Impact of ¹⁸F-FDG PET on the Management in Patients With Recurrent Gynecologic cancer: A Meta-analysis

PURPOSE Gynecological cancer is the most prevalent cancer among women worldwide. We performed a meta-analysis to assess the impact of ¹⁸F-FDG PET on the management of patients with recurrent gynecological cancers, including cervical, uterine, and ovarian cancers. Methods We systematically searched MEDLINE and EMBASE databases for English-language publications. All published studies on the impact of PET scans on the management of patients with recurrent gynecological cancers were reviewed. The proportion of management change (%), defined as the percentage of patients whose management changed after FDG PET to those who underwent FDG PET, was calculated. The data from each study were analyzed using MedCalc Statistical Software version 14.12.0 (MedCalc Software, Ostend, Belgium). Results Nineteen studies including 6191 patients were eligible for inclusion. The impact of FDG PET scan for detecting recurrence/metastasis in patients with gynecologic cancer was evaluated using management change rates, ranging from 9.4% to 60.7% with a pooled effect of 42.0% (95% confidence interval [CI], 34.5%-49.6%; I² = 92.9%). In the subtype analysis, FDG PET scanning resulted in changes in the management in 48.5% (95% CI, 37.8%-59.3%; I² = 67.8%) of cervical cancer, 34.7% (95% CI, 33.4%-36.0%; I² = 0%) of uterine cancer, and 40.3% (95% CI, 26.7%-54.7%; I² = 95.2%) of ovarian cancer cases. Conclusions FDG PET has a significant impact on the restaging of patients with gynecological cancer. These findings suggest that FDG PET should be performed, especially in cases of suspected recurrence/metastasis in the main gynecologic cancer types, including cervical, ovarian, and uterine cancers.