Skip to main content

Advertisement

Log in

Integrated PET/CT as a first-line re-staging modality in patients with suspected recurrence of ovarian cancer

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The aims of this study were to compare CT with PET/CT results in patients with suspected ovarian cancer recurrence and to assess the impact of the PET/CT findings on their clinical management.

Methods

Thirty-two consecutive patients with suspected ovarian cancer recurrence were retrospectively included in the study. Abdominal contrast-enhanced CT and PET/CT with [18F]FDG, in addition to conventional follow-up, were performed in all 32 patients. After the comparison between CT and PET/CT results, based on clinical reports, changes in the clinical management of patients (intermodality changes) due to PET/CT information were analysed.

Results

Twenty of the 32 patients were positive at CT (62.5%) versus 29 (90.6%) at PET/CT. Intermodality changes in management, i.e. use of a different treatment modality, after PET/CT examination were indicated in 14/32 (44%) patients. In particular, before PET/CT study, the planned management was as follows: wait-and-see in 7/32 (22%), further instrumental examinations in 4/32 (12%), chemotherapy in 10/32 (31%), diagnostic surgical treatment in 6/32 (19%) and surgical treatment in the remaining 5/32 (16%). After PET/CT study, wait-and-see was indicated in 1/32 (3%), further instrumental examinations in 7/32 (22%), chemotherapy in 16/32 (50%), diagnostic surgical treatment in 2/32 (6%) and surgical treatment in the remaining 6/32 (19%).

Conclusion

Integrated PET/CT could detect tumour relapse in a higher percentage of patients than could CT. A change in the clinical management was observed in 44% of cases when PET/CT information was added to conventional follow-up findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Greenlee RT, Hill Harmon MB, Murray T, Thun M. Cancer statistics, 2001. CA Cancer J Clin. 2001;51:15–36.

    Article  CAS  PubMed  Google Scholar 

  2. Ries LAG, Miller BA, Hankey BF. SEER cancer statistics review, 1973–1991. National Cancer Institute. NIH Publ. 1997;94:2789.

  3. Topuz E, Aydiner A, Saip P, Eralp Y, Tas F, Salihoglu Y, et al. Correlations of serum CA125 level and computerized tomography (CT) imaging with laparotomic findings following intraperitoneal chemotherapy in patients with ovarian cancer. Eur J Gynaecol Oncol. 2000;21:599–602.

    CAS  PubMed  Google Scholar 

  4. Zimny M, Siggelkow W, Schroder W, Nowak B, Biemann S, Rath W, et al. 2-Fluorine]-fluoro-2-deoxy-D-glucose positron emission tomography in the diagnosis of recurrent ovarian cancer. Gynecol Oncol 2001;83:310–5.

    Article  CAS  PubMed  Google Scholar 

  5. Reske SN, Kotzerke J. FDG-PET for clinical use. Eur J Nucl Med 2001;28:1707–23.

    Article  CAS  PubMed  Google Scholar 

  6. Picchio M, Sironi S, Messa C, Mangili G, Landoni C, Gianolli L, et al. Advanced ovarian carcinoma: usefulness of [18F]FDG-PET in combination with CT for lesion detection after primary treatment. Q J Nucl Med. 2003;47:77–84.

    CAS  PubMed  Google Scholar 

  7. Nakamoto Y, Saga T, Ishimori T, Mamede M, Togashi K, Higuchi 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 

  8. Torizuka T, Nobezawa S, Kanno T, Futatsubashi M, Yoshkawa E, Okada H, et al. Ovarian cancer recurrence: role of whole-body positron emission tomography using 2-[fluorine-18]-fluoro-2-deoxy-D-glucose. Eur J Nucl Med Mol Imaging 2002;29:797–803.

    Article  CAS  PubMed  Google Scholar 

  9. Beyer T, Townsend DW, Brun T, Kinahan PE, Charron M, Roddy R, et al. A combined PET/CT scanner for clinical oncology. J Nucl Med 2000;41:1369–79.

    CAS  PubMed  Google Scholar 

  10. Hany TF, Steinert HC, Goerres GW, Buck A, von Schulthess GK. PET diagnostic accuracy: improvement with in-line PET-CT system: initial results. Radiology 2002;225:575–81.

    Article  PubMed  Google Scholar 

  11. Casey J. Colonography and tumor staging during single-session PET/CT. Nature Clinical Practice Gastroenterology Hepatology 2006;3:184–5.

    Article  Google Scholar 

  12. Berthelsen AK, Holm S, Loft A, Klausen TL, Andersen F, Hojgaard L. PET/CT with intravenous contrast can be used for PET attenuation correction in cancer patients. Eur J Nucl Med Mol Imaging 2005;32:1167–75.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  14. Kurtz AB, Tsimikas JV, Tempany CM, Hamper U, Arger PH, Bree RL, et al. Diagnosis and staging of ovarian cancer: comparative values of Doppler and conventional US, CT, and MR imaging correlated with surgery and histopathologic analysis. Report of the Radiology Diagnostic Oncology Group. Radiology 1999;212:19–27.

    Article  CAS  PubMed  Google Scholar 

  15. Tempany CM, Zou KH, Silverman SG, Brown DL, Kurtz AB, McNeil BJ. Staging of advanced ovarian cancer: comparison of imaging modalities—report from the Radiological Diagnostic Oncology Group. Radiology 2000;215:761–7.

    Article  CAS  PubMed  Google Scholar 

  16. Kubik-Huch RA, Dorffler W, von Schulthess GK, Marincek B, Kochli OR, Seifert B, et al. Value of (18F)-FDG positron emission tomography, computed tomography, and magnetic resonance imaging in diagnosing primary and recurrent ovarian carcinoma. Eur Radiol 2000;10:761–7.

