Impact of FDG PET-CT imaging on the decision making in the biologic suspicion of ovarian carcinoma recurrence
Introduction
Ovarian carcinoma is one of the most common gynecologic malignancies and has a poor prognosis. Most of the time, the diagnosis is made at an advanced stage. Recurrence is frequent, especially in the 2 years following the first-line therapy. Monitoring of the serum tumor marker CA-125 is the reference method for the detection of ovarian carcinoma recurrences with a positive predictive value close to 100%, when there is an increased CA-125 on several measures [1], [2], [3]. However, it does not allow to localize the recurrence nor to differentiate between localized and diffuse disease. Because CA-125 is essentially expressed by serous ovarian carcinoma, it has limited value in the follow-up of the other histologic forms. CA-125 has a relatively low specificity and can be increased in case of inflammation of serous tissues, endometriosis and non-ovarian carcinoma such as hepatic or pancreatic carcinoma.
Despite recent progress in diagnostic imaging, especially MR imaging and helical CT with contrast enhancement, detection of the sites of recurrence using these conventional imaging modalities can be difficult, in particular in the small peritoneal lesions and in case of peritoneal abnormalities due to post-surgical modifications [4], [5]. (18F)-fluoro-d-deoxyglucose positron emission tomography (FDG PET) has demonstrated its usefulness in the early detection of the site of recurrence with an accuracy range from 79% to 96% [6], [7], [8], [9], [10], [11], [12]. Integrated PET-CT has shown to be more sensitive than either technique alone by combining metabolic and anatomic information [7], [13], [14], [15]. However, its impact on the patient management has not yet been assessed. We therefore conducted a questionnaire-based prospective study to evaluate the impact of integrated PET-CT on the decision making in suspicion of ovarian carcinoma recurrence because of an increased CA-125.
Section snippets
Patients characteristics
From October 2004 to November 2006, 29 patients (mean age = 61 years, range 44–80), presenting with a suspected ovarian carcinoma recurrence because of increased CA-125 (mean = 160 IU/ml, median = 75 IU/ml, range 33–1930, Standard Deviation (SD) = 351), were included in this prospective study. The patients were referred by oncologists who had agreed to participate to our questionnaire-based study (see below). The rising of CA-125 was confirmed on at least 2 measures. The characteristics of patients and
Comparison of CT and PET-CT results
The CT scan was positive in 22/29 patients (76%) and negative in 7/29 patients (24%). The PET-CT scan was positive in 27/29 patients (93%) and negative in 2/29 (7%) patients. Table 2 details the distribution of lesions on the CT and PET-CT scans. In 5 patients with negative CT scan but positive PET-CT scan, the FDG PET findings were localized in the peritoneum: perihepatic and perisplenic areas (n = 1); pelvis (n = 1); diffuse carcinomatosis (n = 1, Fig. 1); lymph node abnormalities were also found
PET-CT results
With an accuracy range from 79% to 96% (6–12), PET-CT imaging improves the overall sensitivity and specificity of ovarian tumor recurrence detection, as compared to CT scan and PET scan alone [9], [13], [17].
In our study, the sensitivity of PET-CT imaging was higher than that of CT with 27/29 positive PET-CT scans (93%) compared to 22 positive CT scans (76%), as shown in Table 2. Our results are in agreement with the results of Simcock et al. [18], for whom PET-CT scan was positive in all but
Conclusion
In our prospective study, which evaluated the impact of FDG PET-CT imaging on the decision making, a change of the therapeutic strategy was obtained in approximately one third of patients presenting with a suspected ovarian carcinoma recurrence because of increased CA-125. PET-CT imaging allows a better restaging than CT imaging alone, and the impact on the decision making is particularly obvious in patients with negative CT scan because detection of the recurrence sites may lead to administer
Acknowledgments
This study was supported by the Comité départemental de la Ligue Contre le Cancer des Hauts de Seine.
We would like to thank Pr Francois Goldwasser, Dr Gérard Auclerc, Dr Yves Otmezguine, and Dr Paul-Henri Cottu for their contribution to this study.
References (26)
- et al.
The CA 125 assay as a predictor of clinical recurrence in epithelial ovarian cancer
Am J Obstet Gynecol
(1986) - et al.
Long-term follow-up of ovarian cancer with monthly determinations of serum CA 125
Gynecol Oncol
(1992) - et al.
Clinically occult recurrent ovarian cancer: patient selection for secondary cytoreductive surgery using combined PET/CT
Gynecol Oncol
(2003) - et al.
Positron emission tomography for detecting clinically occult surgically resectable metastatic ovarian cancer
Gynecol Oncol
(2002) - et al.
Clinical Impact of 18F-FDG-PET in the suspicion of recurrent ovarian carcinoma based on elevated tumor marker serum levels
Clin Positron Imaging
(2000) - et al.
2-[Fluorine-18]-fluoro-2-deoxy-d-glucose positron emission tomography in the diagnosis of recurrent ovarian cancer
Gynecol Oncol
(2001) - et al.
Positron emission tomography/computed tomography imaging for the detection of recurrent ovarian and fallopian tube carcinoma: a retrospective review
Gynecol Oncol
(2002) - et al.
Evaluation of integrated whole-body PET/CT in the detection of recurrent ovarian cancer
Eur J Radiol
(2005) - et al.
The impact of PET/CT in the management of recurrent ovarian cancer
Gynecol Oncol
(2006) - et al.
Positive emission tomography for evaluating a complete clinical response in patients with ovarian or peritoneal carcinoma: correlation with second-look laparotomy
Gynecol Oncol
(2001)
Treatment of relapsed carcinoma of the ovary with cisplatin or carboplatin following initial treatment with these compounds
Gynecol Oncol
Cancer of the ovary
N Engl J Med
Peritoneal metastases: detection with spiral CT in patients with ovarian cancer
Radiology
Cited by (62)
Ovarian Cancer
2022, Oncologic Imaging: A Multidisciplinary ApproachThe Value of PET-CT in Ovarian Epithelial Carcinoma: A Population-Based Study in British Columbia, Canada
2020, Journal of Medical Imaging and Radiation SciencesCitation Excerpt :In the context of recurrence, PET/CT in comparison with conventional imaging may further alter known disease distribution [13,14]. PET/CT results may also change management in a third to just over a half of recurrent cases [4,13,14]. However, how these early management changes impact patient quality of life (QoL) and progression-free and overall survival is unknown.
The emerging roles of functional imaging in ovarian cancer with peritoneal carcinomatosis
2018, Clinical RadiologyAccuracy of 18F-FDG PET/CT in detection and restaging of recurrent ovarian cancer
2017, Egyptian Journal of Radiology and Nuclear MedicineCitation Excerpt :(18FDG) PET/CT has serious role in the detection of the recurrence of ovarian cancer depending on increased metabolic tracer uptake of the lesion, also the coalition of the anatomical images with the metabolic ones help in precise determination of the location of the lesion and enable its ability for whole body scanning. The role of PET/CTin the cases of recurrent ovarian cancer was assessed in many studies [12,14–20]. The sensitivity of FDG PET/CT in detection of recurrence of ovarian cancer is 85–100% [21].
F-18 FDG PET/CT metabolic tumor volume predicts overall survival in patients with disseminated epithelial ovarian cancer
2017, European Journal of RadiologyOmental deposits surveillance in gynecological malignancies at first setting follow up: <sup>18</sup>F-FDG PET/CT compared to CT
2017, Egyptian Journal of Radiology and Nuclear Medicine