Integrated FDG PET/CT in Patients with Persistent Ovarian Cancer: Correlation with Histologic Findings

Sironi, Sandro; Messa, Cristina; Mangili, Giorgia; Zangheri, Barbara; Aletti, Giovanni; Garavaglia, Elisabetta; Viganò, Riccardo; Picchio, Maria; Taccagni, Gianluca; Maschio, Alessandro Del; Fazio, Ferruccio

doi:10.1148/radiol.2332031800

Cited by 161 publications

(76 citation statements)

References 34 publications

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“…PET/CT performed better than did CE CT in the detection of paraaortic lymph node involvement. Our results are similar to those of Sironi et al ( 16 ), who reported that PET/CT was better for detecting peritoneal and lymph node metastases than for detecting pelvic local recurrence.…”

Section: Discussionsupporting

confidence: 91%

“…In the prior studies, researchers found that accuracy, sensitivity, and specifi city were 63%-100%, 73%-100%, and 40%-100%, respectively, at the patient level and 72%-96%, 41%-78%, and 75%-99%, respectively, at the region level ( 14,16,17,20,(25)(26)(27)(28)(29)(30). In these prior studies, the diagnostic The number, size (on CE CT and PET/CT images) and SUV max (on PET/CT images) of peritoneal deposits (for all three readers) and of distant (M1) lymph node metastases (readers 1 and 2 only) were signifi cantly associated with poor survival ( Table 5 ).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that, among patients who are suspected of having ovarian cancer recurrence, PET/CT has the greatest utility in those patients with rising CA 125 levels and negative conventional imaging results (13)(14)(15)(16)(17). Furthermore, three recent prospective studies have shown that PET/CT can help modify patient treatment by demonstrating the distribution of recurrent ovarian cancer (18)(19)(20).…”

Section: Patient Characteristicsmentioning

confidence: 99%

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Recurrent Ovarian Cancer: Use of Contrast-enhanced CT and PET/CT to Accurately Localize Tumor Recurrence and to Predict Patients’ Survival

Sala¹,

Kataoka²,

Pandit‐Taskar³

et al. 2010

Radiology

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Purpose:To compare accuracy and interobserver variability in the detection and localization of recurrent ovarian cancer with contrast material-enhanced (CE) computed tomography (CT) and positron emission tomography (PET)/CT and determine whether imaging fi ndings can be used to predict survival. Materials and Methods:Waiving informed consent, the institutional review board approved this HIPAA-compliant, retrospective study of 35 women (median age, 54.4 years) with histopathologically proven recurrent ovarian carcinoma who underwent CE CT and PET/CT before exploratory surgery. All CE CT and PET /CT scans were independently analyzed. Tumor presence, number of lesions, and the size and maximum standardized uptake value (SUV max ) of the largest lesion were recorded for patient and region. Surgical histopathologic fi ndings constituted the reference standard. Areas under the receiver operating characteristic curves (AUCs), k statistics, and hazard ratios were calculated. Results:Readers' AUCs in detection of recurrence for region were 0.85 (95% confi dence interval [CI]: 0.81, 0.90) and 0.78 (95% CI: 0.72, 0.83) for CE CT and 0.84 (95% CI: 0.79, 0.89) and 0.74 (95% CI: 0.67, 0.81) for PET/CT ( P = .76); 12 patients died. At PET/CT, size, number, and SUV max of peritoneal deposits were signifi cantly associated with poor survival for readers 1 and 2 ( P Յ .01 and Յ .05, respectively), as were long-and short-axis diameters, number, and SUV max of distant lymph nodes for reader 1 ( P Յ .001).With CE CT, size (reader 1) and number (readers 1 and 3) of peritoneal deposits were signifi cantly associated with poor survival ( P Յ .01), as were long-and short-axis diameters and number of distant lymph nodes for reader 1 ( P Յ .01). Interobserver agreement ranged from fair (patient, k = 0.30) to moderate (region, k = 0.55) for CE CT and fair (patient, k = 0.24) to substantial (region, k = 0.63) for PET/CT. Conclusion:Preliminary data suggest that CE CT and PET/CT may have similar accuracy in detection of recurrent ovarian cancer. Tumor size, number, and SUV max may have potential as prognostic biomarkers for patients with recurrent ovarian cancer.q RSNA, 2010

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Patient Characteristicsmentioning

confidence: 99%

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Recurrent Ovarian Cancer: Use of Contrast-enhanced CT and PET/CT to Accurately Localize Tumor Recurrence and to Predict Patients’ Survival

Sala¹,

Kataoka²,

Pandit‐Taskar³

et al. 2010

Radiology

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“…In fact, obtaining histopathologic confirmation is not very common, because the patients are mostly treated with chemotherapy. On the other hand, patients with a positive PET/CT and high CA125 levels had a recurrence of disease more frequently, and therefore (13). Small implants (<5 mm) and low disease volumes are inconsistently recognized, particularly in upper abdomen quadrants including the hepatic dome, epigastrium, and left upper abdomen.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic and prognostic evaluation of fluorodeoxyglucose positron emission tomography/computed tomography and its correlation with serum cancer antigen-125 (CA125) in a large cohort of ovarian cancer patients

