Diagnostic value of integrated 18 F-fluoro-2-deoxyglucose positron emission tomography/computed tomography in recurrent epithelial ovarian cancer: accuracy of patient selection for secondary cytoreduction in 134 patients

• Published in: Journal of gynecologic oncology 2018-05, Vol.29 (3), p.1
• Main Authors: Young-jae Lee, Yong-man Kim, Phill-seung Jung, Jong-jin Lee, Jeong-kon Kim, Young-tak Kim, Joo-hyun Nam
• Format: Article
• Language: Korean
• Subjects: Cytoreduction Surgical Procedures; Foreign-Body; Granuloma; Ovarian Neoplasms; Positron Emission Tomography Computed Tomography
• ISSN: 2005-0380

Objective: The aim of this study was to evaluate the diagnostic value of integrated 18 F-fluoro-2-deoxyglucose-positron emission tomography/computed tomography ( 18 F-FDG-PET/CT) for suspected recurrence of epithelial ovarian cancer (EOC) with non-disseminated lesions. Methods: We retrospectively reviewed the medical records of recurrent EOC patients who underwent secondary cytoreduction from January 2000 to December 2013. A total of 134 patients underwent secondary cytoreduction after imaging with either 18 F-FDG-PET/CT or contrast-enhanced computed tomography (CECT). Results: In a patient-based analysis of 134 patients, 124 (92.5%) were confirmed to be positive for malignancy. Among 72 patients with suspected non-disseminated recurrence on 18 F-FDG-PET/CT, 65 (89.0%) were confirmed to have recurrence, giving 98.5% sensitivity, 87.7% accuracy, and 88.9% positive predictive value (PPV). In the 65 patients with recurrence, residual tumor remained in 14 patients, giving an accuracy of patient selection for secondary cytoreduction of 69.4% (50/72) and it is higher than that of CECT (64.0%). In 169 lesions removed from patients who underwent preoperative 18 F-FDG-PET/CT, 135 (79.9%) were confirmed to be positive for malignancy and 124 were accurately detected by 18 F-FDG-PET/CT, giving 91.9% sensitivity, 81.1% accuracy, and 85.5% PPV. Foreign body granuloma was found in 33.3% of 21 lesions with false-positive 18 F-FDG-PET/CT findings (7/21). The mean preoperative cancer antigen 125 (CA-125) level in false-positive patients was 28.8 U/mL. Conclusion: Compared with CECT, 18 F-FDG-PET/CT shows higher sensitivity in lesion-based analysis and better accuracy of patient selection for secondary cytoreduction. However, there is still a need for integration of the results of 18 F-FDG-PET/CT, CECT, and CA-125 levels to aid treatment planning.