Review 10.1586/14737140.6.7.1033 © 2006 Future Drugs Ltd ISSN 1473-7140 1033 www.future-drugs.com Positron emission tomography in gynecological malignancies Rakesh Kumar † , Anil Chauhan, Suman Jana and Simin Dadparvar † Author for correspondence Department of Nuclear Medicine, All India Institute of Medical Sciences, E-62, Ansari Nagar (East) AIIMS Campus, New Delhi – 110029, India Tel.: +91 112 658 8017 Fax: +91 112 658 8663 rkphulia@yahoo.com KEYWORDS: cervical cancer, endometrial cancer, fluorodeoxyglucose, oncology, ovarian cancer, positron emission tomography Positron emission tomography (PET) is a functional diagnostic imaging technique. F-18 fluoro-2-deoxy-D-glucose (FDG) is a commonly used radiopharmaceutical that is an analog of glucose. PET with FDG is now the standard of care in initial staging, monitoring the response to the therapy and management of various cancers. There is not sufficient data to support the use of PET in the initial diagnosis of cervical cancer; however, FDG-PET has a role in initial staging in the detection of distant metastases in patients with cervical cancer. PET has limited value in lesion localization in early stages of ovarian cancer, but plays a significant role in identifying recurrent tumors in patients with rising tumor markers. In this article, the clinical application of PET in gynecological malignancies is reviewed. Expert Rev. Anticancer Ther. 6(7), 1033–1044 (2006) Gynecological malignancy is a major disease bur- den in the female population worldwide. Together, cervical, endometrial and ovarian can- cers constitute most gynecological malignancies; others being vulval, vaginal and fallopian tube carcinoma. Efficient screening procedures, such as the Pap test, have remarkably reduced the inci- dence of cervical cancer over the past few decades in developed countries. However, cervical carci- noma is still the most common cancer in the female population in many developing countries, owing to inefficient screening protocols. Diagnosis of primary tumor and subsequent staging usually incorporates ultrasonography (US), computed tomography (CT ) and mag- netic resonance imaging (MRI). Positron emis- sion tomography (PET ) is a functional imaging technique that depends on the metabolic behav- ior demonstrated by the tumor. T he radiolabeled glucose analog, 18 F-flourodeoxyglucose (FDG), is the most commonly used radiotracer for PET. PET can play an important role in pretreatment staging, evaluating treatment response and detecting the recurrence of gynecological malig- nancy [1,2]. With time, there have been signifi- cant technological advances in PET, especially the hybrid PET /CT scanners that provide both the anatomical and functional aspects of the lesion. In this article, the role of PET in various gynecological malignancies will be discussed. Patient preparation & imaging protocol for gynecological tumors FDG is excreted through the urinary tract and is also physiologically accumulated in the bowel. Intense activity in the urinary and/or gastro-intestinal tract can interfere with the optimal evaluation of abdomen and pelvis. T here are several methods of avoiding urinary bladder activity. T he easiest one is to request that the patient empties their urinary bladder just prior to imaging and initiate imaging from the pelvis, before the bladder is full [3]. The other reported preparations are: use of hydra- tion (intravenous 1 l normal saline) with diu- retics (furosemide) and urinary catheter to drain continuously [3,4]. Koyama and colleagues studied the effect of continuous bladder irriga- tion in 41 patients with the diagnosis of gyne- cological malignancies and found that the FDG activity in the urinary tract was eliminated in 33 (80%) patients after bladder irrigation. After catheterization, the remaining urine in the bladder could contain a small amount of highly concentrated radioactivity, which can poten- tially interfere with image interpretation. To avoid this problem, several authors have used triple lumen Foley’s catheter and, just before scanning over the pelvis, deliver normal saline retrogradely into the urinary bladder to dilute the radioactive urine [5,4]. To date, there is no CONTENTS Patient preparation & imaging protocol for gynecological tumors Normal variant distribution of FDG Ovarian cancer Recurrent ovarian cancer Cervical cancer Recurrent cervical cancer PET in radiation treatment planning Other PET agents Endometrial cancer Expert commentary & five-year view Key issues References Affiliations For reprint orders, please contact reprints@future-drugs.com