Skip to main content

Advertisement

SpringerLink
Log in

Value of 18F-FDG PET/CT in the Detection of Ovarian Malignancy

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

Abstract

Purpose

Ovarian cancer is a leading cause of gynecologic malignancy. As symptoms of ovarian cancer are nonspecific, only 20 % of ovarian cancers are diagnosed while they are still limited to the ovaries. Thus, early and accurate detection of disease is important for an improved prognosis. For the accurate and effective diagnosis of ovarian malignancy on 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), we analyzed several parameters, including visual assessment.

Method

A total of 51 peritoneal lesions in 19 patients who showed ovarian masses with diffuse peritoneal infiltration were enrolled. Twelve patients were confirmed to have ovarian malignancy and seven patients with benign disease by pathologic examination. All patients were examined by 18F-FDG PET/CT, and an additional 2-h delayed 18F-FDG PET/CT was also performed for 15 patients with 42 peritoneal lesions. We measured semiquantitative parameters including maximum and mean standardized uptake values (SUVmax, SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on a 1-h initial 18F-FDG PET/CT image (Parameter1) and on a 2-h delayed image (Parameter2). Additionally, retention indices of each parameter were calculated, and each parameter among the malignant and benign lesions was compared by Mann-Whitney U test. We also assessed the visual characteristics of each peritoneal lesion, including metabolic extent, intensity, shape, heterogeneity, and total visual score. Associations between visual grades and malignancy were analyzed using linear by linear association methods. Moreover, a receiver operating characteristic (ROC) curve was analyzed to compare the effectiveness of significant parameters.

Result

In a comparison between the malignant and benign groups in the analysis of 51 total peritoneal lesions, SUVmax1, SUVmean1, and TLG1 showed significant differences. Also, in the analysis of 42 peritoneal lesions that underwent an additional 2-h 18F-FDG PET/CT examination, SUVmax1,2, SUVmean1,2, TLG2, and the RI of TLG showed significant differences between the malignant and benign groups. MTV did not show significant differences in either the analysis of 51 peritoneal lesions or of 42 lesions. Regarding visual assessments, metabolic intensity, shape, heterogeneity, and total visual score showed an association with malignancy. In the ROC analysis, the AUC of the visual score was larger than the AUC of other parameters in both the analyses of 51 peritoneal lesions and of 42 lesions.

Conclusion

Although further study with a larger patient population is needed, the visual assessment of 18F-FDG PET/CT imaging has a primary role in the detection of malignancy in ovarian cancer patients with assistance from other semi-quantitative parameters.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. Cancer incidence and mortality worldwide: IARC Cancer Base No.11, International Agency for Research on Cancer; 2012. Available from: http://globocan.iarc.fr.

  2. The Korea Central Cancer Registry, National Cancer Center. Annual report of cancer statistics in Korea in 2010. Ministry for Health and Welfare. 2012.

  3. Bast Jr RC, Hennessy B, Mills GB. The biology of ovarian cancer: new opportunities for translation. Nat Rev Cancer. 2009;9(6):415–28.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Forstner R, Hricak H, Occhipinti KA, Powell CB, Frankel SD, Stern JL. Ovarian cancer: staging with CT and MR imaging. Radiology. 1995;197(3):619–26.

    Article  CAS  PubMed  Google Scholar 

  5. 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(3):761–7.

    Article  CAS  PubMed  Google Scholar 

  6. Risum S, Hogdall C, Loft A, Berthelsen AK, Hogdall E, Nedergaard L, et al. The diagnostic value of PET/CT for primary ovarian cancer—a prospective study. Gynecol Oncol. 2007;105(1):145–9.

    Article  PubMed  Google Scholar 

  7. Prakash P, Cronin CG, Blake MA. Role of PET/CT in ovarian cancer. AJR Am J Roentgenol. 2010;194(6):W464–70.

    Article  PubMed  Google Scholar 

  8. Fenchel S, Grab D, Nuessle K, Kotzerke J, Rieber A, Kreienberg R, et al. Asymptomatic adnexal masses: correlation of FDG PET and histopathologic findings. Radiology. 2002;223(3):780–8.

