scholarly journals Role of PET/CT in Assessment of Recurrent Ovarian Tumors

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
S Kadry ◽  
A Haggag ◽  
A Ekbal
Keyword(s):  
Ovarian Cancer ◽  
Tumor Marker ◽  
Early Stage ◽  
Ovarian Tumors ◽  
University Hospital ◽  
Ca 125 ◽  
Early Stage Disease ◽  
Major Health Problem ◽  
Pet Ct ◽  
Suspected Recurrence

Abstract Background Ovarian cancer remains a major health problem worldwide, with over 225,000 new cases and 140,000 deaths reported annually. Despite high response after initial treatment, 20-30% of patients with early-stage disease and up to 75% of patients with advanced disease present with recurrence within two years. Early diagnosis of recurrence is crucial for determination of the best treatment. Aim of the Work is to detect the significance of PET/CT in the early detection of recurrent ovarian tumors. Patients and Method The study included 25 patients who have been diagnosed with ovarian cancer, received treatment and achieved complete response. All of the 25 patients had suspected recurrence either due to elevated tumor markers or suspicious clinical findings. The 25 patients have been referred for PET/CT scan at ElDemerdash university hospital from July 2017 to August 2018. Results Total of 25 patients were included in the study. 18 of 25 patients had high tumor marker (CA 125) level. The remaining 7 patients had suspected recurrence with normal tumor marker levels. Recurrence was confirmed by histopathology or clinical and imaging follow up in 19 patients of the 25 patients. Recurrent disease was not shown in 5 of 19 patients on CECT imaging and 1 of 19 patients on PET/CT imaging. PET/CT had a sensitivity of (94.74%), specificity of (100%) and accuracy of (96%). CECT has been reported with sensitivity of (73.68), specificity of (83.33%) and accuracy of (76%). Conclusion PET/CT is a useful tool and has a higher sensitivity, specificity and accuracy than CECT in detection of recurrent ovarian cancer.

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

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.

GENOMIC AND TRANSCRIPTOME PROFILING OF EPITHELIAL OVARIAN CANCER

2008 ◽  
Vol 31 (4) ◽  
pp. 17
Author(s):  
Rebecca JZ Menzies ◽  
Yury V Bukhman ◽  
Nancy F Ng ◽  
Patricia A Shaw ◽  
Tak W Mak
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Early Stage ◽  
Snp Array ◽  
Ovarian Tumors ◽  
Ca 125 ◽  
Molecular Heterogeneity ◽  
Presenting Symptoms

Background: Epithelial ovarian cancer is the leading cause of death by gynecological malignancy. Due to inadequate screening modalities, a lack of characteristic presenting symptoms, limited treatments and a poor understanding of the molecular underpinnings of the disease, only 25% of ovarian cancers are diagnosed at an early stage. Current 5-year survival rates range from 80%, for disease diagnosed in Stage I to as low as 13% for Stage IV. Current screening for ovarian cancer involves measuring CA-125 levels. However, CA-125 testing has low sensitivity since it can be elevated in a variety of other gynecological diseases. Numerous studies have found molecular heterogeneity between the four histological subtypes of ovarian cancer (serous, endometrioid, clear cell and mucinous). However, treatments remain the same for all subtypes regardless of molecular heterogeneity. Thus, better treatment targets and biomarkers must be found for this disease. Methods:In our study 300 ovarian tumors will be genomically profiled using the Affymetrix Genome-Wide SNP Array 6.0 to identify loci and genes implicated in ovarian cancer. To date, 51 ovarian tumors have been analyzed using the SNP array. Results:Preliminary analysis of copy number variation in these tumors using Partek software has revealed a total of 978 loci. Known amplifications derived from the literature were seen at CCNE1 and ERBB2. Similarly, well known deletions ofp53 and RB1 in ovarian cancer were detected. Novel amplified loci at 18q11.2 and 4q33 were also detected. Novel deletions were detected at 7p13 and 8q22.2. Conclusion: Future work will include running the remaining 249 tumor samples on the SNP array and analyzing the complete dataset using Partek software. Future validation of identified genes in vitro and in vivo may provide insight and possible biomarkers that may be used clinically to benefit the ovarian cancer patient.

