Research ArticleClinical Studies
Open Access

Comparative Analysis of FDG-PET Versus CT/MRI in Staging and Management of Advanced-stage Cervical Cancer

MAHWISH NAYAB, MOSTAFA ELNAGGAR, VIREN ASHER, ANISH BALI, SUMMI ABDUL, MOJCA PERSIC and ANDREW PHILLIPS
Anticancer Research December 2025, 45 (12) 5503-5511; DOI: https://doi.org/10.21873/anticanres.17885

Abstract

Background/Aim: Accurate staging is critical for optimizing treatment in advanced-stage cervical cancer (FIGO stage IB3 and above). This study evaluated the added value of ^18F-fluorodeoxyglucose positron emission tomography (FDG-PET) compared to magnetic resonance imaging (MRI) and computed tomography (CT) in improving staging accuracy and guiding management decisions.

Patients and Methods: A retrospective review was conducted of patients with advanced cervical cancer treated at Derby Gynaecological Cancer Centre (2016-2023) who underwent MRI, CT, and FDG-PET. Differences in staging and management before and after FDG-PET were analyzed using McNemar’s test with Yates’ correction.

Results: DG-PET led to a change in FIGO stage in 13 of 45 cases (29%; p=0.00087). It upstaged 11 cases (24%) – primarily due to previously undetected nodal metastases – and downstaged 2 cases (4%) due to false-positive findings on CT/MRI. Occult nodal disease was identified in 20% of patients. FDG-PET altered management in five cases (11%; p=0.044), most commonly through para-aortic nodal radiotherapy boost adjustments.

Conclusion: FDG-PET appears to enhance staging accuracy and impact treatment planning in advanced cervical cancer, particularly by detecting occult nodal metastasis. However, its utility may be limited in cases where nodal involvement is already evident on MRI/CT.

Keywords:

Introduction

Cervical cancer is the fourth most common cancer in women. In 2022, an estimated 660,000 women were diagnosed with cervical cancer worldwide, and approximately 350,000 women died from the disease (1). While the overall burden of cervical cancer is relatively low in Europe compared to low- and middle-income countries, incidence rates have shown a subtle but steady rise despite widespread implementation of cervical screening programs (2). Although cervical cancer is uncommon in Europe, the incidence of cervical cancer is slowly rising despite the well-established cervical screening program. Age-standardized rates (ASR per 100,000) for incidence of cervical cancer were 13.4, 13.9 and 14.6, while ASR for mortality because of cervical cancer were 4.9, 5 and 6.9, respectively, in 2012, 2018 and 2020, respectively (3-5). In the United Kingdom, however, cervical cancer mortality decreased by 18% over the past decade, with an annual average of 850 deaths between 2017 and 2019 (6). Nevertheless, the persistent incidence and mortality highlight the need for improved strategies in diagnosis and management, particularly in advanced-stage disease.

Management of locally advanced cervical cancer (AdvCC), typically defined as stage IB3 and beyond, remains a clinical challenge. Prognostic factors include tumor size, lympho-vascular space invasion, local and distant metastasis, etc. Nodal metastasis is one of the most important prognostic factors that impact survival (7). Whilst surgical staging with pelvic and para-aortic lymphadenectomy is the gold standard for accurate staging of AdvCC, its association with significant post-operative morbidity has led to non-invasive tests being the investigations of choice (8). Hence, radiological staging remains the recommended modality, especially for confirmed or suspected AdvCC (9).

Diffusion-weighted magnetic resonance imaging (DW-MRI) is considered the imaging modality of choice for local tumor spread, including parametrial, bladder, or bowel involvement (Figure 1 and Figure 2) (10). However, Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) is recommended for nodal staging in all women diagnosed with AdvCC on DW-MRI (11). Definitive platinum-based chemo-radiotherapy and brachytherapy are considered the mainstay treatment for AdvCC. When nodal metastasis is identified, the affected nodal regions are incorporated into the radiotherapy treatment field to ensure adequate coverage and control of the nodal disease. Given up to 11% risk of para-aortic lymph node recurrence, accurate staging is paramount for the management of AdvCC (12, 13).