    Article  CAS  PubMed  Google Scholar 

  17. Ak I, Stokkel MP, Pauwels EK. Positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose in oncology. Part II. The clinical value in detecting and staging primary tumours. J Cancer Res Clin Oncol 2000;126:560–74.

    Article  CAS  PubMed  Google Scholar 

  18. Rose PG, Faulhaber P, Miraldi F, Abdul-Karim FW. Positive emission tomography for evaluating a complete clinical response in patients with ovarian or peritoneal carcinoma: correlation with second-look laparotomy. Gynecol Oncol 2001;82:17–21.

    Article  CAS  PubMed  Google Scholar 

  19. Drieskens O, Stroobants S, Gysen M, Vandenbosch G, Mortelmans L, Vergote I. Positron emission tomography with FDG in the detection of peritoneal and retroperitoneal metastases of ovarian cancer. Gynecol Obstet Invest 2003;55:130–4.

    Article  CAS  PubMed  Google Scholar 

  20. Havrilesky LJ, Kulasingam SL, Matchar DB, Myers ER. FDG-PET for management of cervical and ovarian cancer. Gynaecol Oncol 2005;97:183–91.

    Article  Google Scholar 

  21. Gould MK, Maclean CC, Kuschner WG, Rydzak CE, Owens DK. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA 2001;285:914–24.

    Article  CAS  PubMed  Google Scholar 

  22. Huebner RH, Park KC, Shepherd JE, Schwimmer J, Czernin J, Phelps ME, et al. A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancer. J Nucl Med 2000;41:1177–89.

    CAS  PubMed  Google Scholar 

  23. Seltzer MA, Yap CS, Silverman DH, Meta J, Schiepers C, Phelps ME, et al. The impact of PET on the management of lung cancer: the referring physician’s perspective. J Nucl Med 2002;43:752–6.

    PubMed  Google Scholar 

  24. Smith GT, Hubner KF, McDonald T, Thie JA. Cost analysis of FDG PET for managing patients with ovarian cancer. Clin Positron Imaging 1999;2:63–70.

    Article  PubMed  Google Scholar 

  25. Gambhir SS, Czernin J, Schwimmer J, Silverman DH, Coleman RE, Phelps ME. A tabulated summary of the FDG PET literature. J Nucl Med 2001;42(Suppl 5):1–93.

    Google Scholar 

  26. Hillner BE, Tunuguntla R, Fratkin M. Clinical decisions associated with positron emission tomography in a prospective cohort of patients with suspected or known cancer at one United States center. J Clin Oncol 2004;22:4147–56.

    Article  PubMed  Google Scholar 

  27. Pepe G, Rossetti C, Sironi S, Landoni C, Gianolli L, Pastorino U, et al. Patients with known or suspected lung cancer: evaluation of clinical management changes due to FDG PET study. Nucl Med Commun 2005;26:831–7.

    Article  PubMed  Google Scholar 

  28. Pieterman RM, van Putten JW, Meuzelaar JJ, Mooyaart EL, Vaalburg W, Koeter GH, et al. Preoperative staging of non-small-cell lung cancer with positron-emission tomography. N Engl J Med 2000;343:254–61.

    Article  CAS  PubMed  Google Scholar 

  29. Herder GJ, Van Tinteren H, Comans EF, Hoekstra OS, Teule GJ, Postmus PE, et al. Prospective use of serial questionnaires to evaluate the therapeutic efficacy of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in suspected lung cancer. Thorax 2003;58:47–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Kalff V, Hicks RJ, MacManus MP, Binns DS, McKenzie AF, Ware RE, et al. Clinical impact of 18F fluorodeoxyglucose positron emission tomography in patients with non-small-cell lung cancer: a prospective study. J Clin Oncol 2001;19:111–8.

    Article  CAS  PubMed  Google Scholar 

  31. van Tinteren H, Hoekstra OS, Smit EF, van den Bergh JH, Schreurs AJ, Stallaert RA, et al. Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small-cell lung cancer: the PLUS multicentre randomised trial. Lancet 2002;359:1388–93.

    Article  PubMed  Google Scholar 

  32. MacManus MP, Hicks RJ, Matthews JP, Hogg A, McKenzie AF, Wirth A, et al. High rate of detection of unsuspected distant metastases by PET in apparent stage III non-small-cell lung cancer: implications for radical radiation therapy. Int J Radiat Oncol Biol Phys 2001;50:287–93.

    Article  CAS  PubMed  Google Scholar 

  33. Meta J, Seltzer M, Schiepers C, Silverman DH, Ariannejad M, Gambhir SS, et al. Impact of 18F-FDG PET on managing patients with colorectal cancer: the referring physician’s perspective. J Nucl Med 2001;42:586–90.

    CAS  PubMed  Google Scholar 

  34. Ruiz-Hernandez G, Delgado-Bolton RC, Fernandez-Perez C, Lapena L, Jimenez-Vicioso A, Perez-Castejon MJ, et al. Impact of positron emission tomography with FDG-PET in treatment of patients with suspected recurrent ovarian cancer. Rev Esp Med Nucl 2005;24:113–26.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to F. Fazio.

Additional information

G. Mangili and M. Picchio contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mangili, G., Picchio, M., Sironi, S. et al. Integrated PET/CT as a first-line re-staging modality in patients with suspected recurrence of ovarian cancer. Eur J Nucl Med Mol Imaging 34, 658–666 (2007). https://doi.org/10.1007/s00259-006-0306-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-006-0306-0

Keywords

Navigation