PET/CT in Gynecologic Cancer: Present Applications and Future Prospectsd-A Clinician's Perspective

Providing the proper care for patients with gynecologic malignancies has always been a challenge for clinicians. The persistent need to achieve early diagnosis, adjust proper treatment, enhance surveillance, and improve the outcome of these patients has led to the development of new diagnostic modalities. The last decade witnessed great progress in the use of cross-sectional imaging techniques, such as ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging. These imaging modalities are able to demonstrate anatomic details and morphologic changes, but often fail to discriminate between benign and malignant lesions. The functional information obtained from 18F-fluorodeoxy-glucose (FDG) PET exhibits the high uptake of glucose by malignant cells, but lacks anatomic landmarks. The fusion of PET with CT combines the advantages of these 2 modalities, allowing the anatomic localization of metabolic abnormalities in the female genital tract and beyond in patients with disseminated disease. The literature on FDG-PET in gynecologic malignancies between the years 2000 and 2009 reveals a significant increase in the number of articles that have been published. Whereas in 2003 only one article was published, more than 70 articles were listed in 2009, the vast majority reporting on the use of PET/CT. An attempt to obtain similar information concerning CT and MR imaging divulges a constant average number of 90 articles each year. This increase reflects the clinicians' growing interest in this promising modality, which attempts and is often successful in overcoming some limitations of former conventional diagnostic approach. This article briefly reviews the epidemiology, diagnosis, and treatment of the common gynecologic malignancies, with an emphasis on the shortcomings of current clinical practice.