Evangelista

Palma

Gregianin

et al. 2015

J Turkish German Gynecol Assoc

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Ovarian cancer (OC) accounts for approximately 3% of cancers in women; 125,000 women are estimated to die of the disease each year. OC is curable when identified at an early stage. However, because there is no effective screening test for this tumor and its symptoms are vague, approximately 70-80% of patients are diagnosed at an advanced stage of the disease (stage III and IV, in accordance with the International Federation of Gynecology and Obstetrics (FIGO)); this means that the survival rate is low (1). More than 70% of stage III-IV patients have a relapse of the disease, and even in stage I or II, the relapse rate is 20-25% (2). The serial evaluation of serum cancer antigen-125 (CA125) can be useful to non-invasively detect the recurrence of disease because an elevation in CA125 levels can determine the presence of disease with a high accuracy of 79% to 95%, thus preceding a clinically apparent recurrence by 3 to 6 months (3, 4). However, normal CA125 levels cannot exclude the presence of recurrent Objective: We evaluated the efficacy of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in recurrent disease, response to therapy, and long-term follow-up of ovarian cancer (OC) patients in relation to cancer antigen-125 (CA125) levels and the prognostic meaning of this modality in this subset of subjects. Material and Methods:Between 2005 and 2015, we retrospectively evaluated 125 patients affected by OC who underwent FDG PET/CT imaging at our institution. The indications for PET/CT were recurrence of disease in 78 patients, therapy response assessment in 29, and follow-up in 18. The results of FDG PET/CT were compared with those of histopathology and clinical and radiological progression during follow-up for at least 6 months. The median long-term follow-up was 33 months. The diagnostic accuracies for the different clinical settings were evaluated. The relationships among global survival (GS), FDG PET/CT results, and CA125 levels were evaluated by both Kaplan-Meier and Cox regression analysis.Results: CA125 results were positive (>35 UI/mL) in 62 patients and negative in 63 (49% vs. 51%). The sensitivity and specificity of CA125 were 72% and 91%, respectively. PET/CT imaging showed a sensitivity of 98.6% and a specificity of 77.8% for the assessment of recurrent disease, and a sensitivity of 72.7% and a specificity of 88.9% for therapy evaluation. Meanwhile, in 18 patients evaluated during follow-up, the specificity was 82.3%. GS was significantly higher in case of negative CA125 values at the time of FDG PET/CT, of a negative PET/CT scan and when no evidence of peritoneum recurrence and distant metastases was determined by PET. Multivariate regression analysis showed that only age and peritoneum recurrence as determined by PET were identified as independent predictors of poor prognosis. Conclusion:Metabolic imaging with FDG PET/CT proved useful in patients where OC recurrence was suspected, even when the value of tumor marker CA125 was in a normal range. A positive PET/CT ...

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“…Combined PET/CT is more advantageous in terms of spatial resolution than PET, due to a more precise anatomical localization by accompanying CT images. Several reports established the improvement of the diagnostic accuracy of metastatic lymphadenopathies in patients with primary or recurrent ovarian cancer (11,(18)(19)(20)(21). In our study, both the sensitivities of pelvic lymph node and paraaortic lymph node metastases were low for both CT or MRI and 18 F-FDG PET/CT.…”

Section: Discussionmentioning

confidence: 99%

Comparison of CT or MRI and₁₈F-FDG PET/CT for the Preoperative Staging Accuracy of Ovarian Cancer

Jung

Lee

et al. 2009

J Korean Soc Radiol

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Ovarian cancer has the highest mortality rate of all gynecologic malignant tumors. An exploratory laparotomy is performed when a pelvic tumor is suspected of being malignant. The tumor stage is determined after an exploratory laparatomy and a thorough evaluation of all the specific lesions at risk in accordance with the recommendations of the International Federation of Gynecology and Obstetrics (FIGO) (1).Computed tomography (CT), Magnetic resonance imaging (MRI), and positron Emission Tomography (PET) have also been investigated as supplementary diagnostic tools for ovarian cancer. The accuracy of CT in

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Integrated FDG PET/CT in Patients with Persistent Ovarian Cancer: Correlation with Histologic Findings

Abstract: Integrated PET/CT depicts persistent ovarian carcinoma with a high positive predictive value.

Cited by 161 publications

References 34 publications

Recurrent Ovarian Cancer: Use of Contrast-enhanced CT and PET/CT to Accurately Localize Tumor Recurrence and to Predict Patients’ Survival

Recurrent Ovarian Cancer: Use of Contrast-enhanced CT and PET/CT to Accurately Localize Tumor Recurrence and to Predict Patients’ Survival

Diagnostic and prognostic evaluation of fluorodeoxyglucose positron emission tomography/computed tomography and its correlation with serum cancer antigen-125 (CA125) in a large cohort of ovarian cancer patients

Comparison of CT or MRI and₁₈F-FDG PET/CT for the Preoperative Staging Accuracy of Ovarian Cancer

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Integrated FDG PET/CT in Patients with Persistent Ovarian Cancer: Correlation with Histologic Findings

Abstract: Integrated PET/CT depicts persistent ovarian carcinoma with a high positive predictive value.

Cited by 161 publications

References 34 publications

Recurrent Ovarian Cancer: Use of Contrast-enhanced CT and PET/CT to Accurately Localize Tumor Recurrence and to Predict Patients’ Survival

Recurrent Ovarian Cancer: Use of Contrast-enhanced CT and PET/CT to Accurately Localize Tumor Recurrence and to Predict Patients’ Survival

Diagnostic and prognostic evaluation of fluorodeoxyglucose positron emission tomography/computed tomography and its correlation with serum cancer antigen-125 (CA125) in a large cohort of ovarian cancer patients

Comparison of CT or MRI and18F-FDG PET/CT for the Preoperative Staging Accuracy of Ovarian Cancer

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Comparison of CT or MRI and₁₈F-FDG PET/CT for the Preoperative Staging Accuracy of Ovarian Cancer