FDG-PET/CT to predict optimal primary cytoreductive surgery in patients with advanced ovarian cancer: preliminary results.
OBJECTIVE
Primary cytoreductive surgery (CRS) has a significant impact on prognosis in epithelial ovarian cancer (EOC). Patient selection is important to recognize factors limiting optimal CRS and to avoid unnecessary aggressive surgical procedures. We evaluated the contribution of fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in the presurgical identification of disease sites that may preclude EOC cytoreducibility.


METHODS
Patients with suspected EOC underwent 18F-FDG-PET/CT within 20 days before debulking surgery. The PET/CT results were compared with surgical findings and postsurgery histopathology in order to assess the diagnostic value.


RESULTS
Between August 2013 and January 2014, 29 patients were evaluated. The histopathology showed 23 EOC and 6 benign tumors. The FDG-PET/CT was positive (maximum standardized uptake value [SUVmax] 11.3 ± 5.4) in 21/23 (91%) patients with EOC and provided 2 false-negatives (1 mucinous and 1 clear cell carcinoma; SUVmax ≤2.8). The FDG-PET/CT was true-negative (SUVmax 2.2 ± 1.6) in 4 out of 6 patients (67%). False-positive FDG-PET results were obtained in 2 cellular fibromas (SUVmax 4.8 and 5.6). The sensitivity, specificity, and accuracy of PET/CT to characterize ovarian masses were 91%, 67%, and 86%, respectively. Among the 21 FDG-PET/CT-positive EOC, we detected factors limiting optimal CRS in 6 cases (29%): 4 hepatic hilum infiltration and 2 root mesentery involvement, confirmed at surgical exploration. The FDG-PET did not find limiting factors in the remaining 15 patients (71%) in whom optimal CRS was obtained.


CONCLUSIONS
Fluorodeoxyglucose-PET/CT shows high sensitivity but suboptimal specificity in the characterization of ovarian masses. However, PET/CT may play a role in noninvasively selecting patients with EOC who can benefit from primary CRS.
Nuclear Medicine and PET Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy.
Alessandra
A
Alessi
Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy.
Fabio
F
Martinelli
Nuclear Medicine and PET Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy.
Barbara
B
Padovano
Nuclear Medicine and PET Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy.
Gianluca
G
Serafini
Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy.
Domenica
D
Lorusso
Nuclear Medicine and PET Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy.
Alice
A
Lorenzoni
Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy.
Antonino
A
Ditto
Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy.
Francesca
F
Lecce
Nuclear Medicine and PET Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy.
Marta
M
Mira
Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy.
Cristina
C
Donfrancesco
Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy.
Francesco
F
Raspagliesi
Nuclear Medicine and PET Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy.
Flavio
F
Crippa
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D000077216:Carcinoma, Ovarian Epithelial; D065426:Cytoreduction Surgical Procedures; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage; D006801:Humans; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18