyl{at}gmail.com

Abstract

Objective We aimed to analyze the diagnostic test accuracy of positron emission tomography and a magnetic resonance imaging scan (PET-MRI) fusion in evaluating tumor response after radiochemotherapy in patients with locally advanced cervical cancer.

Methods Patients treated at two institutes between January 2008 and December 2016 were studied retrospectively. Re-evaluation by positron emission tomography (PET) and magnetic resonance imaging (MRI) was performed in a non-concurrent way 4–8 weeks after treatment. A nuclear medicine doctor and a radiologist (subsequently referred as "radiologists"), both experts in gynecological oncology, re-examined the post-treatment MRI and positron emission tomography–computed tomography (PET-CT) separately, and then performed a fusion of these examinations. In this study we describe this “a posteriori fusion methodology”, with two levels, enabling limitation of anatomical shifts. The gold standard was anatomical pathology analysis of the surgical specimen, since all patients underwent surgery following this radiological re-evaluation. The radiologists’ degree of certainty in their diagnoses, and the impact of fusion on their diagnostic confidence were assessed by the radiologists, using two Likert judgment scales. They also adjudicated on possible changes of interpretation after the fusion.

Results Thirty-one patients were included. The PET-MRI fusion has a sensitivity of 79% and a specificity of 90%. The positive predictive value (PPV) was 94%, and the negative predictive value (NPV) was 69%. In 45% of cases (n=13), radiologists reported an improvement in their degree of certainty in their diagnosis using a Likert judgment scale, due to inspecting the PET and MRI fused. A change in interpretation of tumor response was observed using a Likert judgment scale in 31% of cases.

Conclusion PET-MRI fusion improves the radiologist’s own diagnostic confidence in assessing response to concurrent radiochemotherapy in locally advanced cervical cancer. More studies using a latest generation hybrid system will be necessary to further compare to MRI and PET-CT.

  • Cervical Cancer
  • Gynecology
  • Neoplasm, Residual

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/ijgc-2022-003958

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available upon reasonable request.

    View Full Text

    Footnotes

    • AW and CC are joint first authors.

    • Twitter @Alejandra

    • AW and CC contributed equally.

    • Contributors AW: Manuscript writing, Data collection and analysis, Guarantor; CC: Manuscript writing, Data collection and analysis; EG: Blinded post-treatment examinations, fusions; VC-L: Statistical analysis; FG: Blinded post-treatment examinations, fusions; AM: Manuscript editing, Supervision; FC: Project development, resources; PL: Project development, manuscript editing; IBR: Blinded post-treatment examinations, fusions; AJ: Blinded post-treatment examinations, fusions; EL: Resources; EC: Manuscript editing, Supervision; SM: Project development, Manuscript editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.