Figure 1.
Figure 1.

Diffusion-weighted magnetic resonance imaging (DW-MRI) (sagittal section) demonstrating bladder invasion in FIGO stage IVA cervical cancer.

Figure 2.
Figure 2.

Diffusion-weighted magnetic resonance imaging (axial section) demonstrating rectal invasion in FIGO stage IVA cervical cancer.

The primary aim of this study was to evaluate whether FDG-PET provides additional value over computed tomography (CT)/MRI in staging and guiding the management of AdvCC, or if it is just a costly test resulting in treatment delays. Since FDG-PET is recommended for nodal staging, a secondary aim of this study was to evaluate whether it can be omitted in cases where nodal involvement is already evident on DW-MRI. This approach could potentially reduce healthcare costs and minimize delays in initiating treatment.

Patients and Methods

Ethics statement. This study is a retrospective single-center analysis of investigative data – with no patient identifiers or interventions disclosed. No ethical approval was required. This study was registered with the Departmental Audit department as part of the department’s quality assurance processes.

Patient population. All patients with newly diagnosed, histologically proven International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IB3 and beyond cervical cancer at the Derby Gynaecological Cancer Centre (DGCC), University Hospitals of Derby and Burton (UHDB) NHS Foundation Trust between January 2016 and December 2023 (96 months) were identified using the institutional electronic tumor database. To minimize selection bias, all patients who underwent all three imaging modalities – i.e., DW-MRI, CT, and FDG-PET – were selected for this study, provided they had no concurrent active malignancy and had undergone all three modalities, as reported separately.

Methods. Gynaecological oncology multi-disciplinary team (MDT) at Derby receives referrals of cervical cancer from various sources, mainly colposcopy and gynecology clinics. When cervical cancer is suspected, a biopsy is sent for assessment by specialist gynecological histopathologists and examination is performed by subspecialist gynecological oncologists. DW-MRI is the first investigation requested for radiological staging of cervical cancer, followed by CT and FDG-PET. For patients with AdvCC the mainstay treatment is concomitant chemoradiation, although this has changed to neo-adjuvant chemotherapy (NACT) followed by chemoradiation following the publication of the INTERLACE trial (14). If involvement of pelvic nodes was radiologically identified, patients get a para-aortic nodal boost during radiotherapy due to the high risk of para-aortic nodal involvement. The patients with widespread metastatic disease are managed with chemotherapy.

Relevant study data was captured in retrospect by accessing a combination of patient electronic care records, MDT outcome proformas and the UHDB cancer database – populating a study proforma with the following clinical variables: patient age; histology (grade and subtype); smear (updated, results), transvaginal scan findings, DW-MRI & CT stage; FDG-PET stage; MDT outcome. The difference in staging and management plan before and after FDG-PET was noted. Lymph nodes were deemed involved if their size was >1 cm and were round in shape on DW-MRI/CT scan or SUVmax (the highest standardized uptake value indicating concentration of a tracer at the area of interest) was >4 on FDG-PET.

Statistical analysis. Categorical variables were collated as frequencies or percentages. The significance between the change in DW-MRI/CT versus FDG-PET staging and management was calculated by the application of McNemar’s test with Yates’ continuity correction, setting statistical significance at p<0.05. Microsoft Excel for Mac Version 16.98 (25060824, Microsoft Corporation, Redmond, WA, USA) was utilized for analytical support.

Study outcome measures. Primary outcome measure. Compare the FIGO 2018 stage based on initial DW-MRI and CT with the stage based on FDG-PET – evaluating the value FDG-PET added to already performed DW-MRI/CT.

Secondary outcome measure. Compare the change in the management plan between the initial stage based on DW-MRI/CT with the final FDG-PET stage in the group where this was applicable – evaluating the impact of FD-PET on the management of AdvCC, especially if already IIIC and beyond based on DW-MRI.

Evaluate the first imaging modality performed in patients later diagnosed with cervical cancer, particularly the frequent use of transvaginal ultrasound in primary care settings before specialist referral, despite its limited role in advanced disease.

