title: Diagnostic accuracy of 18F-FDG PET/CT in characterizing ovarian lesions and staging ovarian cancer: correlation with transvaginal ultrasonography, computed tomography, and histology.
abstract: OBJECTIVE
  To (a) assess the accuracy of 18F-FDG PET/CT in distinguishing malignant from benign pelvic lesions, compared to transvaginal ultrasonography (TVUS) and (b) to establish the role of whole-body 18F-FDG PET/CT, compared to contrast enhanced computed tomography (CT), in staging patients with ovarian cancer.
  
  
  METHODS
  Fifty consecutive patients with a pelvic lesion, already scheduled for surgery on the basis of physical examination, TVUS, and serum Ca125 levels, were enrolled in the study. Patients' age ranged between 23 and 89 years (mean 64). All patients underwent TVUS including a colour Doppler study followed by a thorax and abdominal CT scan, and whole-body 18F-FDG PET/CT within 2 weeks prior to surgery. Histological findings obtained at surgery were taken as the 'gold standard' to compare 18F-FDG PET/CT and TVUS, and 18F-FDG PET/CT vs. CT. When tissue analysis showed ovarian cancer, the accuracy of 18F-FDG PET/CT and CT were compared for the purpose of obtaining a precise staging.
  
  
  RESULTS
  At surgery, the ovarian lesions were malignant in 32/50 patients (64%) and benign in the remaining 18/50 patients (36%). The sensitivity, specificity, NPV, PPV and accuracy of 18F-FDG PET/CT were 87%, 100%, 81%, 100% and 92%, respectively, compared with 90%, 61%, 78%, 80% and 80%, respectively, for TVUS. In staging ovarian cancer, 18F-FDG PET/CT results were concordant with final pathological staging in 22/32 (69%) patients while CT results were concordant in 17/32 (53%) patients. CT incorrectly down-staged four out of six stage IV patients by missing distant metastasis in the liver, pleura, mediastinum, and in left supraclavicular lymph nodes, which were correctly detected by 18F-FDG PET/CT.
  
  
  CONCLUSIONS
  PET/CT with 18F-FDG provides additional value to TVUS for the differential diagnosis of benign from malignant pelvic lesions, and to CT for the staging of ovarian cancer patients.
authors.affiliation: Nuclear Medicine Department, Policlinico Sant'Orsola Malpighi, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Castellucci
authors.forename: Anna M
authors.initials: AM
authors.lastname: Perrone
authors.forename: Maria
authors.initials: M
authors.lastname: Picchio
authors.forename: Tullio
authors.initials: T
authors.lastname: Ghi
authors.forename: Mohsen
authors.initials: M
authors.lastname: Farsad
authors.forename: Cristina
authors.initials: C
authors.lastname: Nanni
authors.forename: Cristina
authors.initials: C
authors.lastname: Messa
authors.forename: Maria C
authors.initials: MC
authors.lastname: Meriggiola
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pelusi
authors.forename: Adil
authors.initials: A
authors.lastname: Al-Nahhas
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.forename: Ferruccio
authors.initials: F
authors.lastname: Fazio
authors.forename: Stefano
authors.initials: S
authors.lastname: Fanti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010049:Ovarian Diseases / Q000175:diagnosis; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000473:pathology; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18