title: Combined PET/CT for detecting recurrent ovarian cancer limited to retroperitoneal lymph nodes.
abstract: OBJECTIVE
  To evaluate the utility of combined positron emission tomography/computed tomography (PET/CT) for detecting recurrent epithelial ovarian cancer limited to retroperitoneal adenopathy.
  
  
  METHODS
  Fourteen patients (median age = 53 years) with rising serum CA125 levels, and negative or equivocal conventional CT imaging > or = 6 months after primary therapy were retrospectively identified as having recurrent disease limited to retroperitoneal lymph nodes by combined PET/CT and underwent surgical reassessment of targeted nodal basins. Fisher's Exact Test was used to measure the ability of PET/CT to predict isolated retroperitoneal nodal disease.
  
  
  RESULTS
  The median increase in serum CA125 from baseline nadir was 14 U/ml (range = 2-76 U/ml). There were 29 target nodes in 15 nodal basins identified with increased metabolic uptake on combined PET/CT. Eleven patients (78.6%) had recurrent ovarian cancer in retroperitoneal lymph nodes targeted by PET/CT. Of 143 nodes retrieved, 59 contained recurrent ovarian cancer (median nodal diameter = 2.5 cm, range = 0.8-5.2 cm). For all target nodal basins, the sensitivity, specificity, positive and negative predictive values, and accuracy for recurrent ovarian cancer in dissected lymph nodes were: 40.7% (24/59), 94.0% (79/84), 82.8% (24/29), 69.3% (79/114), and 72.0% (103/143) (P < 0.001). PET/CT failed to identify microscopic disease in 59.3% of pathologically positive nodes.
  
  
  CONCLUSIONS
  Combined PET/CT demonstrates high positive predictive value in identifying recurrent ovarian cancer in retroperitoneal lymph nodes when conventional CT findings are negative or equivocal. The high incidence of occult disease within the target nodal basins suggests that regional lymphadenectomy may be necessary for complete secondary cytoreduction of recurrent disease.
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Phipps #281, Baltimore, MD 21287, USA. rbristo@jhmi.edu
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.forename: Robert L
authors.initials: RL
authors.lastname: Giuntoli
authors.forename: Harpreet K
authors.initials: HK
authors.lastname: Pannu
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.forename: Richard L
authors.initials: RL
authors.lastname: Wahl
mesh_terms: D000328:Adult; D000368:Aged; D018394:CA-125 Antigen / Q000097:blood; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010051:Ovarian Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D049268:Positron-Emission Tomography; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D018394:CA-125 Antigen