Results

Patient and disease characteristics. A total of 126 patients with newly diagnosed AdvCC over 96 months were identified. Of them, 45 who received all imaging modalities performed and reported separately were selected for this study (Table I). Among 81 who were excluded, 39 did not receive FDG-PET, while in 42, CT and FDG-PET were performed and reported together. Median age was 49 years (range=28-84 years); and 24.4% (n=11) of the cohort was aged >65 years. The vast majority, 86.7% (n=39), were of squamous subtype; and 77.8% (n=35) were diagnosed with high grade based on cervical biopsy 91.2% (n=41). FIGO stage III and IV disease was diagnosed in 53.3% (n=24) and 28.9% (n=13) of women, respectively.

View this table:
Table I.

Patient characteristics.

Updated cervical smear results were available for14 out of 34 eligible patients (41.2%), in contrast to 58.8% who did not have updated cervical smear. Of the 14 patients with updated cervical screening, 64.3% (n=9) showed either high-grade changes or invasive cancer. Of those with normal smear results 35.7% (n=5), only two had human papillomavirus (HPV) dependent cancer (p16 positive). 64.4% (n=29) had transvaginal ultrasound (TVUS) before any other imaging modality. Of those having TVUS, 65.5% (n=19) showed cervical mass, 6.9% (n=2) showed thickened endometrium, and the rest were normal.

Comparison of staging and management between DW-MRI/CT and FDG-PET. FDG-PET staging was concordant with the radiological staging performed using DW-MRI/CT in 71% (n=32), whereas no concordance was observed in 29% (n=13) (p<0.05). Most of the discordance was due to finding occult nodal metastasis (20%, n=9). The details of the change in stage are demonstrated in Table II and Table III.

View this table:
Table II.

Comparison of computed tomography/diffusion-weighted magnetic resonance imaging (CT/DW-MRI) staging to fluorodeoxyglucose positron emission tomography (FDG-PET) (n=45).

View this table:
Table III.

Details of the changes in stage after fluorodeoxyglucose positron emission tomography (FDG-PET).

Change in management plan after FDG-PET. Significant alteration in management plan was observed in five cases after FDG-PET (11%) (p<0.05). Four patients received a para-aortic node (PAN) boost due to nodal metastasis detected using FDG-PET. In one case PAN boost was withheld due to being down-staged, and it was the only case out of 30 DW-MRI/CT node-positive AdvCC cases in which FDG-PET altered the management.

Discussion

This retrospective study was conducted at DGCC, a large tertiary center managing gynecological cancers within the defined catchment area of the East Midlands region of the United Kingdom. As standard, all UK National Health Service (NHS) patients receive free treatment at the point of delivery, with limited private capacity for the management of AdvCC. Our study population is likely, therefore, to be representative of the wider regional population of those women affected with cervical cancer. Our study demonstrated that FDG-PET altered staging in nearly one-third of patients and led to a significant change in management in 11% of cases, however, it did not change management significantly in DW-MRI-based nodal positive cases. TVUS was the first imaging in most cases but was limited in detecting advanced disease.

There was a significant difference in discordance between FDG-PET and MRI/CT in more than a quarter of cases. FDG-PET was more efficient in detecting nodal metastasis as compared to both MRI and CT combined. This can be attributed to DW-MRI and CT scan relying on the nodal characteristics like shape and size (<1 cm), whereas FDG-PET generates heat maps and relies on SUVmax instead (Figure 3 and Figure 4) (15). In a meta-analysis of 11 studies, PET-CT demonstrated superior diagnostic accuracy for detecting lymph node metastasis in cervical cancer, with a significantly higher area under curve (AUC) (0.824 vs. 0.702; p<0.05) and greater sensitivity and specificity compared to MRI (11). Hence, our findings agree with the available literature.

Figure 3.
Figure 3.

Computed tomography (CT)/fluorodeoxyglucose positron emission tomography (axial section) demonstrating a metabolically active right pelvic node, missed on conventional CT imaging.

