Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-10-2008 | Review Article

Diagnostic accuracy of integrated FDG-PET/contrast-enhanced CT in staging ovarian cancer: comparison with enhanced CT

Authors: Kazuhiro Kitajima, Koji Murakami, Erena Yamasaki, Yasushi Kaji, Ichio Fukasawa, Noriyuki Inaba, Kazuro Sugimura

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 10/2008

Abstract

Purpose

The purpose of the study is to evaluate the accuracy of integrated positron emission tomography and computed tomography (PET/CT) with ¹⁸F-fluorodeoxyglucose (FDG) with IV contrast for preoperative staging of ovarian cancer, in comparison with enhanced CT, using surgical and histopathological findings as the reference standard.

Materials and methods

Forty patients with ovarian cancer underwent FDG-PET/contrast-enhanced CT scans for staging before primary debulking surgery. PET/CT and the CT component separately, were interpreted by two experienced radiologists by consensus for each investigation. Status with regard to lesion inside and outside the pelvis was determined on the basis of histopathology. The significance of differences between the two imaging modalities was determined using the McNemar test.

Results

Staging revealed stage I in 18 patients (IA, n = 9; IB, n = 3; IC, n = 6), stage II in seven (IIA, n = 2; IIB, n = 3; IIC, n = 2), stage III in 14 (IIIA, n = 1; IIIB, n = 3; IIIC, n = 10), and stage IV in one. The results of CT and PET/CT were concordant with the final pathological staging in 22 out of 40 (55%) and 30 out of 40 (75%) cases, respectively. The overall lesion-based sensitivity improved from 37.6% (32 out of 85) to 69.4% (59 out of 85), specificity from 97.1% (578 out of 595) to 97.5% (580 out of 595), and accuracy from 89.7% (610 out of 680) to 94.0% (639 out of 680) between CT and PET/CT. There were significant differences in sensitivity and accuracy, with p values of 5.6 × 10⁻⁷ and 1.2 × 10⁻⁷, respectively.

Conclusion

Integrated FDG-PET/contrast-enhanced CT is a more accurate imaging modality for staging ovarian cancer and useful for selecting appropriate treatment than enhanced CT.

Bristow RE, Duska LR, Lambrou NC, Fishmann EK, O’Neill MJ, Trimble EL, et al. A model for predicting surgical outcome in patients with advanced ovarian carcinoma using computed tomography. Cancer 2000;89:1532–40.PubMedCrossRef

Benedet JL, Jones 3rd, H, Hgan HY, Pecorelli S. FIGO staging classification and clinical practice guidelines in the management of gynecologic disease. Int J Gynecol Obstet. 2000;20:209–62.

Pignata S, Vermorken JB. Ovarian cancer in the elderly. Crit Rev Oncol/Hematol. 2004;49:77–86.CrossRef

McGuire WP, Hoskins WJ, Brady MF, Kucera PR, Partridge EE, Look KY, et al. Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer. N Eng J Med. 1996;334:1–6.CrossRef

Scarabelli C, Gallo A, Franceschi S, Compaqnutta E, De G, Giorda G, et al. Primary cytoreductive surgery with rectosigmoid colon resection for patients with advanced epithelial ovarian carcinoma. Cancer 2000;88:389–97.PubMedCrossRef

Vergote I, De Brabanter J, Fyles A, Bertelsen K, Einhort N, Sevelda P, et al. Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. Lancet 2001;357:176–82.PubMedCrossRef

Kuhn W, Rutke S, Spathe K, Schmalfeldt B, Florack G, von Hunalshansen B, et al. Neoadjuvant chemotherapy followed tumor debulking prolongs survival for patients with poor prognosis in FIGO IIIc ovarian carcinoma. Cancer 2001;92:2585–91.PubMedCrossRef

Nelson BE, Rosenfield AT, Schwartz PE. Preoperative abdominopelvic computed tomographic prediction of optimal cytoreduction in epithelial ovarian carcinoma. J Clin Oncol. 1993;11:166–72.PubMed

Forstner R, Hricak H, Occhipinti KA, Powell CB, Frankel SD, Stern JL. Ovarian cancer: staging with CT and MR imaging. Radiology 1995;197:619–26.PubMed

10.

Tempany CM, Zou KH, Silverman SG, Brown DL, Kurtz AB, McNeil BJ. Staging of advanced ovarian cancer: comparison of imaging modalities—report from the Radiological Diagnostic Oncology Group. Radiology 2000;215:761–7.PubMed

11.

