Background: The reproducibility of positron emission tomography (PET) radiomics features is affected by several factors, such as scanning equipment, drug metabolism time and reconstruction algorithm. We aimed to explore the role of 3D local binary pattern (LBP)-based texture in increasing the accuracy and reproducibility of PET radiomics for predicting pelvic lymph node metastasis (PLNM) in patients with cervical cancer. Methods: We retrospectively analysed data from 177 patients with cervical squamous cell carcinoma. They underwent F-18-fluorodeoxyglucose (F-18-FDG)whole-body PET/computed tomography (PET/CT), followed by pelvic F-18-FDG PET/magnetic resonance imaging (PET/MR). We selected reproducible and informative PET radiomics features using Lin's concordance correlation coefficient, least absolute shrinkage and selection operator algorithm, and established 4 models, PET/CT, PET/CT-fusion, PET/MR and PET/MR-fusion, using the logistic regression algorithm. We performed receiver operating characteristic (ROC) curve analysis to evaluate the models in the training data set (65 patients who underwent radical hysterectomy and pelvic lymph node dissection) and test data set (112 patients who received concurrent chemoradiotherapy or no treatment). The DeLong test was used for pairwise comparison of the ROC curves among the models. Results: The distribution of age, squamous cell carcinoma (SCC), International Federation of Gynaecology and Obstetrics stage and PLNM between the training and test data sets were different (P < 0.05). The LBP-transformed radiomics features (50/379) had higher reproducibility than the original radiomics features (9/107). Accuracy of each model in predicting PLNM was as follows: training data set: PET/CT = PET/CT-fusion = PET/MR-fusion (0.848) and test data set: PET/CT = PET/CT-fusion (0.985) > PET/MR = PET/MR-fusion (0.954). There was no statistical difference between the ROC curve of PET/CT and PET/MR models in both data sets (P > 0.05). Conclusions: The LBP-transformed radiomics features based on PET images could increase the accuracy and reproducibility of PET radiomics in predicting pelvic lymph node metastasis in cervical cancer to allow the model to be generalised for clinical use across multiple centres.