Role of 18-Fluorine Fluoro-deoxy Glucose Positron Emission Tomography (FDG-PET/CT scan) in Suspected Relapsed Ovarian Cancer; an Institutional Experience.

Abdul Wahab; Muhammad Rashid Hanif; Saima Riaz; Shafquat Ali Khan; Musa Azhar; Neelam Siddiqui

doi:10.51253/pafmj.v74iSUPPL-2.4896

Authors

Abdul Wahab Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore Pakistan
Muhammad Rashid Hanif Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore Pakistan
Saima Riaz Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital, Lahore Pakistan.
Shafquat Ali Khan Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore Pakistan
Musa Azhar Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore Pakistan
Neelam Siddiqui Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74iSUPPL-2.4896

Keywords:

CA-125, Ovarian cancer, 18-Fluorine Fluoro-deoxy glucose Positron Emission Tomography (FDG-PET/CT scan)

Abstract

Objectives: To determine the role of 18-Fluorine Fluoro-deoxy glucose Positron Emission Tomography (18F FDG-PET/CT scan) in suspected relapsed ovarian cancer patients.

Study Design: Cross-sectional study.

Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore Pakistan, from Jan 2010 to Dec 2017.

Methodology: A total of 964 patients of epithelial ovarian carcinoma who had histologically proven ovarian cancer diagnosed from January 2010 until December 2017 were reviewed. 70 patients on surveillance who had FDG-PET/CT scan for suspected relapse were included in our study. Data collected from the digital Hospital Information System after Institutional review board approval.

Results: Average age for our study group was 48.6 years ± 11.4 SD. Serous pathology was predominant in 47/70(67.1%) patients followed by Endometroid (14.3%). FDG-PET/CT scan changed the stage in 30% patients. Sensitivity, specificity, positive predictive value, and negative predictive value of FDG-PET/CT were 96%, 72%, 89% and 88% respectively while it is 92%, 76%, 90%, and 80% respectively for conventional CT scan. Average Cancer antigen-125 (CA-125) at suspected relapse is 290. 21 patients (75%) showed FDG avid disease on PET scan in whom CA-125 was normal.

Conclusion: PET scan has better negative predictive value than conventional CT scan to detect relapse in ovarian cancer, its overall sensitivity is comparable to contrast-enhanced CT scan. CA-125 is not a reliable marker for the detection of relapse in ovarian cancer patients.

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References

Jayson GC, Kohn EC, Kitchener HC, Ledermann JA. Ovarian cancer. Lancet 2014; 384(9951): 1376-1388.

Meinhold-Heerlein I, Fotopoulou C, Harter P, Kurzeder C, Mustea A, Wimberger P, et al. The new WHO classification of ovarian, fallopian tube, and primary peritoneal cancer and its clinical implications. Arch Gynecol Obstet 2016; 293(4): 695-700.

Peres LC, Cushing-Haugen KL, Köbel M, Harris HR, Berchuck A, Rossing MA, et al. Invasive epithelial ovarian cancer survival by histotype and disease stage. J Natl Cancer Inst 2019; 111(1): 60-68.

Gadducci A, Cosio S. Surveillance of patients after initial treatm-ent of ovarian cancer. Crit Rev Oncol Hematol 2009; 71(1): 43-52.

Podoloff DA, Advani RH, Allred C, Benson AB, Brown E, Burstein HJ, et al. NCCN task force report: positron emission tomography (PET)/computed tomography (CT) scanning in cancer. J Natl Compr Canc Netw 2007; 5(Suppl 1): S1-22.

Blodgett TM, Meltzer CC, Townsend DW. PET/CT: form and function. Radiology 2007; 242(2): 360-385.

Kitajima K, Murakami K, Yamasaki E, Kaji Y, Fukasawa I, et al. Diagnostic accuracy of integrated FDG-PET/contrast-enhanced CT in staging ovarian cancer: comparison with enhanced CT. Eur J Nucl Med Mol Imaging 2008; 35(10): 1912-1920.

Cook SA, Wilson D, Pourghiasian M, Tinker AV. The Value of PET-CT in Ovarian Epithelial Carcinoma: A Population-Based Study in British Columbia, Canada. J Med Imaging Radiat Sci 2020.