Figure 4.
Figure 4.

Computed tomography (CT)/fluorodeoxyglucose positron emission tomography (axial section) demonstrating a metabolically active right para-aortic node, missed on conventional CT imaging.

Definitive platinum-based chemo-radiotherapy and brachytherapy are considered the mainstay treatment for AdvCC (9, 16, 17). If PAN are positive (3C2), an additional boost to the PAN is delivered in addition to standard radiotherapy. If pelvic lymph nodes (PLN) are radiologically involved (3C1), this carries a high risk of involvement in the para-aortic region (18). Hence, PAN boost is delivered frequently in FIGO 3C1 as well. Our data demonstrate this: although FDG-PET changed the stage in one-third of the cases, it altered the management in only 11% of the cases, most of which received a PAN boost during treatment.

The subgroup analysis of our data revealed that out of 30 DW-MRI/CT node-positive AdvCC cases, FDG-PET altered management in only one case. In that case, CT identified a prominent PAN in the absence of PLN involvement, which DW-MRI and FDG-PET downstaged. Hence, the patient did not receive a PAN boost. This implies that, in cases where MRI/CT detects nodal involvement, FDG-PET adds no/limited value. The cost of FDG-PET is 4.5 times that of a CT scan (19). Moreover, in the present NHS with significant delays for cancer diagnostics, the addition of an FDG-PET scan is likely to delay treatment as the availability of FDG-PET compared to CT is much lower (20). In addition, patients undergoing chemoradiotherapy for cervical cancer FIGO stage <IIIC2 have 4-11% risk of developing PAN metastasis at follow-up (12, 13) with evidence that providing a boost to PAN, even in the absence of PAN metastasis, has disease-free survival benefits (21). These findings suggest the possibility of a more limited role of FDG-PET in changing the management plan. Our data suggest that omitting FDG-PET in CT/MRI node-positive AdvCC is a reasonable option to reduce costs and limit treatment delays with no impact on the management plan. However, this subgroup is small, and further studies are needed to confirm these findings.

Nearly two-thirds of patients with newly diagnosed AdvCC during the study period were excluded because they either had FDG-PET reported alongside CT (n=42, 33%) or did not undergo all three imaging modalities (n=39, 30%). A significant proportion of those who did not undergo PET scanning were diagnosed before the 2018 FIGO staging revision, when FDG-PET became incorporated into the staging of AdvCC. Much of the variation in imaging utilization was dictated by local FDG-PET protocols, and this likely contributed to differences in imaging processes. Similar variation may also exist in other centers managing comparable populations within similar health systems. Our findings suggest that refinement of imaging protocols for suspected AdvCC could be supported by sufficient funding to enable rapid performance and interpretation of FDG-PET.

One of the other limitations of our study is the absence of histological confirmation or surgical staging, such as diagnostic laparoscopy, to verify the findings observed on FDG-PET imaging. While surgical staging is not recommended in radiologically node-positive AdvCC, without histology, it is not possible to definitively assess the diagnostic accuracy of FDG-PET in our cohort. While FDG-PET is a valuable tool in the staging and treatment planning of AdvCC due to its ability to detect metabolic activity suggestive of nodal or distant metastases, it is important to recognize that it is not without limitations. False-positive findings can occur due to non-malignant causes of increased FDG uptake, such as infection, inflammation, or physiological activity (22). This can lead to potential overstaging and may influence clinical decision-making, especially in the absence of a confirmatory biopsy.

Consistent with a group of patients generally attending outside of the screening pathway, more than half of the patients received TVUS as the first imaging modality (23). Of these, a quarter were normal, potentially unduly reassuring clinicians despite the advanced nature of their disease. These findings represented the poor sensitivity of TVUS to AdvCC, highlighting the significance of clinical examination despite a normal TVUS in women with postmenopausal bleeding. They also serve as a note of caution for any postmenopausal bleeding service that operates solely based on a transvaginal ultrasound scan to assess the need for further evaluation.

