Radiologic Detection of Pulmonary Metastatic and Non-Metastatic Disease in Gynecologic Malignancies: Diagnostic Accuracy and Clinical Impact: A Systematic Literature Review

Abstract

Background: Pulmonary involvement is a recognized manifestation of advanced gynecologic malignancies and represents a critical determinant of disease staging, prognosis, and therapeutic planning. Radiologic imaging remains the cornerstone for detecting pulmonary metastatic and non-metastatic disease; however, diagnostic performance varies significantly across imaging modalities and tumor subtypes.

Objective: To systematically review the diagnostic accuracy and clinical impact of radiologic imaging techniques in detecting pulmonary metastatic and non-metastatic disease in gynecologic malignancies.

Methods: A systematic search of PubMed/MEDLINE, Embase, Scopus, and Web of Science was conducted for studies published up to December 2024. Eligible studies evaluated radiologic imaging modalities—chest radiography, computed tomography (CT), positron emission tomography–computed tomography (PET-CT), and magnetic resonance imaging (MRI)—in adult women with gynecologic cancers. Diagnostic accuracy measures and impact on clinical management were synthesized qualitatively.

Results: Twenty-seven studies comprising over 8,500 patients were included. CT demonstrated high sensitivity for pulmonary metastases, while PET-CT offered superior specificity and staging accuracy. Non-metastatic pulmonary findings frequently mimicked metastatic disease, particularly on CT, underscoring the importance of multimodality imaging and clinical correlation.

Conclusion:  Radiologic imaging plays a pivotal role in pulmonary assessment of gynecologic malignancies. CT remains the diagnostic backbone, whereas PET-CT provides added clinical value in staging and management. Standardized imaging pathways are required to optimize diagnostic accuracy and avoid overtreatment.