Ghosh J, Thulkar S, Kumar R, Malhotra A, Kumar A, Kumar L. Role of 18F-fluorodeoxy glucose PET-CT in asymptomatic epithelial ovarian cancer with rising serum CA-125: A pilot study. Natl Med J India 2013; 26: 327-331.

Forstner R, Meissnitzer M, Cunha TM. Update on imaging of ovarian cancer. Curr Radiol Rep 2016; 4(6): 31.

Kang SK, Reinhold C, Atri M, Benson CB, Bhosale PR, Jhingran A, et al. ACR appropriateness criteria® staging and follow-up of ovarian cancer. J Am Coll Radiol 2018; 15(5): S198-S207.

Bilici A, Ustaalioglu BBO, Seker M, Canpolat N, Tekinsoy B, Salepci T, et al. Clinical value of FDG PET/CT in the diagnosis of suspected recurrent ovarian cancer: is there an impact of FDG PET/CT on patient management? Eur J Nucl Med Mol Imaging 2010; 37(7): 1259-1269.

Bottoni P, Scatena R. The role of CA 125 as tumor marker: biochemical and clinical aspects. Advances in Cancer Biomarkers: Springer; 2015.

Rustin GJ, Van Der Burg ME, Griffin CL, Guthrie D, Lamont A, Jayson GC, et al. Early versus delayed treatment of relapsed ovarian cancer (MRC OV05/EORTC 55955): a randomized trial. Lancet 2010; 376(9747): 1155-1163.

Morgan RJ, Armstrong DK, Alvarez RD, Bakkum-Gamez JN, Behbakht K, Chen L-m, et al. Ovarian cancer, version 1.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2016; 14(9): 1134-1163.

National Comprehensive Cancer network, ovarian cancer guidelines. Available at https://www.nccn.org, Version 1.2020-March 11,2020 (Accessed 6/8/2020).

Iyer VR, Lee SI. MRI, CT, and PET/CT for ovarian cancer detection and adnexal lesion characterization. AJR Am J Roentgenol 2010; 194(2): 311-321.

Naganawa S, Yoshikawa T, Yasaka K, Maeda E, Hayashi N, Abe O. Role of delayed-time-point imaging during abdominal and pelvic cancer screening using FDG-PET/CT in the general population. Medicine (2017)96: 46(e8832).

ElHariri MAG, Harira M, Riad MM. Usefulness of PET–CT in the evaluation of suspected recurrent ovarian carcinoma. Egypt J Radiol Nucl Med 2019; 50(1): 1-8.

Abdelhafez Y, Tawakol A, Osama A, Hamada E, El-Refaei S. Role of 18F-FDG PET/CT in the detection of ovarian cancer recurrence in the setting of normal tumor markers. Egypt J Radiol Nucl Med 2016; 47(4): 1787-1794.

Takeuchi S, Lucchini M, Schmeler KM, Coleman RL, Gershenson DM, Munsell MF, et al. Utility of 18F-FDG PET/CT in follow-up of patients with low-grade serous carcinoma of the ovary. Gynecol Oncol 2014; 133(1): 100-104.

Sala E, Kataoka M, Pandit-Taskar N, Ishill N, Mironov S, Moskowitz CS, et al. Recurrent ovarian cancer: use of contrast-enhanced CT and PET/CT to accurately localize tumor recurrence and to predict patients’ survival. Radiology 2010; 257(1): 125-34.

Funicelli L, Travaini L, Landoni F, Trifirò G, Bonello L, Bellomi M. Peritoneal carcinomatosis from ovarian cancer: the role of CT and [18 F] FDG-PET/CT. Abdom imaging 2010; 35(6): 701-707.

Hynninen J, Kemppainen J, Lavonius M, Virtanen J, Matomäki J, Oksa S, et al. A prospective comparison of integrated FDG-PET/contrast-enhanced CT and contrast-enhanced CT for pretreatment imaging of advanced epithelial ovarian cancer. Gynecol Oncol 2013; 131(2): 389-394.

Han EJ, Park HL, Lee YS, Park EK, Song MJ, Yoo IR, et al. Clinical usefulness of post-treatment FDG PET/CT in patients with ovarian malignancy. Ann Nucl Med 2016; 30(9): 600-607.