Preoperative Sensitivity and Specificity for Early-Stage Ovarian Cancer When Combining Cancer Antigen CA-125II, CA 15-3, CA 72-4, and Macrophage Colony-Stimulating Factor Using Mixtures of Multivariate Normal Distributions

2004 ◽  
Vol 22 (20) ◽  
pp. 4059-4066 ◽  
Author(s):  
Steven J. Skates ◽  
Nora Horick ◽  
Yinhua Yu ◽  
Feng-Ji Xu ◽  
Andrew Berchuck ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Early Stage ◽  
Ca 125 ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Macrophage Colony Stimulating Factor ◽  
Macrophage Colony ◽  
Screening Sensitivity ◽  
Stimulating Factor ◽  
Combining Information

Purpose In CA-125–based ovarian cancer screening trials, overall specificity and screening sensitivity of ultrasound after an elevated CA-125 exceeded 99.6% and 70%, respectively, thereby yielding a positive predictive value (PPV) exceeding 10%. However, sensitivity for early-stage disease was only 40%. This study aims to increase preoperative sensitivity for early-stage ovarian cancer while maintaining the annual referral rate to ultrasound at 2% by combining information across CA-125II, CA 15-3, CA 72-4, and macrophage colony-stimulating factor (M-CSF). For direct comparisons between marker panels, all sensitivity results correspond to a 98% fixed first-line specificity (referral rate 2%). Patients and Methods Logistic regression, classification tree, and mixture discriminant analysis (MDA) models were fit to a training data set of preoperative serum measurements (63 patients, 126 healthy controls) from one center. Estimates from the training set applied to an independent validation set (60 stage I to II patients, 98 healthy controls) from two other centers provided unbiased estimates of sensitivity. Results Preoperative sensitivities for early-stage disease of the optimal panels were 45% for CA-125II; 67% for CA-125II and CA 72-4; 70% for CA-125II, CA 72-4, and M-CSF; and 68% for all four markers (latter two results using MDA). Conclusion Efficiently combining information on CA-125II, CA 72-4, and M-CSF significantly increased preoperative early-stage sensitivity from 45% with CA-125II alone to 70%, while maintaining 98% first-line specificity. Screening trials with these markers using MDA followed by referral to ultrasound may maintain previously high levels of specificity and PPV, while significantly increasing early-stage screening sensitivity. MDA is a useful, biologically justified method for combining biomarkers.

scholarly journals Nadir CA-125 has prognostic value for recurrence, but not for survival in patients with ovarian cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Szymon Piatek ◽  
Grzegorz Panek ◽  
Zbigniew Lewandowski ◽  
Dominika Piatek ◽  
Przemyslaw Kosinski ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Proportional Hazards Model ◽  
Early Stage ◽  
Cox Proportional Hazards ◽  
Additive Models ◽  
Cox Proportional Hazards Model ◽  
Ca 125 ◽  
Early Stage Disease ◽  
Risk Of Recurrence ◽  
Increased Risk

AbstractThe objective of this study was to evaluate the nadir CA-125 in patients with epithelial ovarian cancer. A total of 168 patients who achieved complete remission (no clinical and radiological signs, CA-125 ≤ 35 U/ml) after first-line treatment were enrolled in the study. The relationship between CA-125 and survival was examined by applying generalized additive models to the Cox proportional hazards model. The median CA-125 concentration after the treatment was 10 U/ml (2.7–35 U/ml). The nadir CA-125 was related to progression-free survival but not to overall survival. The risk of recurrence in patients with 11–25 U/ml and 26–35 U/ml compared to patients with ≤ 10 U/ml was 1.87 (p < 0.0024) and 2.17 (p < 0.018), respectively. An increased risk of recurrence according to the nadir CA-125 (≤ 10 U/ml vs. 11–25 U/ml and ≤ 10 U/ml vs. 26–35 U/ml) was found in patients with high-grade tumours (hazard ratio, HR = 2.08 and 2.59, respectively), advanced disease (HR = 2.38 and 2.03, respectively), serous histology (HR = 2.08 and 2.43, respectively) and after complete cytoreduction (HR = 2.7 and 2.72, respectively). No correlation between the CA-125 nadir and recurrence risk was found in patients with early-stage disease or those receiving neoadjuvant chemotherapy or bevacizumab.

scholarly journals A descriptive study on histopathology of fallopian tube in neoplastic surface epithelial ovarian tumors