    Article  PubMed  Google Scholar 

  9. Rieber A, Nussle K, Stohr I, Grab D, Fenchel S, Kreienberg R, et al. Preoperative diagnosis of ovarian tumors with MR imaging: comparison with transvaginal sonography, positron emission tomography, and histologic findings. AJR Am J Roentgenol. 2001;177(1):123–9.

    Article  CAS  PubMed  Google Scholar 

  10. Rosenbaum SJ, Lind T, Antoch G, Bockisch A. False-positive FDG PET uptake-the role of PET/CT. Eur Radiol. 2006;16(5):1054–65.

    Article  PubMed  Google Scholar 

  11. Caprio MG, Cangiano A, Imbriaco M, Soscia F, Di Martino G, Farina A, et al. Dual-time-point [18F]-FDG PET/CT in the diagnostic evaluation of suspicious breast lesions. Radiol Med. 2010;115(2):215–24.

    Article  CAS  PubMed  Google Scholar 

  12. Costantini DL, Vali R, Chan J, McQuattie S, Charron M. Dual-time-point FDG PET/CT for the evaluation of pediatric tumors. AJR Am J Roentgenol. 2013;200(2):408–13.

    Article  PubMed  Google Scholar 

  13. Zhuang H, Pourdehnad M, Lambright ES, Yamamoto AJ, Lanuti M, Li P, et al. Dual time point 18F-FDG PET imaging for differentiating malignant from inflammatory processes. J Nucl Med. 2001;42(9):1412–7.

    CAS  PubMed  Google Scholar 

  14. Lee S, Park T, Park S, Pahk K, Rhee S, Cho J, et al. The Clinical Role of Dual-Time-Point 18F-FDG PET/CT in differential diagnosis of the Thyroid Incidentaloma. Nucl Med Mol Imaging. 2014;48(2):121–9.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Lee HY, Hyun SH, Lee KS, Kim BT, Kim J, Shim YM, et al. Volume-based parameter of 18F-FDG PET/CT in malignant pleural mesothelioma: prediction of therapeutic response and prognostic implications. Ann Surg Oncol. 2010;17(10):2787–94.

    Article  PubMed  Google Scholar 

  16. Chung HH, Kim JW, Han KH, Eo JS, Kang KW, Park NH, et al. Prognostic value of metabolic tumor volume measured by FDG-PET/CT in patients with cervical cancer. Gynecol Oncol. 2011;120(2):270–4.

    Article  PubMed  Google Scholar 

  17. Huang W, Zhou T, Ma L, Sun H, Gong H, Wang J, et al. Standard uptake value and metabolic tumor volume of 18F-FDG PET/CT predict short-term outcome early in the course of chemoradiotherapy in advanced non-small cell lung cancer. Eur J Nucl Med Mol Imaging. 2011;38(9):1628–35.

    Article  CAS  PubMed  Google Scholar 

  18. Yoo J, Choi JY, Lee KT, Heo JS, Park SB, Moon SH, et al. Prognostic significance of volume-based metabolic parameters by 18F-FDG PET/CT in gallbladder carcinoma. Nucl Med Mol Imaging. 2012;46(3):201–6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Chung HH, Kwon HW, Kang KW, Kim JW, Park NH, Song YS, et al. Preoperative [18F]FDG PET/CT predicts recurrence in patients with epithelial ovarian cancer. J Gynecol Oncol. 2012;23(1):28–34.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Liao S, Lan X, Cao G, Yuan H, Zhang Y. Prognostic predictive value of total lesion glycolysis from 18F-FDG PET/CT in post-surgical patients with epithelial ovarian cancer. Clin Nucl Med. 2013;38(9):715–20.

    Article  PubMed  Google Scholar 

  21. Miller TR, Pinkus E, Dehdashti F, Grigsby PW. Improved prognostic value of 18F-FDG PET using a simple visual analysis of tumor characteristics in patients with cervical cancer. J Nucl Med. 2003;44(2):192–7.

    PubMed  Google Scholar 

  22. Ciernik IF, Dizendorf E, Baumert BG, Reiner B, Burger C, Davis JB, et al. Radiation treatment planning with an integrated positron emission and computer tomography (PET/CT): a feasibility study. Int J Radiat Oncol Biol Phys. 2003;57(3):853–63.

    Article  PubMed  Google Scholar 

  23. 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(8):1369–79.

