Gynecologic cancers, PET/CT, cost-effectivness, staging, follow-up
Introduction: Tumors of the female genital tract are a major cause of mortality among women in Western countries: the most frequent of these cancers is endometrial cancer, while the most lethal is ovarian cancer. Aim: The aim of the present work was to review the published literature on the utility of metabolic imaging in the staging, re-staging and post-treatment monitoring of cervical, endometrial and ovarian cancer. We also evaluated the relevance of evidence as to the cost-effectiveness of introducing PET/CT in the work-up of gynecological malignancies. Methods: EMBASE and Pub-Med Literature searches were made from 2007 to 2014. Results: Despite the availability of multiple imaging techniques, estimating the extent of primary disease and locoregional lymph node involvement is still based on clinical and surgical evaluation, while distant metastases may be assessed accurately and non-invasively using PET/CT. PET/CT may also be a useful tool in planning radiotherapy and in predicting response to treatment. Moreover when recurrence occurs, PET/CT accurately evaluates its extent and orients further therapies. Finally PET/CT seems to be cost-effective for ovarian cancer, whereas there is little evidence for cervical cancer and no data for endometrial cancer. Conclusion: A body of evidence is growing about the usefulness of PET/CT in management of gynecological malignancies as a complementary tool in addition to clinical evaluation and biochemical surveillance; moreover few data are available about the cost-effectiveness of introducing this method in clinical practice and further evaluations are needed addressing this topic.