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EANM guideline on the role of 2-[18F]FDG PET/CT in diagnosis, staging, prognostic value, therapy assessment and restaging of ovarian cancer, endorsed by the American College of Nuclear Medicine (ACNM), the Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the International Atomic Energy Agency (IAEA)

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Abstract

In most patients with ovarian carcinoma, the diagnosis is reached when the disease is long past the initial stages, presenting already an advanced stage, and they usually have a very bad prognosis. Cytoreductive or debulking surgical procedures, platinum-based chemotherapy and targeted agents are key therapeutic elements. However, around 7 out of 10 patients present recurrent disease within 36 months from the initial diagnosis. The metastatic spread in ovarian cancer follows three pathways: contiguous dissemination across the peritoneum, dissemination through the lymphatic drainage and, although less importantly in this case, through the bloodstream. Radiological imaging, including ultrasound, CT and MRI, are the main imaging techniques in which management decisions are supported, CT being considered the best available technique for presurgical evaluation and staging purposes. Regarding 2-[18F]FDG PET/CT, the evidence available in the literature demonstrates efficacy in primary detection, disease staging and establishing the prognosis and especially for relapse detection. There is limited evidence when considering the evaluation of therapeutic response. This guideline summarizes the level of evidence and grade of recommendation for the clinical indications of 2-[18F]FDG PET/CT in each disease stage of ovarian carcinoma.

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Abbreviations

2-[18F]FDG:

2-[18F]Fluoro-2-deoxy-D-glucose

AOC:

Advanced ovarian cancer

BOT:

Borderline ovarian tumour

CEA:

Serum carcinoembryonic antigen

CT:

Computed tomography

ceCT:

Contrast-enhanced computed tomography

EOC:

Early-stage ovarian carcinoma

EORTC:

European Organisation for Research and Treatment of Cancer

ESMO:

European Society of Medical Oncology

ESGO:

European Society of Gynaecological Oncology

FIGO:

International Federation of Gynaecology and Obstetrics

IAEA:

International Atomic Energy Agency

IOTA:

International Ovarian Tumour Analysis group

LBM:

Lean body mass

LGSC:

Low-grade serous carcinoma

PCI:

Peritoneal cancer index

PET:

Positron emission tomography

MATV or MTV:

Metabolic active tumour volume

MRI:

Magnetic resonance imaging

sBOT(s):

Serous borderline ovarian tumour(s)

SUL:

Standardized uptake value using lean body mass (LBM)

SUV:

Standardized uptake value

TAUS:

Transabdominal ultrasound

TLG:

Total lesion glycolysis

TVUS:

Transvaginal ultrasound

US:

Ultrasound or echography

VOI:

Volume of interest

WHO:

World Health Organization

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Acknowledgements

The authors are grateful to the International Atomic Energy Agency (IAEA) for scientific and logistic support. They also appreciate the contribution of the EANM National Societies of Nuclear Medicine and EANM committees who reviewed the guideline.

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Authors and Affiliations

  1. Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), La Rioja, Logroño, Spain

    Roberto C. Delgado Bolton

  2. Department of Nuclear Medicine, Caen University Hospital, Caen, France

    Nicolas Aide

  3. INSERM U1086 ANTICIPE, Normandie Université, Caen, France

    Nicolas Aide

  4. Department of Radiology, University of Southern California, Los Angeles, CA, USA

    Patrick M. Colletti

  5. Academic Division Gynaecology and Obstetrics, University of Torino, Mauriziano Hospital, Torino, Italy

    Annamaria Ferrero

  6. Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency (IAEA), Vienna, Austria

    Diana Paez & Francesco Giammarile

  7. Department of Nuclear Medicine, Hospices Civils de Lyon, Université Claude Bernard, Lyon 1, Lyon, France

    Andrea Skanjeti

  8. Department of Nuclear Medicine, Centre Léon Bérard, Lyon, France

    Francesco Giammarile

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  1. Roberto C. Delgado Bolton
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Correspondence to Roberto C. Delgado Bolton.

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EANM: Roberto C. Delgado Bolton, Nicolas Aide, and Francesco Giammarile

IAEA: Francesco Giammarile and Diana Paez

ACNM and SNMMI: Patrick M. Colletti

Endorsements

IAEA: endorsed 04/2021

ACNM: endorsed 04/2021

SNMMI: endorsed 04/2021

This article is part of the Topical Collection on Oncology - Genitourinary

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Delgado Bolton, R.C., Aide, N., Colletti, P.M. et al. EANM guideline on the role of 2-[18F]FDG PET/CT in diagnosis, staging, prognostic value, therapy assessment and restaging of ovarian cancer, endorsed by the American College of Nuclear Medicine (ACNM), the Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the International Atomic Energy Agency (IAEA). Eur J Nucl Med Mol Imaging 48, 3286–3302 (2021). https://doi.org/10.1007/s00259-021-05450-9

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