Question about SUV on PET/CT scan

[amylynn445]

I was treated for Primary Squamous Vaginal Cancer Stage I last year. I received chemo(cisplatin)/rads along with internal radiation treatment (SYED proceedure for 42 hrs as inpatient).

I was told that I have a very small area of necrotic scar tissue at the area of previous tumor. My rad/onco wanted to follow up on this further. So I had a biopsy which read: Minute focus of atypical squamous epithelium present, predominatly inflamed necrotic tissue with surface ulceration. It also added in comment section: Multiple biopsies predominatly consist of inflammatory necrotic debris. A single fragment of viable surface epithelium with underlying atypical squamous epithelium is present, can not rule out residual/recurrent squamous cell carcinoma. (My gyn/onco figured it would come back like this due to the radiation damage)

I then had a PET/CT scan and chest xray. Chest xray was unremarkable and clear. The PET/CT scan results: There is a focal increased glucose concentration noted in the pelvis most likely near the cervical region of the uterus. The peak SUV of this lesion is 8.2 The rest of the examination otherwise is unremarkable. There is no hypermetabolic lymphadenopathy seen. Elsewhere in the body is within normal limits. There is no evidence of metastic disease appreciated.

The CT of the pelvis read: There are metal clips noted in the lower pelvis about the cervical region of the uterus. There is no free fluid seen. No significant lymphadenopathy is appreciated. Compared to the previous exam, no obvious interval change is seen except for 2 metallic clips in the area of the cervix of the uterus.

I have since been sent to a well known clinic for a second opinion from a second gyno/onco. My physical exam revealed no visible abnormalities or findings (except for the known area of necrotic tissue). He said he was not impressed with the results I have had so far in indicating that I have cancer still in the same area and that this could be just necrotic tissue from the rad treatments. And that the "hot spot" although it is abnormal in the 8.2 SUV this does not make him feel definately that this is cancer. I was told this could be from all the healing that is going on and inflammation (I finished treatments 10 months ago, don't know how long it takes to heal from rad treatments)

Could this hot spot be caused from inflammation and necrotic tissue? And the CT scan did not mention any masses seen only the metallic clips left from the SYED proceedure. Could those metal clips cause the SUV to be abonormal? And is 8.2 SUV considered very high?

Sorry for such a long post and quesitons. I have been trying to find info. on SUV but there is little out there and it seems it is all relative to the individual's type of cancer. Vaginal cancer from my understanding is treated much like cervical cancer and there is little info. out there due to the rarity of vaginal cancer. Incidently, my tumor (in the beginning was between the size of a nickel and quarter as it was explained to me) was located in the upper left fornix of the vagina, right behind the cervix. It was found incidently on an annual exam, I was tense and unable to lie still due to nerves (had I not been, chances are this mass would not have been found until it was too late) I never had a single symptom that anything was wrong, I had a pap come back abnormal that triggered further investigation, and my cervix was found to be completely normal.

Thank you for your time in answering this post. It is appreciated.

[swanda]

2 years ago i went to gyn for regular check. i told them i had some discomfort around my 3rd and 4th day of my period. Only when inserting tampon. I had a lot of pain on the right side.  
They did all the usual tests and a internal sono. Seen nothing.  For the past 2 years I've just delt with pain.  The pain has become more often. Like if I sit for a long period of time or stand up quickly.  So I went back for the regular check and to discuss the pain.  All test came back good, but when they did the internal they finally seen what they called an open vaginal lesion on the upper area of the vagina.  I have a scheduled biopsy for Jan. 29 2010. The computer does not give you much information about this.  I have no other symptoms.  Everything  I read is so vage and so far doesn't pertain to my situation.  I'm very confused and nervous!

[amylynn445]

Also, I had just had a biopsy of the area 4 days prior to the PET/CT scan, the 2nd opinion oncologist also said that inflammation/healing can cause abnormal results.

I was shocked to see that I had metal clips in my cervix!