[18F]fluorodeoxyglucose positron emission tomography/computed tomography and trophoblastic disease: the gynecologist perspective

INTRODUCTION: Gestational trophoblastic disease (GTD) is a group of different pregnancy-related diseases that includes hydatidiform mole (HM), invasive mole, gestational choriocarcinoma (CC), placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). The potential role of F-18-2-fluoro-2-deoxy-D-glucose ([F-18]FDG) positron emission tomography (PET) in diagnostic setting and follow up phase of GTD is still largely debated. EVIDENCE ACQUISITION: The aim of this review is to examine the role of [F-18]FDG PET/computed tomography (CT) in diagnosis, treatment and follow up of different disease subtypes. A systematic computerized search of the literature, from 1996 until December 2015 was performed in PubMed and MEDLINE to identify relevant papers to be included for this purpose. All pertinent articles and their reference lists were systematically reviewed in order to identify other studies for potential inclusion. EVIDENCE SYNTHESIS: Regarding HM a potential prognostic relevance of maximum standardized uptake value (SUV max) of molar tissue within the uterus before evacuation has been suggested. Considering CC staging, most [F-18]FDG PET evaluations confirmed the results of conventional imaging. However [F-18]FDG PET played a key role in discriminating ambiguous lesions on routine imaging work-up. [F-I8]FDG PET was particularly useful in evaluating disease recurrence and chemo-resistance, thanks to the possibility of an early identification of the active tumor site. Since the main treatment of PSTT is surgery, the contribution of [F-18]FDG PET in differential diagnosis and in providing a more precise mapping of resectable metastasis or the complete response to treatment is advisable. CONCLUSIONS: Since the role of [F-18]FDG PET and PET/CT in diagnostic setting and follow up of GTN is still controversial, further studies are required to clarify this issue.