Coakley FV. Staging ovarian cancer: role of imaging. Radiol Clin North Am. 2002;40:609–36.PubMedCrossRef

12.

Coakley FV, Choi PH, Gougoutas CA, Pothuri B, Venkatraman E, Chi D, et al. Peritoneal metastases: detection with spiral CT in patients with ovarian cancer. Radiology 2002;223:495–9.PubMedCrossRef

13.

Ricke J, Sehouli J, Hach C, Hanninen EL, Lichtenegger W, Felix R. Prospective evaluation of contrast-enhanced MRI in the depiction of peritoneal spread in primary or recurrent ovarian cancer. Eur Radiol. 2003;13:943–9.PubMedCrossRef

14.

Kurtz AB, Tsimikas JV, Tempany CMC, Hamper UM, Arger PH, Bree RL, et al. Diagnosis and staging of ovarian cancer: comparative values of Doppler and conventional US, CT, and MR imaging correlated with surgery and histopathologic analysis—report of the Radiology Diagnostic Oncology Group. Radiology 1999;212:19–27.PubMed

15.

Forstner R. Radiographical staging of ovarian cancer: Imaging findings and contribution of CT and MRI. Eur Radiol. 2007;17:3223–35.PubMedCrossRef

16.

Pannu HK, Bristow RE, Montz FJ, Fishman EK. Multidetector CT of peritoneal carcinomatosis from ovarian cancer. RadioGraphics 2003;23:687–701.PubMedCrossRef

17.

Huber S, Medl M, Baumann L, Czembirek H. Value of ultrasound and magnetic resonance imaging in the preoperative valuation of suspected ovarian masses. Anticancer Res. 2002;22:2501–8.PubMed

18.

Woodward PF, Hosseinzadeh K. Radiographic staging of ovarian carcinoma with pathologic correlation. RadioGraphics 2004;24:225–46.PubMedCrossRef

19.

Qayyum A, Coakley FV, Westphalen AC, Hricak H, Okuno WT, Powell B. Role of CT and MR imaging in predicting optimal cytoreduction of newly diagnosed primary epithelial ovarian cancer. Gynecol Oncology. 2005;96:301–6.CrossRef

20.

Mitchell DG, Hill MC, Hill S, Zaloudek C. Serous carcinoma of the ovary: CT identification of metastatic calcified implants. Radiology 1986;158:649–52.PubMed

21.

Beyer T, Townsend DW, Brun T, Kinahan PE, Charron M, Roddy R, et al. A combined PET/CT scanner for clinical oncology. J Nucl Med. 2000;41:1369–79.PubMed

22.

Bar-Shalom R, Yefremov N, Guralnik L, Gaitini D, Frenkel A, Kuten A, et al. Clinical performance of PET/CT in evaluation of cancer: Additional value for diagnostic imaging and patient management. J Nucl Med. 2003;44:1200–9.PubMed

23.

Bristow RE, Del Carmen MG, Pannu HK, Cohade C, Zahurak ML, Fishman EK, et al. Clinically occult recurrent ovarian cancer: Patient selection for secondary cytoreductive surgery using combined PET/CT. Gynecol Oncol. 2003;90:519–28.PubMedCrossRef

24.

Sironi S, Messa C, Mangili G, Zangheri B, Aletti G, Garevaglia E, et al. Integrated FDG PET/CT in patients with ovarian cancer: Correlation with histologic findings. Radiology 2004;233:433–40.PubMedCrossRef

25.

Pannu HK, Cohade C, Bristow RE, Fishman EK, Wahl RL. PET-CT detection of abdominal recurrence of ovarian cancer: Radiologic–surgical correlation. Abdom Imaging. 2004;39:398–403.

26.

Bristow RE, Giuntoli RL II, Pannu HK, Schulick RD, Fishman EK, Wahl RL. Combined PET/CT for detecting recurrent ovarian cancer limited to retroperitoneal lymph nodes. Gynecol Oncol. 2005;99:294–300.PubMedCrossRef

27.

Mangili G, Picchio M, Sironi S, Vigano R, Rabaiotti E, Bornaghi D, et al. Integrated PET/CT as a first-line re-staging modality in patients with suspected recurrence of ovarian cancer. Eur J Nucl Med Mol Imaging. 2007;34:658–66.PubMedCrossRef

28.

