To operate or to radiate: the added value of the maximal standardized uptake value in PET–FDG in cervical cancer patients

Cervical cancer is one of the leading causes of death among women with gynecological malignancies. In early stages of the disease (IB-IIA), surgical treatment alone is usually the treatment of choice. However, some high-risk patients are referred for postoperative chemo-radiotherapy, leading to increased morbidity. Maximal Standardized Uptake Value (SUV_max) is a positron emission tomography–computed tomography (PET–CT)-derived semiquantitative measurement of fluorodeoxyglucose (FDG) uptake in a defined lesion and may reflect tumor aggressiveness. The purpose of this study was to determine whether preoperative high SUV_max values can be used for the selection of initial therapy, thus reducing the side effects resulting from bimodal treatment. PET–CT studies of 46 cervical cancer patients who underwent surgery were reviewed, and SUV_max data were collected. Statistical analyses were performed to determine the relationships between SUV_max values and clinical parameters, modalities of treatment, and outcomes. SUV_max was found to correlate with depth of tumor invasion (r = 0.46, p < 0.003). A statistically significant correlation was also found between SUV_max and histological grade, with the mean and variance of SUV_max significantly lower for grade one, as compared to grades two and three (mean 1.10, 11.06, and 8.88; variance 3.57, 45.60, and 29.79, respectively; p < 0.0001 and p = 0.076). A possible SUV_max cutoff value of 10.08 was identified as a potential indicator of increased risk for receiving bimodal treatment, with a sensitivity of 61.5 % and a specificity of 75.8 %. SUV_max can be used for differentiating early-stage cervical cancer patients who will need postoperative adjuvant treatment and therefore can serve as an additional modality to reduce the need for bimodal therapy in these patients.