Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-04-2007 | Original article

Role of [¹⁸F]FDG PET/CT in the assessment of suspected recurrent ovarian cancer: correlation with clinical or histological findings

Authors: Hyun Hoon Chung, Won Jun Kang, Jae Weon Kim, Noh-Hyun Park, Yong-Sang Song, June-Key Chung, Soon-Beom Kang, Hyo-Pyo Lee

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 4/2007

Abstract

Purpose

To evaluate the accuracy of integrated positron emission tomography (PET) and computed tomography (CT) for depiction of suspected recurrent ovarian carcinoma after treatment, with use of clinical or histological findings as the reference standard.

Methods

Seventy-seven women (median age, 51 years) with ovarian carcinoma treated with primary cytoreductive surgery followed by platinum-based combination chemotherapy were included, and [¹⁸F]fluorodeoxyglucose (FDG) PET/CT was performed for suspected recurrence. In all patients, imaging findings were compared with results of histological examination after surgical exploration or clinical follow-up to determine the diagnostic accuracy of PET/CT in the evaluation of disease status. Fisher’s exact test was used to measure the ability of PET/CT to predict recurrent lesions.

Results

Forty-five (58.4%) of the 77 patients had documented recurrence during surgical exploration or clinical follow-up, while 32 (41.6%) had no evidence of recurrent tumour. Of the 45 patients with recurrent disease, 27 (60%) were confirmed to have recurrence by surgical biopsy. A correlation was found between PET/CT and histological or clinical analyses (κ = 0.894). The overall sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET/CT were 93.3%, 96.9%, 94.8%, 97.7% and 91.2%, respectively. PET/CT modified the diagnostic or treatment plan in 19 (24.7%) patients, by leading to the use of previously unplanned therapeutic procedures in 11 (57.9%) patients and the avoidance of previously planned diagnostic procedures in eight (42.1%) patients.

Conclusion

Integrated FDG PET/CT is a sensitive post-therapy surveillance modality for the detection of recurrent ovarian cancer; it aids decisions on treatment plans and may ultimately have a favourable impact on prognosis.

Bristow RE, Duska LR, Lambrou NC, Fishman 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

Forstner R, Chen M, Hricak H. Imaging of ovarian cancer. J Magn Reson Imaging 1995;5:606–13.PubMedCrossRef

Amendola MA. The role of CT in the evaluation of ovarian malignancy. Crit Rev Diagn Imaging 1985;24:329–68.PubMed

Meyers MA. Distribution of intra-abdominal malignant seeding: dependency on dynamics of flow of ascitic fluid. Am J Roentgenol Radium Ther Nucl Med 1973;119:198–206.PubMed

Forstner R, Hricak H, White S. CT and MRI of ovarian cancer. Abdom Imaging 1995;20:2–8.PubMedCrossRef

Nakamoto Y, Saga T, Ishimori T, Mamede M, Togashi K, Higuchi T, et al. Clinical value of positron emission tomography with FDG for recurrent ovarian cancer. AJR Am J Roentgenol 2001;176:1449–54.PubMed

Kubik-Huch RA, Dorffler W, von Schulthess GK, Marincek B, Kochli OR, Seifert B, et al. Value of (¹⁸F)-FDG positron emission tomography, computed tomography, and magnetic resonance imaging in diagnosing primary and recurrent ovarian carcinoma. Eur Radiol 2000;10:761–7.PubMedCrossRef

Jimenez-Bonilla J, Maldonado A, Morales S, Salud A, Zomeno M, Roman J, et al. Clinical impact of¹⁸F-FDG-PET in the suspicion of recurrent ovarian carcinoma based on elevated tumor marker serum levels. Clin Positron Imaging 2000;3:231–6.PubMedCrossRef

Yuan CC, Liu RS, Wang PH, Ng HT, Yeh SH. Whole-body PET with (fluorine-18)-2-deoxyglucose for detecting recurrent ovarian carcinoma. Initial report. J Reprod Med 1999;44:775–8.PubMed

10.

Torizuka T, Nobezawa S, Kanno T, Futatsubashi M, Yoshikawa E, Okada H, et al. Ovarian cancer recurrence: role of whole-body positron emission tomography using 2-[fluorine-18]-fluoro-2-deoxy-D-glucose. Eur J Nucl Med Mol Imaging 2002;29:797–803.PubMedCrossRef

11.

Yen RF, Sun SS, Shen YY, Changlai SP, Kao A. Whole body positron emission tomography with¹⁸F-fluoro-2-deoxyglucose for the detection of recurrent ovarian cancer. Anticancer Res 2001;21:3691–4.PubMed

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.PubMed

13.

Rose PG, Faulhaber P, Miraldi F, Abdul-Karim FW. Positive emission tomography for evaluating a complete clinical response in patients with ovarian or peritoneal carcinoma: correlation with second-look laparotomy. Gynecol Oncol 2001;82:17–21.PubMedCrossRef

14.

Bristow RE, Simpkins F, Pannu HK, Fishman EK, Montz FJ. Positron emission tomography for detecting clinically occult surgically resectable metastatic ovarian cancer. Gynecol Oncol 2002;85:196–200.PubMedCrossRef

15.

Charron M, Beyer T, Bohnen NN, Kinahan PE, Dachille M, Jerin J, et al. Image analysis in patients with cancer studied with a combined PET and CT scanner. Clin Nucl Med 2000;25:905–10.PubMedCrossRef

16.

Kluetz PG, Meltzer CC, Villemagne VL, Kinahan PE, Chander S, Martinelli MA, et al. Combined PET/CT imaging in oncology. Impact on patient management. Clin Positron Imaging 2000;3:223–30.PubMedCrossRef

17.