Furthermore, capturing one-third of the patients managed for histologically proven FIGO stage IB3 and beyond over 96 months within a cancer center, especially due to exclusion criteria, generated limited numbers. Despite endeavors to standardize the assessment of patients within our center, by a retrospective study design, the potential bias – and hence its impact on our overall results – cannot be fully eliminated. Moreover, the study compared DW-MRI and CT results interpreted by radiologists in their initial report (instead of gynecological oncology specialist radiologists) to FDG-PET, which might have led to a reduction in the quality of DW-MRI and CT interpretation.

Conclusion

Given the limitations of this study, FDG-PET appears to improve staging and guide therapeutic decision-making in cervical cancer, primarily through the detection of occult nodal metastases. These findings should be validated in a prospective trial. Selective use of FDG-PET, particularly in cases where nodal involvement is already evident on DW-MRI/CT, may be both cost-effective and help minimize delays between diagnosis and treatment initiation. TVUS is a poor screening tool for cervical cancer; therefore, clinical examination should be performed to rule out cervical pathology, especially in women with postmenopausal bleeding, even if the TVUS results are normal.

Acknowledgements

The Authors thank Nyabanda Judith Molanza, medical student University of Nottingham, for her contribution in the data collection.

Footnotes

  • Authors’ Contributions

    Mahwish Nayab: Data curation, Formal analysis, Investigation, Project administration, Software, Visualization, Writing-original draft, Writing-review & editing. Mostafa Elnaggar: Conceptualization, Validation, Writing-review & editing. Viren Asher: Validation, Writing-review & editing, Anish Bali: Writing-review & editing. Summi Abdul: Writing-review & editing. Mojca Persic: Writing-review & editing. Andrew Phillips: Conceptualization, Formal analysis, Methodology, Resources, Supervision, Validation, Writing-review & editing.

  • Conflicts of Interest

    None of the Authors have any conflicts of interest to declare in relation to this study.

  • Funding

    None of the Authors received any funding related to this study.

  • Artificial Intelligence (AI) Disclosure

    No artificial intelligence (AI) tools, including large language models or machine learning software, were used in the preparation, analysis, or presentation of this manuscript.

  • Received August 19, 2025.
  • Revision received September 9, 2025.
  • Accepted September 15, 2025.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

