title: Detection of nodal metastases by 18F-FDG PET/CT in apparent early stage ovarian cancer: a prospective study.
abstract: BACKGROUND
  The rate of nodal metastases in ovarian cancer macroscopically confined to the pelvis is about 15%-20%. Systematic pelvic and aortic lymphadenectomy improves staging but it is associated with increased morbidity and costs. The purpose of this study was to evaluate the role of 18F-FDG PET/CT in the pre-operative nodal metastases detection in ovarian cancer grossly confined to the pelvis.
  
  
  METHODS
  From 2006 to 2012, 68 consecutive women with epithelial ovarian cancer confined to the pelvis underwent 18F-FDG PET/CT followed by surgery inclusive of systematic pelvic and aortic lymphadenectomy (SAPL). 18F-FDG PET/CT images were analyzed and correlated to histological examination.
  
  
  RESULTS
  Twenty-six women underwent bilateral and 42 unilateral SAPL with 3165 nodes removed and analyzed. Median number of dissected nodes was 42 (range 16-91). Twelve women (17.6%) had nodal metastases. 18F-FDG PET/CT correctly identified 10 patients with nodal involvement. Sensitivity, specificity, accuracy, positive and negative-predictive value of 18F-FDG PET/CT in detecting nodal metastases were 83.3%, 98.2%, 95.6%, 90.9% and 96.5%, respectively, on overall patient-based, and 75.5%, 99.4%, 98.1%, 87.5% and 98.6%, respectively, on nodal lesion site-based analysis.
  
  
  CONCLUSIONS
  18F-FDG PET/CT is an accurate tool for the detection of nodal metastases. Metabolic imaging could be used to select women who could benefit from systematic lymphadenectomy. The high negative predictive value allows avoidance of SAPL in the vast majority of women, minimizing operative and post surgical complications. Further larger prospective investigation is required to confirm our data.
authors.affiliation: Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza; University of Milan-Bicocca, Milan, Italy. Electronic address: maurosignorelli78@gmail.com.
authors.forename: Mauro
authors.initials: M
authors.lastname: Signorelli
authors.forename: Luca
authors.initials: L
authors.lastname: Guerra
authors.forename: Cecilia
authors.initials: C
authors.lastname: Pirovano
authors.forename: Cinzia
authors.initials: C
authors.lastname: Crivellaro
authors.forename: Robert
authors.initials: R
authors.lastname: Fruscio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Buda
authors.forename: Marco
authors.initials: M
authors.lastname: Cuzzucrea
authors.forename: Federica
authors.initials: F
authors.lastname: Elisei
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ceppi
authors.forename: Cristina
authors.initials: C
authors.lastname: Messa
mesh_terms: D000328:Adult; D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D049268:Positron-Emission Tomography / Q000379:methods; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Early stage; Lymphadenectomy; Ovarian cancer; PET/CT