The influence of CA 125 and CEA levels on the results of (18)F-deoxyglucose positron emission tomography in suspected recurrence of epithelial ovarian cancer.
OBJECTIVE
The follow-up of epithelial ovarian cancer (OCA) consists of clinical investigation, sonography, and tumor markers (TMs), especially CA 125. If tumor recurrence is suspected, other imaging modalities including positron emission tomography (PET) with (18)F-deoxyglucose (FDG) are often used. While there is still no consensus about the method of choice and the timing of its application, this study aims to find a TM threshold at which a PET would be appropriate.


METHODS
A total of 90 PET studies and the associated CA 125 values (normal value < 35 U/ml) were available in 71 patients during the follow-up after primary therapy for OCA. In 48 studies a CEA value (normal value < 3 ng/ml) was also available. The results of PET imaging were related to the level of TM increase.


RESULTS
In 23/90 studies the PET scan was normal. These patients had a median CA 125 of 13.3 U/ml (range 4.2-168 U/ml). In 67/90 studies the PET indicated a potential recurrence of OCA and the median CA 125 was 166.7 U/ml (range 13.3-4,060 U/ml). The TM levels were significantly different (p < 0.001, U-test). With one exception, there were no normal PET scans above CA 125 levels of 30 U/ml; between 20 and 30 U/ml PET was positive in 4/7 studies.


CONCLUSIONS
In suspected recurrence of OCA, if imaging modalities are to be used, an FDG PET may be considered. Since the costs of this investigation are high, it should be restricted to clinical situations where it is likely to be most effective. In this study a PET indication is worthwhile at CA 125 levels of approximately 30 U/ml.
Department of Nuclear Medicine, Hospital and Medical School, Johann Wolfgang Goethe University, Frankfurt/Main, Germany. christian.menzel@em.uni-frankfurt.de
Christian
C
Menzel
Natascha
N
Döbert
Nadja
N
Hamscho
Konstantin
K
Zaplatnikov
Sotirios
S
Vasvatekis
Vanja
V
Matic
Nicola
N
Wördehoff
Frank
F
Grünwald
D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood*; D002272:Carcinoembryonic Antigen / Q000097:blood*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D009362:Neoplasm Metastasis / Q000000981:diagnostic imaging; D009375:Neoplasms, Glandular and Epithelial / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000097:blood / Q000473:pathology / Q000628:therapy*; D049268:Positron-Emission Tomography; D011859:Radiography; D019275:Radiopharmaceuticals; D012008:Recurrence; D012016:Reference Values; D012189:Retrospective Studies
D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D002272:Carcinoembryonic Antigen; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18