title: Early detection of recurrent ovarian cancer in patients with low-level increases in serum CA-125 levels by 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography.
abstract: OBJECTIVE
  Serum CA-125 has been shown to be a sensitive tumor marker of recurrent ovarian cancer. The goal of this study was to evaluate the use of 2-[F-18]fluoro-2-deoxy-d-glucose-positron emission tomography/computed tomography (FDG-PET/CT) in the early detection of recurrent ovarian cancer in patients with low-level increases in serum CA-125 levels.
  
  
  METHODS
  Patients who demonstrated a normalization of serum CA-125 levels after complete remission of ovarian cancer were recruited for this study. FDG-PET/CT was performed to evaluate serum CA-125 levels ≥ 35 U/mL (Group 1) or progressive low-level increases in the levels of serum CA-125 (Group 2). The results were analyzed based on pathology, disease progression, and/or clinical follow-up.
  
  
  RESULTS
  Twenty-seven (27) consecutive patients consented to the aforementioned criteria (n = 16 in Group 1 and n = 11 in Group 2). In Group 1, of the 16 patients, 15 had a proven tumor recurrence, and the remaining 1 had a second primary cancer with no evidence of recurrent ovarian lesions. In Group 2, all 11 patients had recurrent tumors. The use of FDG-PET/CT allowed the detection of recurrences in 25 patients and a second primary cancer in 1 patient, which included all of the patients in Group 1 and 10 of the 11 patients in Group 2. The detection rate of FDG-PET/CT for recurrent ovarian cancer was 100% in Group 1 and 90.9% in Group 2 (15/15 vs. 10/11, p = 0.423). FDG-PET/CT changed the intended management in 14 (53.8%) of the patients, which included 4 cases in Group 1 and 10 cases in Group 2.
  
  
  CONCLUSIONS
  FDG-PET/CT has the ability to detect recurrent ovarian cancer and second primary tumors in patients with increased levels of serum CA-125. FDG-PET/CT affects the clinical management by localizing recurrent lesions and creating a specific treatment plan for each patient, especially patients who demonstrate a low-level increase in serum CA-125 levels.
authors.affiliation: Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China. njpeng@vghks.gov.tw
authors.forename: Nan-Jing
authors.initials: NJ
authors.lastname: Peng
authors.forename: Wen-Shiung
authors.initials: WS
authors.lastname: Liou
authors.forename: Ren-Shyan
authors.initials: RS
authors.lastname: Liu
authors.forename: Chin
authors.initials: C
authors.lastname: Hu
authors.forename: Daw-Guey
authors.initials: DG
authors.lastname: Tsay
authors.forename: Cheng-Bin
authors.initials: CB
authors.lastname: Liu
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000378:metabolism; D018394:CA-125 Antigen / Q000097:blood*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000000981:diagnostic imaging* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging* / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18