Impact of FDG PET-CT imaging on the decision making in the biologic suspicion of ovarian carcinoma recurrence.
OBJECTIVE
The aim of this prospective study was to evaluate the impact of integrated PET-CT on treatment management in ovarian carcinoma recurrence suspicion because of increased CA-125.


METHODS
Twenty-nine patients (mean age=61 years), initially treated for ovarian carcinoma (FIGO stage I n=2, stage II n=3, stage III n=21 and stage IV n=3), presenting with increased CA-125 (mean=160 IU/ml, range 33-1930), underwent subsequently a CT and a PET-CT scans. The recurrence was acknowledged by the referring physicians for all patients. The impact of PET-CT on patient's management was evaluated by comparing the therapeutic decision mentioned respectively on the pre and post PET-CT questionnaires filled in by the oncologists.


RESULTS
The CT scan was positive in 22/29 patients (76%) and negative in 7/29 patients (24%). The PET-CT scan was positive in 27/29 patients (93%) and negative in 2/29 (7%) patients. Five out of the seven patients with a negative CT scan had a positive PET-CT scan. In comparison to CT scan alone, the PET-CT scan modified the disease distribution for 16 patients (55%; p<0.001) in the following ways: more advanced disease (n=11), more limited disease (n=4), and different localizations (n=1). The assessment of pre and post PET-CT questionnaires showed a statistically significant change in the decision making for 10 patients (34%, p<0.0001).


CONCLUSIONS
This questionnaire-based study showed that PET-CT imaging allows a better restaging than CT and induces a change in clinical management in over one third of patients with suspected ovarian carcinoma recurrence on increased CA-125.
Soussan
Michael
M
Nuclear Medicine Department, Rene Huguenin Cancer Research Center, Saint-Cloud, France.
Wartski
Myriam
M
Cherel
Pascal
P
Fourme
Emmanuelle
E
Goupil
Alain
A
Le Stanc
Elise
E
Callet
Nasrine
N
Alexandre
Jérôme
J
Pecking
Alain-Paul
AP
Alberini
Jean-Louis
JL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018394:CA-125 Antigen / Q000097:blood; D003657:Decision Making; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000000981:diagnostic imaging* / Q000628:therapy; D010051:Ovarian Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000628:therapy; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed
D018394:CA-125 Antigen; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18