Predictive value of PET-CT imaging versus AGO-scoring in patients planned for cytoreductive surgery in recurrent ovarian cancer

Purpose: The purpose of this study was to assess the sensitivity and diagnostic accuracy of integrated positron emission tomography/computed tomography (PET/CT) in detecting recurrent ovarian cancer in treated patients presenting with rising CA-125 levels during clinical follow-up and compare it with those of CT alone. Materials and Methods: This was a retrospective study. We evaluated 45 patients with pathologically proven ovarian carcinoma who underwent PET/CT during October 2010–November 2013 at our institution for suspected relapse; IRB deemed that approval for this retrospective study was not required. Of these, 35 patients who presented with rising CA-125 levels during clinical follow-up were included in this study. Remaining 10 patients were excluded as they had normal CA-125 levels. At least three previous consecutive CA-125 readings and initial conventional imaging before uorodeoxyglucose-PET/CT were noted. Sensitivity and diagnostic accuracy for tumour detection with PET/CT and CT alone were calculated; histological analysis after biopsy/second look surgery or clinical- radiologic follow-up/response to chemotherapy was taken as reference standard. K statistics (Cohen K) was used for statistical analysis. Results: Of 35 patients with suspected relapse, one patient was lost to follow up. 30 patients were documented to have relapsed, while in four patients, recurrence was not identi ed either on CT or PET-CT and they were proved to be disease free on 2-year follow-up. Amongst these relapsed patients, 10/30 cases were proven histologically, 3 with imaging-guided biopsy and 7 with second-look surgery, whereas 20/30 were con rmed on clinical/radiological follow-up (ranging from 3 to 6 months) or by response to chemotherapy on subsequent imaging. Of 30 patients with relapse, PET-CT highlighted recurrence in 27. Sensitivity, speci city, positive predictive value, negative predictive value, and diagnostic accuracy of integrated PET/CT were calculated to be 90%, 75%, 96%, 50%, and 88%, respectively. CT alone detected recurrence in 20 patients. Sensitivity, speci city, positive predictive value, negative predictive value, and diagnostic accuracy of CT were calculated to be 73.3%, 100%, 100%, 33%, and 76%, respectively. Conclusion: PET/CT is a highly sensitive and accurate post-therapy surveillance modality for the detection of recurrent ovarian cancer in patients with rising tumour markers as compared to CT alone. Key words: CA125, uorodeoxyglucose, ovarian cancer, positron emission tomography/computed tomography, recurrence

Download Full-text

Clinically occult recurrent ovarian cancer: patient selection for secondary cytoreductive surgery using combined PET/CT

Gynecologic Oncology ◽

10.1016/s0090-8258(03)00336-6 ◽

2003 ◽

Vol 90 (3) ◽

pp. 519-528 ◽

Cited By ~ 147

Author(s):

Robert E Bristow ◽

Marcela G del Carmen ◽

Harpreet K Pannu ◽

Christian Cohade ◽

Mariana L Zahurak ◽

...

Keyword(s):

Ovarian Cancer ◽

Cancer Patient ◽

Patient Selection ◽

Cytoreductive Surgery ◽

Ovarian Cancer Patient ◽

Recurrent Ovarian Cancer ◽

Secondary Cytoreductive Surgery ◽

Pet Ct ◽

Selection For

Download Full-text

Audit on the role and efficacy of PET/CT in recurrent ovarian cancer settings in a tertiary care centre in India

10.1055/s-0039-1685301 ◽

2016 ◽

Author(s):

K. R. Suhas

Keyword(s):

