Abstract
The aim of this retrospective study was to evaluate the contribution of fluorine-18-fluoro-deoxyglucose (FDG) positron emission tomography (PET) to the clinical management and survival outcome of patients (pts) suspected of recurrent ovarian carcinoma, with the hypothesis that early diagnosis of recurrent ovarian cancer may improve overall survival (OS). Fifty-three FDG PET/CT scans were retrospectively analyzed for 42 pts. CT and PET/CT findings were confirmed by imaging and clinical follow-up, and/or pathology, which were considered as the gold standard diagnosis. The treatment plan based on CT staging was compared with that based on PET/CT findings. Medical records were reviewed for pts characteristics, progression-free survival (PFS), and OS. PFS and OS were analyzed using the Cox proportional hazards regression model. The final diagnosis of recurrence was established pathologically (n = 16), or by a median clinical follow-up of 6.5 years (range 0.5-7.5) after the PET/CT (n = 37). PET/CT provided a higher detection sensitivity (92.2%, 47/51) than CT (60.8%, 31/51) (p < 0.001). Globally, PET/CT modified the treatment plan in 56.6% (30/53) and in 65.2% (15/23) when the CT was negative prior to PET/CT. In 30 cases, those benefited from a modified treatment plan, these changes led to the intensification of a previous treatment procedure in 83.3% (25/30), and to a reduction in the previous treatment procedure in 16.6% of cases (5/30). The Cox regression multivariate analysis showed that the number of lesions visualized by CT and presence of lung lesions detected by PET/CT were significantly associated with PFS (p = 0.002 and p = 0.035, respectively). On account of its impact on treatment planning, and especially in predicting patient outcome, FDG PET is a valuable diagnostic tool for cases of suspected ovarian cancer recurrence.
Highlights
Ovarian cancer has the highest mortality of all gynecological cancers [1]
The recurrence was suspected due to abnormal results by conventional imaging (CI) in 30/53 positron emission tomography (PET)/CT (56.6%) and an isolated elevated serum tumor marker CA 125 was observed in 23/47 PET/CT (48.9%)
Recurrence was histopathologically confirmed in 30% (16/53) of cases, or by clinical follow-up for other patients, with a median clinical follow-up of 6.5 years after PET/CT
Summary
Ovarian cancer has the highest mortality of all gynecological cancers [1]. Ovarian carcinoma is usually diagnosed at a late stage due to the paucity and insidious onset of symptoms [2]. CT and MRI imaging (either soon after treatment or at later stages) are of limited value for optimally differentiating a recurrence signal from a post-surgical status, or due to their inability to detect normal-sized lymph node metastases [5]. The aim of this retrospective study was to evaluate the contribution of fluorine-18-fluoro-deoxyglucose (FDG) positron emission tomography (PET) to the clinical management and survival outcome of patients (pts) suspected of recurrent ovarian carcinoma, with the hypothesis that early diagnosis of recurrent ovarian cancer may improve overall survival (OS)
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