    CAS  PubMed  Google Scholar 

  24. Kostakoglu L, Agress Jr H, Goldsmith SJ. Clinical role of FDG PET in evaluation of cancer patients. Radiographics. 2003;23(2):315–40. quiz 533.

    Article  PubMed  Google Scholar 

  25. Lerman H, Metser U, Grisaru D, Fishman A, Lievshitz G, Even-Sapir E. Normal and abnormal 18F-FDG endometrial and ovarian uptake in pre- and postmenopausal patients: assessment by PET/CT. J Nucl Med. 2004;45(2):266–71.

    PubMed  Google Scholar 

  26. Adams MC, Turkington TG, Wilson JM, Wong TZ. A systematic review of the factors affecting accuracy of SUV measurements. AJR Am J Roentgenol. 2010;195(2):310–20.

    Article  PubMed  Google Scholar 

  27. Costelloe CM, Macapinlac HA, Madewell JE, Fitzgerald NE, Mawlawi OR, Rohren EM, et al. 18F-FDG PET/CT as an indicator of progression-free and overall survival in osteosarcoma. J Nucl Med. 2009;50(3):340–7.

    Article  PubMed  Google Scholar 

  28. Hatt M, Visvikis D, Albarghach NM, Tixier F, Pradier O, Cheze-le RC. Prognostic value of 18F-FDG PET image-based parameters in oesophageal cancer and impact of tumour delineation methodology. Eur J Nucl Med Mol Imaging. 2011;38(7):1191–202.

    Article  PubMed  Google Scholar 

  29. Liao S, Penney BC, Wroblewski K, Zhang H, Simon CA, Kampalath R, et al. Prognostic value of metabolic tumor burden on 18F-FDG PET in nonsurgical patients with non-small cell lung cancer. Eur J Nucl Med Mol Imaging. 2012;39(1):27–38.

    Article  CAS  PubMed  Google Scholar 

  30. Hustinx R, Smith RJ, Benard F, Rosenthal DI, Machtay M, Farber LA, et al. Dual time point fluorine-18 fluorodeoxyglucose positron emission tomography: a potential method to differentiate malignancy from inflammation and normal tissue in the head and neck. Eur J Nucl Med. 1999;26(10):1345–8.

    Article  CAS  PubMed  Google Scholar 

  31. Lee JK, Min KJ, So KA, Kim S, Hong JH. The effectiveness of dual-phase 18F-FDG PET/CT in the detection of epithelial ovarian carcinoma: a pilot study. J Ovarian Res. 2014;7(1):15.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Cheng G, Torigian DA, Zhuang H, Alavi A. When should we recommend use of dual time-point and delayed time-point imaging techniques in FDG PET? Eur J Nucl Med Mol Imaging. 2013;40(5):779–87.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of Interest

Taegyu Park, Sinae Lee, Soyeon Park, Eunsub Lee, Kisoo Pahk, Seunghong Rhee, Jaehyuk Cho, Chulhan Kim, Jae Seon Eo, Jae Gol Choe and Sungeun Kim declare that they have no conflict of interest.

Ethical Statement

The institutional review board approval number of this study is KUGH14038. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients included in the study. Additional informed consent was obtained from all patients for whom identifying information is included in this article.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Korea University Guro Hospital, Seoul, South Korea

    Taegyu Park, Sinae Lee, Soyeon Park, Eunsub Lee & Jae Seon Eo

  2. Department of Nuclear Medicine, Korea University Anam Hospital, #73, Inchon-ro, Seoungbuk-gu, Seoul, 136-705, South Korea

    Kisoo Pahk, Seunghong Rhee, Jaehyuk Cho, Jae Gol Choe & Sungeun Kim

  3. Department of Nuclear Medicine, Korea University Ansan Hospital, Ansan, South Korea

    Chulhan Kim

Authors
  1. Taegyu Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sinae Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Soyeon Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eunsub Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kisoo Pahk
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Seunghong Rhee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jaehyuk Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chulhan Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jae Seon Eo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jae Gol Choe
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sungeun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sungeun Kim.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Park, T., Lee, S., Park, S. et al. Value of 18F-FDG PET/CT in the Detection of Ovarian Malignancy. Nucl Med Mol Imaging 49, 42–51 (2015). https://doi.org/10.1007/s13139-014-0303-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13139-014-0303-3

Keywords

Search

Navigation