FDG PET/CT in the clinical management of patients with ovarian cancer after primary treatment

Objectives PET/CT with FDG has been introduced in clinical settings to diagnose ovarian cancer relapse after surgery and/or chemotherapy, and to assess the efficacy of chemotherapy. Aim of the study was to retrospectively evaluate the added value of FDG-PET/CT in the clinical management of pts with ovarian cancer after primary treatment.

Methods Fifty-five pts with ovarian cancer were evaluated for a total of 213 PET/CT studies (89 for restaging, 87 for therapy response assessment, 37 during follow-up). Whole-body PET/CT scans were performed with a GE Healthcare Discovery ST/8 scanner. Pts fasted for at least 6 hours prior to examination and blood glucose levels were checked before each study. Visual inspection was used for the analysis of PET/CT findings. PET/CT results were assessed by using pathology or follow-up as gold standard.

Results PET/CT showed an overall sensitivity and specificity of 93% and 94%, respectively. During restaging, PET/CT provided correct information in 77/89 evaluations, changing appropriately patient management in 52% of cases, mainly when Ca125 levels were elevated and ce-CT was negative or not performed. Moreover, PET/CT provided correct information changing patient management in 11% of cases with negative Ca125 and suspected disease relapse on the basis of ce-CT. In the evaluation of therapy response, PET/CT induced a correct change in treatment strategy in 68/87 of cases. During follow-up, PET/CT appropriately modified clinical management in 15/37 of cases, by either excluding disease or disclosing cancer relapse in pts who were apparently disease-free.

Conclusions In this clinical study FDG-PET/CT resulted to be a highly sensitive and specific tool for the evaluation of pts affected by ovarian cancer during restaging, follow-up and after treatment. In a relevant proportion of cases PET/CT was primary in determining a change of the clinical management of pts by disclosing or excluding disease