References

  1. ↵
    1. World Health Organization
    . Cervical cancer [Internet]. Geneva, Switzerland, WHO, 2024. Available at: https://www.who.int/news-room/fact-sheets/detail/cervical-cancer [Last accessed on September 1, 2025]
  2. ↵
    1. Landy R,
    2. Pesola F,
    3. Castañón A,
    4. Sasieni P
    : Impact of cervical screening on cervical cancer mortality: estimation using stage-specific results from a nested case-control study. Br J Cancer 115(9): 1140-1146, 2016. DOI: 10.1038/bjc.2016.290
    OpenUrlCrossRefPubMed
  3. ↵
    1. Dyba T,
    2. Randi G,
    3. Bray F,
    4. Martos C,
    5. Giusti F,
    6. Nicholson N,
    7. Gavin A,
    8. Flego M,
    9. Neamtiu L,
    10. Dimitrova N,
    11. Negrão Carvalho R,
    12. Ferlay J,
    13. Bettio M
    : The European cancer burden in 2020: Incidence and mortality estimates for 40 countries and 25 major cancers. Eur J Cancer 157: 308-347, 2021. DOI: 10.1016/J.EJCA.2021.07.039
    OpenUrlCrossRefPubMed
    1. Ferlay J,
    2. Steliarova-Foucher E,
    3. Lortet-Tieulent J,
    4. Rosso S,
    5. Coebergh JW,
    6. Comber H,
    7. Forman D,
    8. Bray F
    : Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. Eur J Cancer 49(6): 1374-1403, 2013. DOI: 10.1016/j.ejca.2012.12.027
    OpenUrlCrossRefPubMed
  5. ↵
    1. Ferlay J,
    2. Colombet M,
    3. Soerjomataram I,
    4. Dyba T,
    5. Randi G,
    6. Bettio M,
    7. Gavin A,
    8. Visser O,
    9. Bray F
    : Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018. Eur J Cancer 103: 356-387, 2018. DOI: 10.1016/J.EJCA.2018.07.005
    OpenUrlCrossRefPubMed
  6. ↵
    1. Cancer Research UK
    . Cancer mortality for common cancers [Internet]. London, UK, Cancer Research UK. Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/mortality/common-cancers-compared [Last accessed on September 8, 2025]
  7. ↵
    1. Dostalek L,
    2. Runnebaum I,
    3. Raspagliesi F,
    4. Vergote I,
    5. Dusek L,
    6. Jarkovsky J,
    7. Cibula D
    : Oncologic outcome after completing or abandoning (radical) hysterectomy in patients with cervical cancer and intraoperative detection of lymph node positivity; ABRAX (ABandoning RAd hyst in cerviX cancer). Int J Gynecol Cancer 30(2): 261-264, 2020. DOI: 10.1136/ijgc-2019-000890
    OpenUrlAbstract/FREE Full Text
  8. ↵
    1. Pomel C,
    2. Martinez A,
    3. Bourgin C,
    4. Beguinot M,
    5. Benoit C,
    6. Naik R,
    7. Dauplat J,
    8. Lebouedec G,
    9. Ferron G
    : Survival effect of laparoscopic para-aortic staging in locally advanced cervical cancer: a retrospective cohort analysis. BJOG 124(7): 1089-1094, 2017. DOI: 10.1111/1471-0528.14492
    OpenUrlCrossRefPubMed
  9. ↵
    1. Reed N,
    2. Balega J,
    3. Barwick T,
    4. Buckley L,
    5. Burton K,
    6. Eminowicz G,
    7. Forrest J,
    8. Ganesan R,
    9. Harrand R,
    10. Holland C,
    11. Howe T,
    12. Ind T,
    13. Iyer R,
    14. Kaushik S,
    15. Music R,
    16. Sadozye A,
    17. Shanbhag S,
    18. Siddiqui N,
    19. Syed S,
    20. Percival N,
    21. Whitham NL,
    22. Nordin A,
    23. Fotopoulou C
    : British Gynaecological Cancer Society (BGCS) cervical cancer guidelines: Recommendations for practice. Eur J Obstet Gynecol Reprod Biol 256: 433-465, 2021. DOI: 10.1016/j.ejogrb.2020.08.020
    OpenUrlCrossRefPubMed
  10. ↵
    1. Chen J,
    2. Kitzing YX,
    3. Lo G
    : Systematic review-role of MRI in cervical cancer staging. Cancers (Basel) 16(11): 1983, 2024. DOI: 10.3390/cancers16111983
