Abstract
The most frequently used molecular imaging technique is currently 18F-deoxy-glucose (FDG) positron emission tomography (PET). FDG-PET holds promise in the evaluation of recurrent or residual ovarian cancer when CA125 levels are rising and conventional imaging, such as ultrasound, CT, or MRI, is inconclusive or negative. Recently, integrated PET/CT, in which a full-ring-detector clinical PET scanner and a multidetector helical CT scanner are combined, has enabled the acquisition of both metabolic and anatomic imaging data using one device in a single diagnostic session. This can also provide precise anatomic localization of suspicious areas of increased FDG uptake and rule out false-positive PET findings. FDG-PET/CT is an accurate modality for assessing primary and recurrent ovarian cancer and may affect management. FDG-PET/CT may provide benefits for detection of recurrent of ovarian cancer and improve surgical planning. And FDG-PET has been shown to predict response to neoadjuvant chemotherapy and survival in advanced ovarian cancer. This review focuses on the role of FDG-PET and FDG-PET/CT in the management of patients with ovarian cancer. Recently, we have evaluated 16α-18F-fluoro-17β-estradiol (FES)-PET, which detects estrogen receptors. In a preliminary study we reported that FES-PET provides information useful for assessing ER status in advanced ovarian cancer. This new information may expand treatment choice for such patients.
Highlights
Ovarian cancer is the second most common gynecologic malignancy
The sensitivity of FDG-positron emission tomography (PET) in the detection of ovarian cancer was 78% in our study [32]; this was lower than the results reported in the literature, which have been in the range of 83% to 86% [33,34,35,36,37]
Adding FDG-PET/computed tomography (CT) increased specificity from 61% to 100%, negative predictive value (NPV) from 78% to 81%, positive predictive value (PPV) from 80% to 100%, and accuracy from 80% to 92%
Summary
Ovarian cancer is the second most common gynecologic malignancy. It has a relatively poor prognosis, accounting for approximately half of all deaths related to gynecologic cancer [1]. Adding FDG-PET/CT increased specificity from 61% to 100%, negative predictive value (NPV) from 78% to 81%, PPV from 80% to 100%, and accuracy from 80% to 92% They concluded that FDG-PET/CT provides additional information to TVUS in the differential diagnosis of benign from malignant pelvic lesions [37]. We evaluated whether FDG uptake, quantified as SUV by PET in ovarian epithelial tumors, correlates with clinical stage [51,52], tumor grade [53], cell proliferation [54,55,56], or glucose metabolism [57], all of which are reported to be biomarkers for response to chemotherapy, prognosis, and overall survival in ovarian cancer patients. This information may be useful in expanding treatment choices for such patients
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