Makhija S, Howden N, Edwards R, Kelley J, Townsend DW, Meltzer CC. Positron emission tomography/computed tomography imaging for the detection of recurrent ovarian and fallopian tube carcinoma: a retrospective review. Gynecol Oncol 2002;85:53–8.PubMedCrossRef

18.

Dizendorf EV, Treyer V, Von Schulthess GK, Hany TF. Application of oral contrast media in coregistered positron emission tomography-CT. AJR Am J Roentgenol 2002;179:477–81.PubMed

19.

Cook GJ, Fogelman I, Maisey MN. Normal physiological and benign pathological variants of 18-fluoro-2-deoxyglucose positron-emission tomography scanning: potential for error in interpretation. Semin Nucl Med 1996;26:308–14.PubMedCrossRef

20.

Shreve PD, Anzai Y, Wahl RL. Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants. Radiographics 1999;19:61–77; quiz 150–1.PubMed

21.

Hubner KF, McDonald TW, Niethammer JG, Smith GT, Gould HR, Buonocore E. Assessment of primary and metastatic ovarian cancer by positron emission tomography (PET) using 2-[¹⁸F]deoxyglucose (2-[¹⁸F]FDG). Gynecol Oncol 1993;51:197–204.PubMedCrossRef

22.

Fleiss J. Statistical methods for rates and proportions, 2nd ed. New York: Wiley; 1981; p.163–79.

23.

Kumar R, Alavi A. PET imaging in gynecologic malignancies. Radiol Clin North Am 2004;42:1155–67, ix.PubMedCrossRef

24.

Pannu HK, Bristow RE, Cohade C, Fishman EK, Wahl RL. PET-CT in recurrent ovarian cancer: initial observations. Radiographics 2004;24:209–23.PubMedCrossRef

25.

Kim S, Chung JK, Kang SB, Kim MH, Jeong JM, Lee DS, et al. [¹⁸F]FDG PET as a substitute for second-look laparotomy in patients with advanced ovarian carcinoma. Eur J Nucl Med Mol Imaging 2004;31:196–201.PubMedCrossRef

26.

Murakami M, Miyamoto T, Iida T, Tsukada H, Watanabe M, Shida M, et al. Whole-body positron emission tomography and tumor marker CA125 for detection of recurrence in epithelial ovarian cancer. Int J Gynecol Cancer 2006;16 Suppl 1:99–107.PubMedCrossRef

27.

Chang WC, Hung YC, Kao CH, Yen RF, Shen YY, Lin CC. Usefulness of whole body positron emission tomography (PET) with¹⁸F-fluoro-2-deoxyglucose (FDG) to detect recurrent ovarian cancer based on asymptomatically elevated serum levels of tumor marker. Neoplasma 2002;49:329–33.PubMed

28.

Burger C, Goerres G, Schoenes S, Buck A, Lonn AH, Von Schulthess GK. PET attenuation coefficients from CT images: experimental evaluation of the transformation of CT into PET 511-keV attenuation coefficients. Eur J Nucl Med Mol Imaging 2002;29:922–7.PubMedCrossRef

29.

Garrett PR, Meshkov SL, Perlmutter GS. Oral contrast agents in CT of the abdomen. Radiology 1984;153:545–6.PubMed

30.

Antoch G, Kuehl H, Kanja J, Lauenstein TC, Schneemann H, Hauth E, et al. Dual-modality PET/CT scanning with negative oral contrast agent to avoid artifacts: introduction and evaluation. Radiology 2004;230:879–85.PubMed

31.

Nehmeh SA, Erdi YE, Kalaigian H, Kolbert KS, Pan T, Yeung H, et al. Correction for oral contrast artifacts in CT attenuation-corrected PET images obtained by combined PET/CT. J Nucl Med 2003;44:1940–4.PubMed

32.

Kalff V, Hicks RJ, Ware RE, Hogg A, Binns D, McKenzie AF. The clinical impact of¹⁸F-FDG PET in patients with suspected or confirmed recurrence of colorectal cancer: a prospective study. J Nucl Med 2002;43:492–9.PubMed

33.

Czernin J, Phelps ME. Positron emission tomography scanning: current and future applications. Annu Rev Med 2002;53:89–112.PubMedCrossRef

34.

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

35.

Drieskens O, Stroobants S, Gysen M, Vandenbosch G, Mortelmans L, Vergote I. Positron emission tomography with FDG in the detection of peritoneal and retroperitoneal metastases of ovarian cancer. Gynecol Obstet Invest 2003;55:130–4.PubMedCrossRef

Title: Role of [18F]FDG PET/CT in the assessment of suspected recurrent ovarian cancer: correlation with clinical or histological findings
Authors: Hyun Hoon Chung
Won Jun Kang
Jae Weon Kim
Noh-Hyun Park
Yong-Sang Song
June-Key Chung
Soon-Beom Kang
Hyo-Pyo Lee
Publication date: 01-04-2007
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 4/2007
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-006-0260-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Role of [¹⁸F]FDG PET/CT in the assessment of suspected recurrent ovarian cancer: correlation with clinical or histological findings

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2007

How early? ASAP: molecular and functional imaging!

Simultaneous evaluation of myocardial blood flow, cardiac function and lung water content using [15O]H2O and positron emission tomography

Post-therapy surveillance of patients with uterine cancers: value of integrated FDG PET/CT in the detection of recurrence

Quantification of Parkinson’s disease-related network expression with ECD SPECT

Myocardial perfusion imaging with a novel SPECT/CT system: all that glitters is not gold

Visualization of five hyperplastic parathyroid glands using 99mTc-sestamibi scintigraphy in a patient with chronic renal failure