Abstract
Background
The present study investigates the usefulness of 18F-FDG-PET/CT (PET/CT) in distinguishing between benign and malignant ovarian teratomas.
Methods
This study includes 4 mature teratomas (MTs) with malignant transformation, 8 immature teratomas (ITs), and 16 MTs that were diagnosed after surgical resection. Preoperative tumor marker values, MRI findings, PET/CT SUVmax values, and other clinical parameters were retrospectively compared with those of 14 patients who had MTs.
Results
The median CA125 was significantly higher for ITs than for MTs (P = 0.04). The median AFP was significantly higher for ITs than for MTs (P = 0.0034). The median SUVmax values for MTs with malignant transformation, ITs, and MTs were 18.3 (5.3–23.3), 6.0 (3.6–22.6), and 1.1 (1.0–15.5), respectively. SUVmax was significantly higher in MTs with malignant transformation and ITs than in MTs (P = 0.004, P = 0.0007). With a cut-off SUVmax of 3.6 to distinguish between benign and malignant MTs, sensitivity was 100 %, specificity was 81 %, positive predictive value was 80 %, negative predictive value was 100 %, and diagnostic accuracy was 89 % (AUC 0.94). However, one patient with an MT had a high SUVmax corresponding to values in the central nervous system (CNS).
Conclusions
18F-FDG-PET/CT has a high diagnostic accuracy in distinguishing between benign and malignant ovarian teratomas. Thus, PET/CT may be useful in cases where the diagnosis is unclear on MRI and other clinical findings. However, some MTs with abundant CNS tissue may have a high SUVmax. Therefore, the diagnosis of a benign or malignant lesion should be made carefully in conjunction with other clinical findings.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
NCCN Clinical Practice Guidelines in Oncology. Ovarian cancer, including fallopian tube cancer and primary peritoneal cancer version 3.2014. http://www.nccn.org/professionals/physiciangls/pdf/ovarian.pdf of subordinate document. Accessed Nov 2014
Moore RG, Miller MC, Disilvestro P et al (2011) Evaluation of the diagnostic accuracy of the risk of ovarian malignancy algorithm in women with a pelvic mass. Obstet Gynecol 118(2 Pt 1):280
Kitajima K, Suzuki K, Senda M et al (2011) FDG-PET/CT for diagnosis of primary ovarian cancer. Nucl Med Commun 32(7):549–553
Tanizaki Y, Kobayashi A, Shiro M et al (2014) Diagnostic value of preoperative SUVmax on FDG-PET/CT for the detection of ovarian cancer. Int J Gynecol Cancer 24(3):454–460
Konishi H, Takehara K, Kojima A et al (2014) Maximum standardized uptake value of fluorodeoxyglucose positron emission tomography/computed tomography is a prognostic factor in ovarian clear cell adenocarcinoma. Int J Gynecol Cancer 24(7):1190–1194
Nishijima N, Kajihara M (2014) A case of mature cystic teratoma presenting intense FDG uptake. Jap J Clin Radiol 59:1769–1773
Konishi H, Takehara K, Okame S et al (2014) Is fluorodeoxyglucose positron emission tomography, computed tomography useful for the diagnosis of borderline ovarian tumors? Obstet Gynecol 63(1):9–12
Cho A, Kim SW, Choi J et al (2014) The additional value of attenuation correction CT acquired during 18F-FDG PET/CT in differentiating mature from immature teratomas. Clin Nucl Med 39(3):e193–e196
Kitajima K, Murakami K, Yamasaki E et al (2008) Diagnostic accuracy of integrated FDG-PET/contrast-enhanced CT in staging ovarian cancer: comparison with enhanced CT. Eur J Nucl Med Mol Imaging 35(10):1912–1920
Kawai M, Kano T, Furuhashi Y et al (1991) Immature teratoma of the ovary. Gynecol Oncol 40(2):133–137
Hackethal A, Brueggmann D, Bohlmann MK et al (2008) Squamous-cell carcinoma in mature cystic teratoma of the ovary: systematic review and analysis of published data. Lancet Oncol 9(12):1173–1180
Suzuki M, Kobayashi H, Sekiguchi I et al (1995) Clinical evaluation of squamous cell carcinoma antigen in squamous cell carcinoma arising in mature cystic teratoma of the ovary. Oncology 52(4):2872–2890
Kikkawa F, Ishikawa H, Tamakoshi K et al (1997) Squamous cell carcinoma arising from mature cystic teratoma of the ovary: a clinicopathologic analysis. Obstet Gynecol 89(6):1017–1022
Balink H, Apperloo MJ, Collins J (2012) Assessment of ovarian teratoma and lymphadenopathy by 18F-FDG PET/CT. Clin Nucl Med 37(8):804–806
Fenchel S, Grab D, Nuessle K et al (2002) Asymptomatic adnexal masses: correlation of FDG PET and histopathologic findings. Radiology 223(3):780–788
Kawahara K, Yoshida Y, Kurokawa T et al (2004) Evaluation of positron emission tomography with tracer 18-fluorodeoxyglucose in addition to magnetic resonance imaging in the diagnosis of ovarian cancer in selected women after ultrasonography. J Computer Assist Tomogr 28(4):505–516
Miyasaka N, Kubota T (2011) Unusually intense 18F-fluorodeoxyglucose (FDG) uptake by a mature ovarian teratoma: a pitfall of FDG positron emission tomography. J Obstet Gynaecol Res 37(6):623–628
Koyama K, Okamura T, Kawabe J et al (2003) Evaluation of 18F-FDG PET with bladder irrigation in patients with uterine and ovarian tumors. J Nucl Med 44(3):353–358
Acknowledgements
This study is supported by Health and Labour Sciences Research Expenses for Commision.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Yokoyama, T., Takehara, K., Yamamoto, Y. et al. The usefulness of 18F-FDG-PET/CT in discriminating benign from malignant ovarian teratomas. Int J Clin Oncol 20, 960–966 (2015). https://doi.org/10.1007/s10147-015-0800-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10147-015-0800-0