Diagnostic applications of nuclear medicine: Uterine cancers

Abstract

Cervical and uterine malignancies are a significant health issue for women worldwide. Uterine cancers are the most common gynecological cancers, although ovarian cancers have the highest mortality. The primary modalities for anatomic imaging are ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). These imaging tools are used for the diagnosis, staging, and posttherapy follow-up for detection of recurrent disease; however, they lack biologic information. Positron emission tomography (PET) with [18F] fluoro-2-deoxy-D-glucose ([18F]FDG) imaging plays a critical role in the evaluation of cervical and uterine malignancies. A number of studies have established the role of [18F]FDG PET in the staging and prognosis of advanced cervical cancer. PET/MRI scanners with newer technology are available and in future may be the mainstay in assessment of gynecologic malignancies. Radionuclide lymphoscintigraphy is an established technique for sentinel lymph node (SNL) mapping in vulvar cancer. For cervical and endometrial cancer, it can help prevent morbidities that follow lymphadenectomies and there is convincing evidence that SLN mapping can be useful in early-stage disease. In this chapter, we discuss the role of nuclear imaging, especially [18F]FDG PET scanning, and summarize the initial experiences with PET/MRI in cervical and uterine cancers; we also discuss the use of lymphoscintigraphy in gynecological cancers.