2019 ◽  
Vol 8 (2) ◽  
pp. 385
Author(s):  
Ashna C. Manuel ◽  
Radhamani M. V. ◽  
Priya V. ◽  
Deepa S.
Keyword(s):  
Ovarian Cancer ◽  
Fallopian Tube ◽  
Protective Factor ◽  
Early Stage ◽  
Oral Contraceptive Pill ◽  
Ovarian Surface Epithelium ◽  
Descriptive Study ◽  
Ovarian Tumors ◽  
Surface Epithelium ◽  
Early Stage Disease

Background: The incidence of cancer is increasing day by day. Ovarian cancer ranks as the fifth leading cause of cancer related death among women worldwide. The cure rate of early stage disease is high. The accepted view is that ovarian cancer arises from ovarian surface epithelium. Recent evidence suggested that around sixty percentage of women without a genetic predisposition who developed sporadic ovarian cancer also have early tubal lesion and cancer. The present study aims to find out the histopathology of fallopian tube in neoplastic surface epithelial ovarian tumour.Methods: A descriptive study was conducted among hundred women who had undergone surgery for malignant and benign surface epithelial ovarian tumor from Govt. Medical College, Kottayam for one year from January-December 2017.Results: Fifty percent of the patients had malignant surface epithelial ovarian tumors.Conclusions: The risk factors of malignant surface epithelial ovarian tumors include age above fifty years and post-menopausal women. Whereas oral contraceptive pill use is a protective factor against malignant surface epithelial ovarian tumors. The fimbrial end of fallopian tube is the site of origin of malignancy in high grade ovarian epithelial carcinoma. So, prophylactic bilateral salpingectomy should be encouraged in all patients who have completed family and undergoing hysterectomy. This will reduce the morbidity and mortality due to ovarian carcinoma.

scholarly journals Nadir CA-125 Is Prognostic for Recurrence, but Not for Survival in Patients With Ovarian Cancer

2021 ◽  
Author(s):  
Szymon Piatek ◽  
Grzegorz Panek ◽  
Zbigniew Lewandowski ◽  
Dominika Piatek ◽  
Przemyslaw Kosinski ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Proportional Hazards Model ◽  
Early Stage ◽  
Additive Models ◽  
Cox Proportional Hazards Model ◽  
Ca 125 ◽  
Early Stage Disease ◽  
Risk Of Recurrence

Abstract Objective of this study was to evaluate nadir CA-125 in patients with epithelial ovarian cancer. 168 patients, who achieved complete remission (no clinical and radiological signs, CA-125< 35 U/ml) after first line treatment were enrolled in the study. The relation between CA-125 and survival were examined using generalized additive models applied to the Cox proportional hazards model. The median CA-125 concentration after the treatment was 10 U/ml (2.7-35 U/ml). No correlation between CA-125 nadir and overall survival was found (p linear = 0.13; p nonlinear = 0.52). Patients with CA-125 serum concentrations of 11 - 25 U/ml and 26 - 35 U/ml had significantly higher risk of recurrence compared to patients with CA-125 concentration ≤ 10 U/ml with HR = 1.865 (P <0.0024) and HR = 2.17 (P <0.018), respectively. Nadir CA125 was not relevant for risk of recurrence in FIGO I and II (p=0.75 and p=0.99, respectively), neoadjuvant chemotherapy (p=0.49 and p=0.26 respectively) or bevacizumab (p=0.066 and p=0.26). Nadir CA-125 is not related to overall survival. Risk of ovarian cancer relapse increase with CA-125 nadir level. However in patients with early stage disease or those receiving neoadjuvant chemotherapy or bevacizumab may not be associated with recurrence risk.

scholarly journals Validation of Candidate Serum Ovarian Cancer Biomarkers for Early Detection

2007 ◽  
Vol 2 ◽  
pp. 117727190700200 ◽  
Author(s):  
Feng Su ◽  
Jennifer Lang ◽  
Ashutosh Kumar ◽  
Carey Ng ◽  
Brian Hsieh ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Early Detection ◽  
Regression Models ◽  
Serum Proteins ◽  
Early Stage ◽  
Ovarian Tumors ◽  
Ca 125 ◽  
Endometrioid Adenocarcinoma ◽  
Serum Samples ◽  
Early Stage Ovarian Cancer

