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An Audit on the Role of PET/CT in Recurrent Ovarian Cancer in a Tertiary Care Centre

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Indian Journal of Gynecologic Oncology Aims and scope Submit manuscript

Abstract

Introduction

Ovarian cancers tend to recur in 50–70 % cases. 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 in suspected ovarian cancer recurrences.

Materials and Methods

PET/CT was done in cases with rising or above normal CA-125. These patients with abnormal PET/CT findings were taken up for a secondary cytoreductive surgery, and histopathological reports were taken as the standard against which PET/CT positive findings were compared.

Results

Of the 52 patients with suspected recurrence, 40 patients with a PET-CT scan with findings suggestive of an avid uptake underwent surgery. Of the 40 patients who underwent a secondary cytoreductive surgery, 38 had histopathologically confirmed recurrence. PET-CT detected a total of 86 lesions, of which 38 were in the lymph nodes, 32 were peritoneal lesions and 14 were pelvic, 2 were metastatic in the parenchyma of liver. Mean diameter of the lesions detected was 2.2 cm (range 0.3–6.2 cm). PET-CT accurately identified 72 of the 80 histopathologically proven lesions. The overall lesion-based sensitivity of PET-CT is 90 %, specificity 66.7 %, positive predictive value being 83.7 % and negative predictive value 77.7 % and the overall accuracy being 81.9 %.

Conclusions

Correlation between PET/CT and histopathological disease: κ (Cohen value) = 0.88 suggests excellent correlation. Selected patients with ovarian cancer recurrence may benefit from PET-CT at the time of even no. or minimal CA-125 elevation by early detection and successful cytoreduction.

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References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics: 2009. CA Cancer J Clin. 2009;59(4):225–49.

    Article  PubMed  Google Scholar 

  2. Aabo K, Adams M, Adnitt P, et al. Chemotherapy in advanced ovarian cancer: four systematic meta-analyses of individual patient data from 37 randomized trials. Advanced Ovarian Cancer Trialists’ Group. Br J Cancer. 1998;78(11):1479–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Armstrong DK, Bundy B, Wenzel L, et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med. 2006;354(1):34–43.

    Article  CAS  PubMed  Google Scholar 

  4. Omura GA, Brady MF, Homesley HD, et al. Long-term follow-up and prognostic factor analysis in advanced ovarian carcinoma: the Gynecologic Oncology Group experience. J Clin Oncol. 1991;9:1138–50.

    CAS  PubMed  Google Scholar 

  5. Pannu HK, Bristow RE, Cohade C, Fishman EK, Wahl RL. PET–CT in recurrent ovarian cancer: initial observations. Radio Gr. 2004;24(1):209–23.

    Google Scholar 

  6. Forstner R, Hricak H, Powell CB, Azizi L, Frankel SB, Stern JL. Ovarian cancer recurrence: value of MR imaging. Radiology. 1995;196:715–20.

    Article  CAS  PubMed  Google Scholar 

  7. Sironi S, Messa C, Mangili G, Zangheri B, et al. Integrated FDG PET/CT in patients with persistent ovarian cancer: correlation with histologic findings. Radiology. 2004;233(2):433–40.

    Article  PubMed  Google Scholar 

  8. Petru E, Lück HJ, Stuart G, et al. Gynecologic Cancer Intergroup (GCIG) proposals for changes of the current FIGO staging system. Eur J Obstet Gynecol Reprod Biol. 2009;143(2):69–74.

    Article  PubMed  Google Scholar 

  9. Heintz AP, Odicino F, Maisonneuve P, et al. Carcinoma of the ovary: FIGO 6th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet. 2006;95(suppl 1):S161–92.

    Article  PubMed  Google Scholar 

  10. Cho SM, Ha HK, Byun JY, et al. Usefulness of FDG PET for assessment of early recurrent epithelial ovarian cancer. AJR Am J Roentgenol. 2002;179(2):391–5.

    Article  PubMed  Google Scholar 

  11. Wilder JL, Pavlik E, Straughn JM, Kirby T, Higgins RV, DePriest PD, Ueland FR, Kryscio RJ, Whitley RJ, van Nagell J. Clinical implications of a rising serum CA-125 within the normal range in patients with epithelial ovarian cancer: a preliminary investigation. Gynecol Oncol. 2003;89(2):233–5.

    Article  CAS  PubMed  Google Scholar 

  12. Rising C, Anjegard M, Einhorn N. Clinical relevance of the CA 125 assay in monitoring of ovarian cancer patients. Am J Clin Oncol. 1991;14(2):111–4.

    Article  Google Scholar 

  13. Bristow RE, del Carmen MG, Pannu HK, Cohade C, Zahurak ML, Fishman EK, Wahl RL, Montz FJ. Clinically occult recurrent ovarian cancer: patient selection for secondary cytoreductive surgery using combined PET/CT. Gynecol Oncol. 2003;90(3):519–28.

    Article  PubMed  Google Scholar 

  14. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86.

    Article  CAS  PubMed  Google Scholar 

  15. Hawkins RE, Roberts K, Wiltshaw E, et al. The clinical correlates of serum CA125 in 169 patients with epithelial ovarian carcinoma. Br J Cancer. 1989;60:634–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Rustin GJ, van der Burg ME, Griffin CL, Guthrie D, Lamont A, Jayson GC, Kristensen G, Mediola C, Coens C, Qian W, Parmar MK. Early versus delayed treatment of relapsed ovarian cancer (MRC OV05/EORTC 55955): a randomised trial. Lancet. 2010;376(9747):1155–63.