    OpenUrlCrossRefPubMed
  11. ↵
    1. He T,
    2. Sun J,
    3. Wu J,
    4. Wang H,
    5. Liang C,
    6. Wang H,
    7. Li S,
    8. Su S
    : PET-CT versus MRI in the diagnosis of lymph node metastasis of cervical cancer: A meta-analysis. Microsc Res Tech 85(5): 1791-1798, 2022. DOI: 10.1002/jemt.24039
    OpenUrlCrossRefPubMed
  12. ↵
    1. Peters M,
    2. de Leeuw AAC,
    3. Nomden CN,
    4. Tanderup K,
    5. Kirchheiner K,
    6. Lindegaard JC,
    7. Kirisits C,
    8. Haie-Meder C,
    9. Sturdza A,
    10. Fokdal L,
    11. Mahantshetty U,
    12. Hoskin P,
    13. Segedin B,
    14. Bruheim K,
    15. Rai B,
    16. Huang F,
    17. Cooper R,
    18. van der Steen-Banasik E,
    19. van Limbergen E,
    20. Pieters BR,
    21. Tan LT,
    22. van Rossum PSN,
    23. Nesvacil N,
    24. Nout R,
    25. Schmid MP,
    26. Pötter R,
    27. Jürgenliemk-Schulz IM, EMBRACE Collaborative Group
    : Risk factors for nodal failure after radiochemotherapy and image guided brachytherapy in locally advanced cervical cancer: An EMBRACE analysis. Radiother Oncol 163: 150-158, 2021. DOI: 10.1016/j.radonc.2021.08.020
    OpenUrlCrossRefPubMed
  13. ↵
    1. Nomden CN,
    2. Pötter R,
    3. de Leeuw AAC,
    4. Tanderup K,
    5. Lindegaard JC,
    6. Schmid MP,
    7. Fortin I,
    8. Haie-Meder C,
    9. Mahantshetty U,
    10. Hoskin P,
    11. Segedin B,
    12. Bruheim K,
    13. Rai B,
    14. Huang F,
    15. Cooper R,
    16. Van Der Steen Banasik E,
    17. Van Limbergen E,
    18. Jürgenliemk-Schulz IM, EMBRACE Collaborative Group
    : Nodal failure after chemo-radiation and MRI guided brachytherapy in cervical cancer: Patterns of failure in the EMBRACE study cohort. Radiother Oncol 134: 185-190, 2019. DOI: 10.1016/j.radonc.2019.02.007
    OpenUrlCrossRefPubMed
  14. ↵
    1. McCormack M,
    2. Eminowicz G,
    3. Gallardo D,
    4. Diez P,
    5. Farrelly L,
    6. Kent C,
    7. Hudson E,
    8. Panades M,
    9. Mathew T,
    10. Anand A,
    11. Persic M,
    12. Forrest J,
    13. Bhana R,
    14. Reed N,
    15. Drake A,
    16. Adusumalli M,
    17. Mukhopadhyay A,
    18. King M,
    19. Whitmarsh K,
    20. McGrane J,
    21. Colombo N,
    22. Mak C,
    23. Mandal R,
    24. Chowdhury RR,
    25. Alamilla-Garcia G,
    26. Chávez-Blanco A,
    27. Stobart H,
    28. Feeney A,
    29. Vaja S,
    30. Hacker AM,
    31. Hackshaw A,
    32. Ledermann JA, INTERLACE investigators
    : Induction chemotherapy followed by standard chemoradiotherapy versus standard chemoradiotherapy alone in patients with locally advanced cervical cancer (GCIG INTERLACE): an international, multicentre, randomised phase 3 trial. Lancet 404(10462): 1525-1535, 2024. DOI: 10.1016/S0140-6736(24)01438-7
    OpenUrlCrossRefPubMed
  15. ↵
    1. Akkus Yildirim B,
    2. Onal C,
    3. Erbay G,
    4. Cem Guler O,
    5. Karadeli E,
    6. Reyhan M,
    7. Koc Z
    : Prognostic values of ADCmean and SUVmax of the primary tumour in cervical cancer patients treated with definitive chemoradiotherapy. J Obstet Gynaecol (Lahore) 39(2): 224-230, 2019. DOI: 10.1080/01443615.2018.1492528
    OpenUrlCrossRefPubMed
  16. ↵
    1. Landoni F,
    2. Maneo A,
    3. Colombo A,
    4. Placa F,
    5. Milani R,
    6. Perego P,
    7. Favini G,
    8. Ferri L,
    9. Mangioni C
    : Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet 350(9077): 535-540, 1997. DOI: 10.1016/S0140-6736(97)02250-2
    OpenUrlCrossRefPubMed
  17. ↵
    1. Cibula D,
    2. Raspollini MR,