Objective We have previously analyzed protein profiles using Surface Enhanced Laser Desorption and Ionization Time-Of-Flight Mass Spectroscopy (SELDI-TOF-MS) [Kozak et al. 2003, Proc. Natl. Acad. Sci. U.S.A. 100:12343–8] and identified 3 differentially expressed serum proteins for the diagnosis of ovarian cancer (OC) [Kozak et al. 2005, Proteomics, 5:4589–96], namely, apolipoprotein A-I (apoA-I), transthyretin (TTR) and transferin (TF). The objective of the present study is to determine the efficacy of the three OC biomarkers for the detection of early stage (ES) OC, in direct comparison to CA125. Methods The levels of CA125, apoA-I, TTR and TF were measured in 392 serum samples [82 women with normal ovaries (N), 24 women with benign ovarian tumors (B), 85 women with ovarian tumors of low malignant potential (LMP), 126 women with early stage ovarian cancer (ESOC), and 75 women with late stage ovarian cancer (LSOC)], obtained through the GOG and Cooperative Human Tissue Network. Following statistical analysis, multivariate regression models were built to evaluate the utility of the three OC markers in early detection. Results Multiple logistic regression models (MLRM) utilizing all biomarker values (CA125, TTR, TF and apoA-I) from all histological subtypes (serous, mucinous, and endometrioid adenocarcinoma) distinguished normal samples from LMP with 91% sensitivity (specificity 92%), and normal samples from ESOC with a sensitivity of 89% (specificity 92%). MLRM, utilizing values of all four markers from only the mucinous histological subtype showed that collectively, CA125, TTR, TF and apoA-I, were able to distinguish normal samples from mucinous LMP with 90% sensitivity, and further distinguished normal samples from early stage mucinous ovarian cancer with a sensitivity of 95%. In contrast, in serum samples from patients with mucinous tumors, CA125 alone was able to distinguish normal samples from LMP and early stage ovarian cancer with a sensitivity of only 46% and 47%, respectively. Furthermore, collectively, apoA-I, TTR and TF (excluding CA-125) distinguished i) normal samples from samples representing all histopathologic subtypes of LMP, with a sensitivity of 73%, ii) normal samples from ESOC with a sensitivity of 84% and iii) normal samples from LSOC with a sensitivity of 97%. More strikingly, the sensitivity in distinguishing normal versus mucinous ESOC, utilizing apoA-I, TF and TTR (CA-125 excluded), was 95% (specificity 86%; AUC 95%). Conclusions These results suggest that the biomarker panel consisting of apoA-I, TTR and TF may significantly improve early detection of OC.

The Role of CA 125 in Screening for Ovarian Cancer

1998 ◽  
Vol 13 (4) ◽  
pp. 216-220 ◽  
Author(s):  
A.N. Rosenthal ◽  
I.J. Jacobs
Keyword(s):  
Ovarian Cancer ◽  
Early Stage ◽  
Survival Rates ◽  
Ca 125 ◽  
Early Stage Disease ◽  
Mathematical Algorithm ◽  
Gynaecological Malignancy ◽  
Stage Disease ◽  
Screening Strategies ◽  
Randomised Controlled

Ovarian cancer has the worst prognosis of any gynaecological malignancy, primarily because it tends to present at an advanced stage. The excellent survival rates of early stage disease have provided the rationale for efforts to detect ovarian cancer early by screening, in the hope that survival rates will be improved. Available data suggests that CA 125 is elevated in the majority of epithelial ovarian malignancies prior to clinical presentation. Large trials of screening for ovarian cancer indicate that using a CA 125 cutoff value of 30 U/mL has good sensitivity, but inadequate specificity for detecting preclinical disease. Use of transvaginal ultrasonography as a second-line test in women with elevated CA 125 levels improves specificity to acceptable levels, as does use of a mathematical algorithm which analyses rates of change of CA 125. Two major randomised controlled trials, investigating the effect of screening strategies incorporating CA 125 on mortality, are currently underway.