    Article  PubMed  Google Scholar 

  17. Tanner EJ, Chi DS, Eisenhauer EL, Diaz-Montes TP, Santillan A, Bristow RE. Surveillance for the detection of recurrent ovarian cancer: survival impact or lead-time bias? Gynecol Oncol. 2010;117(2):336–40.

    Article  PubMed  Google Scholar 

  18. Harter P, du Bois A, Hahmann M, et al. Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial. Ann Surg Oncol. 2006;13:1702–10.

    Article  PubMed  Google Scholar 

  19. Bristow RE, del Carmen MG, Pannu HK, Cohade C, Zahurak ML, Fishman EK, et al. Clinically occult recurrent ovarian cancer: patient selection for secondary cytoreductive surgery using combined PET/CT. Gynecol Oncol. 2003;90(3):519–28.

    Article  PubMed  Google Scholar 

  20. Eisenkop SM, Friedman RL, Spirtos NM. The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma. Cancer. 2000;88(1):144–53.

    Article  CAS  PubMed  Google Scholar 

  21. Boellaard R, O’Doherty MJ, Weber WA, Mottaghy FM, Lonsdale MN, Stroobants SG, Oyen WJ, Kotzerke J, Hoekstra OS, Pruim J, Marsden PK. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging. 2010;37(1):181–200.

    Article  PubMed  Google Scholar 

  22. Kim HJ, Kim JK, Cho KS. CT features of serous surface papillary carcinoma of the ovary. AJR Am J Roentgenol. 2004;183(6):1721–4.

    Article  PubMed  Google Scholar 

  23. Qayyum A, Coakley FV, Westphalen AC, Hricak H, Okuno WT, Powell B. Role of CT and MR imaging in predicting optimal cytoreduction of newly diagnosed primary epithelial ovarian cancer. Gynecol Oncol. 2005;96(2):301–6.

    Article  PubMed  Google Scholar 

  24. Gu P, Pan LL, Wu SQ, et al. CA 125, PET alone, PET–CT, CT and MRI in diagnosing recurrent ovarian carcinoma: a systematic review and meta-analysis. Eur J Radiol. 2009;71:164–74.

    Article  PubMed  Google Scholar 

  25. Ak I, Stokkel MP, Pauwels EK. Positron emission tomography with FDG in oncology: the clinical value in detecting and staging primary tumors. J Cancer Res Clin Oncol. 2000;126:560–74.

    Article  CAS  PubMed  Google Scholar 

  26. Torizuka T, Nobezawa S, Kanno T, et al. Ovarian cancer recurrence: role of whole-body positron emission tomography using FDG. Eur J Nucl Med Mol Imaging. 2002;29:797–803.

    Article  CAS  PubMed  Google Scholar 

  27. Flamen P, Stroobants S, Cutsem EV, et al. Additional value of whole-body positron emission tomography with FDG in recurrent colorectal cancer. J Clin Oncol. 1999;17:894–901.

    CAS  PubMed  Google Scholar 

  28. Schelling M, Avril N, Nahrig J, et al. Positron emission tomography using FDG for monitoring primary chemotherapy in breast cancer. J Clin Oncol. 2000;18:1689–95.

    CAS  PubMed  Google Scholar 

  29. Nakamoto Y, Saga T, Ishimori T, et al. Clinical value of positron emission tomography with FDG for recurrent ovarian cancer. AJR Am J Roentgenol. 2001;176:1449–54.

    Article  CAS  PubMed  Google Scholar 

  30. Simcock B, Neesham D, Quinn M, Drummond E, Milner A, Hicks RJ. The impact of PET/CT in the management of recurrent ovarian cancer. Gynecol Oncol. 2006;103(1):271–6.

    Article  PubMed  Google Scholar 

  31. Cho SM, Ha HK, Byun JY, et al. Usefulness of FDG PET for assessment of early recurrent epithelial ovarian cancer. AJR Am J Roentgenol. 2002;179:391–5.

    Article  PubMed  Google Scholar 

  32. Zimny M, Siggelkow W, Schroder W, et al. FDG positron emission tomography in the diagnosis of recurrent ovarian cancer. Gynecol Oncol. 2001;83:310–5.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Gynae Oncology, RGCIRC, Sector-5, Rohini, New Delhi, 110085, India

    Kanika Batra Modi, Rupinder Sekhon, Rashmi Rekha Bora, Shweta Giri, Vandana Jain & Sudhir Rawal

  2. Surgical Oncology, RGCIRC, New Delhi, India

    Swati Shah, K. R. Suhas & Sudhir Rawal

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  1. Kanika Batra Modi
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  2. Rupinder Sekhon
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  3. Rashmi Rekha Bora
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  4. Shweta Giri
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  5. Vandana Jain
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  7. K. R. Suhas
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Correspondence to Kanika Batra Modi.

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Batra Modi, K., Sekhon, R., Bora, R.R. et al. An Audit on the Role of PET/CT in Recurrent Ovarian Cancer in a Tertiary Care Centre. Indian J Gynecol Oncolog 14, 40 (2016). https://doi.org/10.1007/s40944-016-0069-x

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  • DOI: https://doi.org/10.1007/s40944-016-0069-x

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