    3. Planchamp F,
    4. Centeno C,
    5. Chargari C,
    6. Felix A,
    7. Fischerová D,
    8. Jahnn-Kuch D,
    9. Joly F,
    10. Kohler C,
    11. Lax S,
    12. Lorusso D,
    13. Mahantshetty U,
    14. Mathevet P,
    15. Naik R,
    16. Nout RA,
    17. Oaknin A,
    18. Peccatori F,
    19. Persson J,
    20. Querleu D,
    21. Bernabé SR,
    22. Schmid MP,
    23. Stepanyan A,
    24. Svintsitskyi V,
    25. Tamussino K,
    26. Zapardiel I,
    27. Lindegaard J
    : ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer - Update 2023. Int J Gynecol Cancer 33(5): 649-666, 2023. DOI: 10.1136/ijgc-2023-004429
    OpenUrlAbstract/FREE Full Text
  18. ↵
    1. Eifel PJ,
    2. Winter K,
    3. Morris M,
    4. Levenback C,
    5. Grigsby PW,
    6. Cooper J,
    7. Rotman M,
    8. Gershenson D,
    9. Mutch DG
    : Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of Radiation Therapy Oncology Group Trial (RTOG) 90-01. J Clin Oncol 22(5): 872-880, 2004. DOI: 10.1200/JCO.2004.07.197
    OpenUrlAbstract/FREE Full Text
  19. ↵
    1. Ghaneh P,
    2. Hanson R,
    3. Titman A,
    4. Lancaster G,
    5. Plumpton C,
    6. Lloyd-Williams H,
    7. Yeo ST,
    8. Edwards RT,
    9. Johnson C,
    10. Abu Hilal M,
    11. Higginson AP,
    12. Armstrong T,
    13. Smith A,
    14. Scarsbrook A,
    15. McKay C,
    16. Carter R,
    17. Sutcliffe RP,
    18. Bramhall S,
    19. Kocher HM,
    20. Cunningham D,
    21. Pereira SP,
    22. Davidson B,
    23. Chang D,
    24. Khan S,
    25. Zealley I,
    26. Sarker D,
    27. Al Sarireh B,
    28. Charnley R,
    29. Lobo D,
    30. Nicolson M,
    31. Halloran C,
    32. Raraty M,
    33. Sutton R,
    34. Vinjamuri S,
    35. Evans J,
    36. Campbell F,
    37. Deeks J,
    38. Sanghera B,
    39. Wong WL,
    40. Neoptolemos JP
    : PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer. Health Technol Assess 22(7): 1-114, 2018. DOI: 10.3310/hta22070
    OpenUrlCrossRefPubMed
  20. ↵
    1. Nuffield Trust
    . Cancer waiting time targets [Internet]. London, UK, Nuffield Trust, 2023. Available atm: https://www.nuffieldtrust.org.uk/resource/cancer-waiting-time-targets [Last accessed on September 8, 2025]
  21. ↵
    1. Bukkems LJH,
    2. Jürgenliemk-Schulz IM,
    3. van der Leij F,
    4. Peters M,
    5. Gerestein CG,
    6. Zweemer RP,
    7. van Rossum PSN
    : The impact of para-aortic lymph node irradiation on disease-free survival in patients with cervical cancer: A systematic review and meta-analysis. Clin Transl Radiat Oncol 35: 97-103, 2022. DOI: 10.1016/j.ctro.2022.05.006
    OpenUrlCrossRefPubMed
  22. ↵
    1. Dejanovic D,
    2. Hansen NL,
    3. Loft A
    : PET/CT variants and pitfalls in gynecological cancers. Semin Nucl Med 51(6): 593-610, 2021. DOI: 10.1053/j.semnuclmed.2021.06.006
    OpenUrlCrossRefPubMed
  23. ↵
    1. Wheeler KC,
    2. Goldstein SR
    : Transvaginal ultrasound for the diagnosis of abnormal uterine bleeding. Clin Obstet Gynecol 60(1): 11-17, 2017. DOI: 10.1097/GRF.0000000000000257
    OpenUrlCrossRefPubMed
Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools
Reprints and Permissions
Comparative Analysis of FDG-PET Versus CT/MRI in Staging and Management of Advanced-stage Cervical Cancer
MAHWISH NAYAB, MOSTAFA ELNAGGAR, VIREN ASHER, ANISH BALI, SUMMI ABDUL, MOJCA PERSIC, ANDREW PHILLIPS
Anticancer Research Dec 2025, 45 (12) 5503-5511; DOI: 10.21873/anticanres.17885
Twitter logo Facebook logo Mendeley logo

Jump to section

Keywords