F18-FDG coincidence-PET in patients with suspected gynecological malignancy.
OBJECTIVE
To assess the role of F18-FDG imaging with a dual-head coincidence mode gamma camera (Co-PET) in identifying malignant tumors in patients with a suspicious adnexal mass depicted by conventional imaging methods.


METHODS
F18-FDG Co-PET was performed preoperatively in 18 women (mean age 56.38 years) with suspected malignant gynecologic tumors according to clinical and abdomino-pelvic/transvaginal ultrasound or computed tomography findings. Exploratory laparotomy was performed in all patients within the 10 days post-F18-FDG Co-PET study, and the definitive diagnosis of the adnexal masses was established by histopathological examination.


RESULTS
Histopathological examinations of the surgically excised adnexal masses revealed eight malignant, one borderline, and nine benign neoplastic tumors. Four benign tumors had no F18-FDG uptake, while the remaining five tumors, all leiomyomas, showed mild FDG accumulation. Eight malignant tumors showed intense F18-FDG uptake. Sensitivity, specificity, PPV, and NPV of F18-FDG co-PET in differentiating benign from malign adnexal masses were 88%, 44%, 61%, and 80%, respectively. Tumor to background ratios (T/B) in benign lesions (2.04 +/- 0.27) were significantly lower than in malignant lesions (7.4 +/- 0.99).


CONCLUSIONS
F18-FDG Co-PET is of clinical value when assessing suspicious malignant adnexal masses. False-negative F18-FDG results might arise from borderline disease. Moderate F18-FDG uptake in leiomyomas can result false-positive, but T/B ratios may be helpful in such cases.
Zor
E
E
Department of Nuclear Medicine, Osmangazi University Medical Faculty, Eskişehir, Turkey.
Stokkel
M P
MP
Ozalp
S
S
Vardareli
E
E
Yalçin
O Tarik
OT
Ak
I
I
D000230:Adenocarcinoma / Q000000981:diagnostic imaging; D000291:Adnexal Diseases / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D015902:Gamma Cameras; D005833:Genital Neoplasms, Female / Q000000981:diagnostic imaging*; D006801:Humans; D007813:Laparotomy; D007889:Leiomyoma / Q000000981:diagnostic imaging; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18