Ovarian Cancer ◽

Cytoreductive Surgery ◽

Predictive Value ◽

Ca 125 ◽

Histopathological Diagnosis ◽

Secondary Cytoreductive Surgery ◽

Ct Findings ◽

Pet Ct ◽

The Mean ◽

Suspected Recurrence

Ovarian cancers tend to recur in 15-70% cases. CA-125 - is a tumor marker used for monitoring therapeutic response, and in surveillance, for recurrent disease. However, it has a limited role as a persistent high level can signify either recurrence or persistence of residual tumor. Metastases from ovarian cancer primarily involve the peritoneum rather than parenchymal sites; thus, the presence of small-volume recurrence or metastatic deposits on the visceral surfaces poses a challenge for interpretation of CT and MR images. PET/CT utilizes its property of higher accumulation in malignant cells to provide both anatomic and functional information for diagnosing malignant tumors. Objectives: The objectives of the study were to find the correlation between PET/CT findings and final histopathological diagnosis after a secondary cytoreductive surgery in suspected ovarian cancer recurrences. Materials and Methods: PET/CT was done in cases with rising or above normal CA-125 and no radiological findings. These patients with abnormal PET/CT findings were taken up for a secondary cytoreductive surgery and histopathological proven were taken as the standard against which PET/CT positive findings was compared. Results: The mean age in our group of patients with suspected recurrence was 53 years (Range 39-74 years). Of the 52 patients with suspected recurrence, 40 patietnts with a PET-CT scan with findings suggestive of an avid uptake underwent surgery. 22 patients had serous histology, 12 mucinous and 8 had clear cell carcinoma. Stage-wise distribution at the time of primary surgery is as follows stage I-3, stage II-7, stage III-26, stage IV-4. Of the 40 patients who underwent a second look surgery 32 had histopathologically confirmed recurrence. PET-CT detected a total of 86 lesions in the 40 patients who underwent surgery. Of these, 38 were in the lymph nodes 28 in para-aortic and 10 in pelvic, 32 were peritoneal lesions and 14 were pelvic, 2 were metastatic in the parenchyma of liver. Detection of the lesion on PET-CT was size dependant, of the 9 lesions were missed on PET-CT, 7 were less than 0.5 cm. The mean diameter of the lesions detected was 2.2 cm (range 0.3-6.2 cm). PET-CT accurately identified 62 of 70 histopathologically proven lesions. The overall lesion-based sensitivity of PET-CT is 88.6%, specificity 56.2%, Positive predictive value being 72.1%, negative predictive value of 69.2%. Accuracy of detecting lesions greater than 1 cm is 78.6% (44 of 56 lesions). Conclusions: Corelation between PET/CT and histopathologicaldisease: k (cohen value) = 0.81 which suggests excellent correlation. For selected patients with ovarian cancer recurrence may benefit from a comprehensive radiographic imaging survey (PET-CT) at the time of even no or minimal CA-125 elevation in early detection and successful cytoreductive surgical resection and an increase in overall survival.

Download Full-text

Randomized controlled phase III study to evaluate the impact of secondary cytoreductive surgery in recurrent ovarian cancer – AGO DESKTOP III/ENGOT ov20

10.1055/s-0038-1671029 ◽

2018 ◽

Author(s):

P Harter ◽

J Sehouli ◽

W Meier ◽

A Reuss ◽

P Hillemanns ◽

...

Keyword(s):

Ovarian Cancer ◽

Cytoreductive Surgery ◽

Recurrent Ovarian Cancer ◽

Phase Iii ◽

Randomized Controlled ◽

Secondary Cytoreductive Surgery ◽

Phase Iii Study ◽

The Impact

Download Full-text

Diagnostic accuracy of PET/CT scan in evaluation of clinically suspected recurrent ovarian cancer

Journal of Fatima Jinnah Medical University ◽

10.37018/txti8122 ◽

2021 ◽

Vol 14 (4) ◽

pp. 156-160

Author(s):

Nimrah Sultana ◽

Shaista Shoukat ◽

Sadaf Nausheen ◽

Bakhtawar Memon

Keyword(s):

Ovarian Cancer ◽

Diagnostic Accuracy ◽

Ovarian Carcinoma ◽

Ct Scan ◽

Tumor Marker ◽

Recurrent Ovarian Cancer ◽

Ca 125 ◽

Pet Ct ◽

Suspected Recurrence ◽

Pet Ct Scan

Background: Accurate evaluation of ovarian carcinoma is utmost important for effective management. PET/CT is reported to be effective in evaluation of suspected recurrence of ovarian carcinoma. This study aims to assess the accuracy of PET/CT in evaluation of recurrent ovarian cancer among clinically suspected cases with rising tumor marker or suspicious clinic-radiological findings. Patients and methods: This prospective cross-sectional study was conducted at Radiology department of Jinnah Postgraduate Medical Centre Karachi from 22nd April 2019 to 21st April 2020. Patients having age of 40 to 60 years and referred for PET scan with suspected recurrence of ovarian carcinoma were consecutively enrolled. Patients were suspected due to relevant history, clinical findings and initial imaging investigations with elevated CA-125 level. Results of 18FDG PET/CT scan was correlated with the raised tumor findings. The PET/CT scan showing abnormally elevated FDG take-up and higher SUV values than the background activity considered recurrence. Diagnostic accuracy of PET/CT was calculated taking raised tumor level as reference category. Results: Of 65 patients, median age was 50 (43-56) years. The findings showed positive cases in 57 (87.7%) while negative in 8 (12.3%) patients, whereas the findings of tumor marker showed raised tumor marker in 61 (93.8%) patients. Diagnostic accuracy of PET/CT showed sensitivity, specificity, positive predicted value, negative predated value, and overall diagnostic accuracy as 93.44%, 100%, 100%, 50%, and 93.85% respectively. Conclusion: A higher accuracy of PET/CT was observed in the diagnosis of recurrent ovarian cancer among clinically suspected cases, thus helping in devising an appropriate management plan by the treating physician.

Download Full-text