Surveillance procedures for patients treated for epithelial ovarian cancer: a review of the literature

2007 ◽  
Vol 17 (1) ◽  
pp. 21-31 ◽  
Author(s):  
A. Gadducci ◽  
S. Cosio ◽  
P. Zola ◽  
F. Landoni ◽  
T. Maggino ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Fdg Pet ◽  
Recurrent Disease ◽  
Early Stage ◽  
Gynecological Cancer ◽  
Ca 125 ◽  
Early Stage Disease ◽  
Asymptomatic Patients

Epithelial ovarian cancer is the leading cause of death from gynecological cancer in the Western countries. Approximately 20%–30% of patients with early-stage disease and 50%–75% of those with advanced disease who obtain a complete response following first-line chemotherapy will ultimately develop recurrent disease, which more frequently involves the pelvis and abdomen. Few formal guidelines exist regarding the surveillance of these patients, and there is no agreement in the literature about the type and timing of examinations to perform. Moreover, the objective of follow-up is unclear as recurrent epithelial ovarian cancer continues to be a therapeutic dilemma and quite all the relapsed patients will eventually die of their disease. The follow-up of asymptomatic patients generally include complete clinical history, serum cancer antigen (CA)125 assay, physical examination, and often ultrasound examination, whereas additional radiologic imaging techniques are usually performed when symptoms or signs appear.18Fluoro-2-deoxy-glucose (18FDG)–positron emission tomography (PET) has a sensitivity of 90% and a specificity of 85% approximately for the detection of recurrent disease, and this examination appears to be particularly useful for the diagnosis of recurrence when CA125 levels are rising and conventional imaging is inconclusive or negative. Recently, technologic advances have led to novel combined18FDG-PET/computed tomography (CT) devices, which perform contemporaneous acquisition of both18FDG-PET and CT images. The role of18FDG-PET/CT for the detection of recurrent ovarian cancer is very promising, and this technique may be especially useful for the selection of patients with late recurrent disease who may benefit from secondary cytoreductive surgery.

scholarly journals Sonomorphology and colour flow Doppler studies in differentiating between benign and malignant ovarian masses

2017 ◽  
Vol 6 (2) ◽  
pp. 626
Author(s):  
Shyamala Jothy M. ◽  
Anju Padmasekar
Keyword(s):  
Ovarian Cancer ◽  
Scoring System ◽  
Early Stage ◽  
Menopausal Status ◽  
Ca 125 ◽  
Screening Methods ◽  
Surgical Removal ◽  
Color Flow ◽  
Early Stage Disease ◽  
Ovarian Masses

Background: Ovarian cancer is the most frequent cause of death from Gynaecological malignancies in the world. Most patients with epithelial ovarian cancer are asymptomatic in early stage disease and usually present with stage III or IV disease. There are various screening methods for detection of ovarian cancer like bimanual pelvic examination, ultrasound examination (TVS and TAS) with or without color Doppler flow imaging and measurement of various circulating proteins like CA 125. The Purpose of a study is to determine optimal cut off point for a morphological scoring system and color flow directed Doppler values to differentiate benign and malignant ovarian masses.Methods: This study was done at Department of obstetrics and Gynaecology, Government Rajah Mirasudhar Teaching Hospital attached to Government Thanjavur Medical College, Thanjavur, Tamilnadu, India during the period of June – 2011 to October – 2012. This study consisted of 73 patients, 3 patients were not operated as they were not fit for surgery for medical reasons. Hence 70 patients were included in the study. A note was made of their main symptoms at admission, Parity, menopausal status, family history of carcinoma. Patients admitted with diagnosis of ovarian masses and clearly ovarian by sonomorphology and surgery were only included in this study. Morphological Score, RI and PI were calculated. All patients underwent exploratory laparotomy with surgical removal of the tumor. The final diagnosis obtained based on HPE were classified as either benign or malignant. The score of each mass and the Doppler values were assessed individually and in combination with regard to its relationship to final diagnosis.Results: In summary the resistance to flow measurement obtained by Doppler had a higher sensitivity and specificity compared to the morphological scoring system in differentiating benign and malignant ovarian masses. The combination of morphological score and Doppler Measurements improved the specificity positive predictive value for differentiating benign and malignant ovarian masses. Conclusions: The combination of ultrasound and Doppler values is better in differentiating benign from malignant ovarian masses. The cut off point for ultrasound guided morphological scoring system was 4 and Doppler velocimetry for differentiating benign and malignant ovarian masses was a RI of 0.55 and PI of 0.8.

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