title: A prospective comparison of integrated FDG-PET/contrast-enhanced CT and contrast-enhanced CT for pretreatment imaging of advanced epithelial ovarian cancer.
abstract: OBJECTIVE
  The use of tumor debulking surgery in the management of epithelial ovarian cancer (EOC), which is often disseminated in the peritoneal cavity at the time of diagnosis, has a significant impact on prognosis. We compared (18)F-fluorodeoxyglucose (FDG) positron emission tomography/contrast-enhanced computed tomography (PET/CT) to contrast-enhanced CT for the detection of dissemination into the abdominal cavity preventing successful primary debulking surgery.
  
  
  METHODS
  Forty-one women with EOC underwent preoperative whole-body low-dose FDG-PET/CT followed by diagnostic high dose contrast-enhanced CT scan, and the results were compared with systematically recorded surgical findings as a reference standard. Both site-based and patient-based analyses were conducted.
  
  
  RESULTS
  FDG-PET/CT was superior to conventional CT for the detection of carcinomatosis in subdiaphragmatic peritoneal surfaces (p=0.020) and in the bowel mesentery (p=0.001). Patient-based analysis of upper abdominal areas requiring extensive surgical procedures showed no significant differences between the two imaging methods. The sensitivity of PET/CT and CT was poor in certain areas of the peritoneal cavity (64% vs. 27% in the small bowel mesentery and 65% vs. 55% in the right upper abdomen). Extra-abdominal disease spread was detected by PET/CT in 32 patients and by CT in 25 patients.
  
  
  CONCLUSIONS
  PET/CT was not superior to CT for the detection of intra-abdominal disease spread. Patients with suspected EOC should be referred for upfront radical surgery regardless of the results of preoperative imaging studies. PET/CT is more effective for the detection of extra-abdominal disease than CT, but the clinical significance of this finding is unclear.
authors.affiliation: Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, FI-20520 Turku, Finland. Electronic address: johanna.hynninen@utu.fi.
authors.forename: Johanna
authors.initials: J
authors.lastname: Hynninen
authors.forename: Jukka
authors.initials: J
authors.lastname: Kemppainen
authors.forename: Maija
authors.initials: M
authors.lastname: Lavonius
authors.forename: Johanna
authors.initials: J
authors.lastname: Virtanen
authors.forename: Jaakko
authors.initials: J
authors.lastname: Matomäki
authors.forename: Sinikka
authors.initials: S
authors.lastname: Oksa
authors.forename: Olli
authors.initials: O
authors.lastname: Carpén
authors.forename: Seija
authors.initials: S
authors.lastname: Grénman
authors.forename: Marko
authors.initials: M
authors.lastname: Seppänen
authors.forename: Annika
authors.initials: A
authors.lastname: Auranen
mesh_terms: D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009367:Neoplasm Staging / Q000379:methods; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Operability; Ovarian cancer; PET/CT; Preoperative imaging; Staging