Impact of FDG PET-CT imaging on the decision making in the biologic suspicion of ovarian carcinoma recurrence

Abstract

Objectives. The aim of this prospective study was to evaluate the impact of integrated PET-CT on treatment management in ovarian carcinoma recurrence suspicion because of increased CA-125. Methods. Twenty-nine patients (mean age = 61 years), initially treated for ovarian carcinoma (FIGO stage I n = 2, stage II n = 3, stage III n = 21 and stage IV n = 3), presenting with increased CA-125 (mean = 160 IU/ml, range 33–1930), underwent subsequently a CT and a PET-CT scans. The recurrence was acknowledged by the referring physicians for all patients. The impact of PET-CT on patient’s management was evaluated by comparing the therapeutic decision mentioned respectively on the pre and post PET-CT questionnaires filled in by the oncologists. Results. The CT scan was positive in 22/29 patients (76%) and negative in 7/29 patients (24%). The PET-CT scan was positive in 27/29 patients (93%) and negative in 2/29 (7%) patients. Five out of the seven patients with a negative CT scan had a positive PET-CT scan. In comparison to CT scan alone, the PET-CT scan modified the disease distribution for 16 patients (55%; p < 0.001) in the following ways: more advanced disease ( n = 11), more limited disease ( n = 4), and different localizations ( n = 1). The assessment of pre and post PET-CT questionnaires showed a statistically significant change in the decision making for 10 patients (34%, p < 0.0001). Conclusion. This questionnaire-based study showed that PET-CT imaging allows a better restaging than CT and induces a change in clinical management in over one third of patients with suspected ovarian carcinoma recurrence on increased CA-125.