Abstract
Objective: Ovarian cancer recurrence is often a major problem for patients who have undergone treatment. This prospective study was undertaken to evaluate the diagnostic accuracy of positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG)/ computed tomography (CT) in patients with suspected for ovarian cancer recurrence.
 Methods: A total of 43 women who underwent surgery or chemotherapy for ovarian cancer were enrolled in this study. They underwent18 F-FDG PET/CT scan due to raised CA-125 levels, clinical suspicion of ovarian cancer recurrence, or alterations detected on CT.18 F-FDG PET/CT findings for the women were compared with the final diagnosis.
 Results: CA-125 was elevated in 13 patients, while 34 patients presented with alterations on CT, and 9 patients presented with both results’ positivity. 17 patients confirmed to have an ovarian cancer recurrence, all with abnormal findings on PET/ CT. 20 patients remained disease-free during follow-up, all with normal PET/CT findings. There were 9 patients with raised CA-125 levels and normal conventional imaging, all with positive18 F-FDG PET/CT. Among the 30 patients with normal CA-125 levels, 9 patients presented with a positive PET/CT scan. Lymph nodes were the most frequent site. Its sensitivity, specificity, positive predictive value, and negative predictive valuewere 94%, 91%, 77%, and 95%, respectively.
 Conclusion: 18F-FDG PET/CT is a useful modality for evaluating the cancer recurrence and extent of the disease. Lymph nodes were the most frequent site. However, there was no statistical significance found between CA-125 levels and 18F-FDG PET/CT findings.
 Bangladesh Journal of Medical Science Vol.20(2) 2021 p.302-312
Highlights
A majority of the women with ovarian cancer demonstrate total clinical remission after surgery and first-line chemotherapy
The study was approved by the Research Ethics Committee (Human;USMKK/ PPP/jepem[250.3.(19)]), UniversitiSains Malaysia and National Medical Research Register (NMRR12-250-11120).Data from all included patients were taken from 18F-FDG positron emission tomography (PET)/computed tomography (CT) request forms, including the age, date of confirmed diagnosis of cancer ovary, date of PET/CT scan, CECT findings, and CA-125 levels
The lesions in various areas with the corresponding standardized uptake value (SUV) detected by 18F-FDG PET/CT are summarized (Table 2)
Summary
A majority of the women with ovarian cancer demonstrate total clinical remission after surgery and first-line chemotherapy. In patients with advanced disease, 50% to 70% are noted to have persistent or recurrent disease even after completion of treatment[1]. Evaluating early recurrent disease in ovarian cancer is challenging. For those with high serum tumor markers and negative computed tomography (CT) or magnetic resonance imaging (MRI) findings, functional imaging with 18F-FDG positron emission tomography (PET)/CT helps evaluate early recurrent or small-volume disease[2, 3]. This imaging modality precedes anatomic imaging, as it can detect the changes earlier than morphological changes.
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