PET and PET-CT imaging of gynecological malignancies: present role and future promise

In this article, we have reviewed the current role of PET/PET-computed tomography (CT) in the management of gynecological malignancies. The promise of this technique is becoming increasingly evident, based upon several studies conducted in these malignancies. 2-fluoro-2-deoxy-D-glucose-PET appears to have a potential role in assessing response to treatment and forecasting prognosis. For cervical carcinoma, the modality has proven useful in both the staging of untreated advanced cervical cancer and restaging of the disease. its role in prognostication of the disease and in detecting lesions in the setting of post-treatment unexplained tumor-marker elevation appears promising. PET is of great benefit as a diagnostic tool in ovarian carcinoma when there is an increase in serum CA-125 and CT/MRI or conventional imaging are inconclusive or negative. With regard to its role in endometrial carcinoma, its benefit is particularly emphasized in the setting of post-therapy surveillance of the disease, although, in a limited series, it also appears to give additional information in the pretreatment states. PET may be of value in detecting the extra-uterine lesions that are not visualized with CT/MRI. Data on the role of 2-fluoro-2-deoxy-D-glucose-PET imaging in the management of vulvar and vaginal cancer are relatively sparse at this time but the modality appears to be of value in staging disease and is more effective than conventional diagnostic modalities with respect to detecting nodal metastasis in both malignancies.