Chung HH, Kang WJ, Kim JW, Park NH, Song YS, Chung JK, et al. Role of [¹⁸F]FDG PET/CT in the assessment of suspected recurrent ovarian cancer: correlation with clinical or histological findings. Eur J Nucl Med Mol Imaging. 2007;34:480–6.PubMedCrossRef

29.

Yoshida Y, Kurokawa T, Kawahara K, Tsuchida T, Okazawa H, Fujibayashi Y, et al. Incremental benefits of FDG positron emission tomography over CT alone for the preoperative staging of ovarian cancer. AJR Am J Roentgenol. 2004;182:227–33.PubMed

30.

Castellucci P, Perrone AM, Picchio M, Ghi T, Farsad M, Nanni C, et al. Diagnostic accuracy of ¹⁸F-FDG PET/CT in characterizing ovarian lesions and staging ovarian cancer: Correlation with transvaginal ultrasonography, computed tomography, and histology. Nucl Med Commun. 2007;28:589–95.PubMedCrossRef

31.

Antoch G, Stattaus J, Nemat AT, Marnitz S, Beyer T, Kuehl H, et al. Non-small cell lung cancer: Dual-modality PET/CT in preoperative staging. Radiology 2003;229:526–33.PubMedCrossRef

32.

Antoch G, Saoudi N, Kuehl H, Dahmen G, Muller SP, Beyer T, et al. Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-d-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: Comparison with CT and PET. J Clin Oncol. 2004;22:4357–68.PubMedCrossRef

33.

Grab D, Flock F, Stohr I, Nussle K, Rieber A, Fenchel S, et al. Classification of asymptomatic adnexal masses by ultrasound, magnetic resonance imaging, and positron emission tomography. Gynecol Oncol. 2000;77:454–9.PubMedCrossRef

34.

Rieber A, Nussle K, Stohr I, Grab D, Fenchel S, Kreienberg R, et al. Preoperative diagnosis of ovarian tumors with MR imaging: comparison with transvaginal sonography, positron emission tomography, and histologic findings. AJR Am J Roentgenol. 2001;177:123–9.PubMed

35.

Risum S, Hogdall C, Loft A, Berthelsen AK, Hogdall E, Nedergaard L, et al. The diagnostic value of PET/CT for primary ovarian cancer—A prospective study. Gynecol Oncol. 2007;105:145–9.PubMedCrossRef

36.

Sironi S, Buda A, Picchio M, Perego P, Moreni R, Pollegrino A, et al. Lymph node metastasis in patients with clinically early stage cervical cancer: Detection with integrated FDG PET/CT. Radiology 2006;238:272–9.PubMedCrossRef

37.

Mawlawi O, Erasmus JJ, Munden RF, Pan T, Knight AE, Macapinlac HA, et al. Quantifying the effect of IV contrast media on integrated PET/CT: clinical evaluation. AJR Am J Roentgenol. 2006;186:308–19.PubMedCrossRef

Title: Diagnostic accuracy of integrated FDG-PET/contrast-enhanced CT in staging ovarian cancer: comparison with enhanced CT
Authors: Kazuhiro Kitajima
Koji Murakami
Erena Yamasaki
Yasushi Kaji
Ichio Fukasawa
Noriyuki Inaba
Kazuro Sugimura
Publication date: 01-10-2008
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 10/2008
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-008-0890-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diagnostic accuracy of integrated FDG-PET/contrast-enhanced CT in staging ovarian cancer: comparison with enhanced CT

Abstract

Purpose

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2008

EANM procedure guideline for treatment of refractory metastatic bone pain

Detection of bone metastases in patients with prostate cancer by 18F fluorocholine and 18F fluoride PET–CT: a comparative study

Concordance between results of somatostatin receptor scintigraphy with 111In-DOTA-DPhe1-Tyr3-octreotide and chromogranin A assay in patients with neuroendocrine tumours

Chemotherapy response assessment in stage IV melanoma patients—comparison of 18F-FDG-PET/CT, CT, brain MRI, and tumormarker S-100B

Selective hepatic arterial infusion of In-111-DTPA-Phe1-octreotide in neuroendocrine liver metastases

Macrocyclic chelator-coupled gastrin-based radiopharmaceuticals for targeting of gastrin receptor-expressing tumours