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FDG-PET/CT to predict optimal primary cytoreductive surgery in patients with advanced ovarian cancer: preliminary results

Abstract

Aims and background

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.

Tumori 2016; 102(1): 103 - 107

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/tj.5000396

Authors

Alessandra Alessi, Fabio Martinelli, Barbara Padovano, Gianluca Serafini, Domenica Lorusso, Alice Lorenzoni, Antonino Ditto, Francesca Lecce, Marta Mira, Cristina Donfrancesco, Francesco Raspagliesi, Flavio Crippa

Article History

Disclosures

Financial support: None.
Conflict of interest: None.

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Authors

Affiliations

  • Nuclear Medicine and PET Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy
  • Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy

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