Abstract
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Objectives Non-invasive surveillance procedures in patients with ovarian carcinoma after primary treatment and NED are still debated and several criticisms have been raised on the reliability of Ca125 as a marker for tumor recurrence. We studied the accuracy of 18F FDG PET scan (PET) in patients with epithelial ovarian carcinoma after treatment.
Methods We retrospectively evaluated 62 consecutive females during follow-up after surgery and chemotherapy with 130 PET (76 PET/CT) and Ca125 determinations. In 55 studies PET was performed in patients with negative marker and clinical suspicion of relapse or recurrence; in the remaining 75 studies, patients presented progressive rising or high Ca125 levels (cNED or with negative/doubtful radiological investigations). Sensitivity, specificity and accuracy of PETs were based on clinical follow-up (all patients) and US/CT/MR scan (44 cases).
Results In Table PET and Ca125 results are displayed. About the discordant results, in 12/13 cases PET correctly detected recurrences(s), in 16/19 PET failed, in 3/19 PET indicated an early response to therapy. PETs showed 7 supra-diaphragmatic, 62 sub-diaphragmatic district lesions and 25 in liver, lung, bone. PET and Ca125 TP,TN,FP,FN results were 68,45,1,16, and 72,43,3,12 respectively. PET sensitivity was 81%, specificity 98%, accuracy 87%, while PPV and NPV resulted 99% and 74% respectively.
Conclusions PET is an useful tools to plan the best treatment when Ca125 progressively raises. PET can identify tumor relapse also in patients with negative serum markers levels. PET can fail the detection of very small lesions and serosal (peritoneal/mesenteric) metastases (especially near to physiologic high intestinal uptake)
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