Utility of 18F-FDG PET/CT in follow-up of patients with low-grade serous carcinoma of the ovary
Introduction
Ovarian carcinoma is the second most common gynecological malignancy in the United States and the most lethal; it accounted for nearly 15,500 deaths in the United States in 2012 [1]. Ovarian carcinoma is a heterogeneous disease including several distinct tumor subtypes. The serous subtype accounts for approximately 60% to 80% of ovarian cancer cases [2]. A two-tier grading system—low-grade and high-grade—for invasive ovarian serous carcinoma has been described [3]. Low-grade serous carcinoma (LGSC) accounts for fewer than 10% of ovarian serous carcinomas [4]. LGSC has different clinical behavior from high-grade serous carcinoma and is characterized by young age at diagnosis and prolonged overall survival [5].
Computed tomography (CT) and measurement of serum tumor marker antigen 125 (CA-125) are currently standard surveillance modalities in patients with ovarian cancer [6]. However, CA-125 poorly correlates with objective response and radiographic imaging, such as CT scans, does not often provide accurate information due to desmoplasia, calcification and fibrosis frequently associated with LGSC tumor nodules [7]. Since metabolic function may better discriminate active from treated tumor, we hypothesized that nuclear imaging, including 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET), would be a useful surveillance tool in patients diagnosed with and treated for LGSC.
Section snippets
Materials and methods
This study was approved by the Institutional Review Board of The University of Texas MD Anderson Cancer Center and was performed in compliance with the Health Insurance Portability and Accountability Act. The Institutional Review Board waived the requirement for informed consent. We retrospectively reviewed the database of the Department of Gynecologic Oncology and Reproductive Medicine at MD Anderson and identified 71 consecutive patients with ovarian LGSC who were referred to our institution
Patient characteristics
Patient characteristics are shown in Table 1. Of the 48 patients in the study, 47 had primary surgery and 1 had neoadjuvant chemotherapy as initial treatment. Thirty-nine patients had recurrence. As the diagnosis of recurrence, 22 patients (56%) were detected by imaging studies, nine patients (23%) had an increasing CA-125 level, seven patients (18%) were symptomatic, and one patient (3%) had an abnormality detected by a pelvic examination. The median interval from initial treatment to disease
Discussion
In this study, we found that PET/CT performed during follow-up after initial treatment had an impact on the management plan in 30% of patients with LGSC. We also found that sensitivity, specificity, and accuracy in the detection of LGSC recurrence were 94%, 100%, and 97%, respectively, for PET/CT. Furthermore, we showed that TLG at the time of diagnosis of recurrence may be a predictor of outcome.
Our findings regarding the impact of PET/CT on patient management agree with those of previous
Conflicts of interest and sources of funding
This work was supported in part by the National Institutes of Health through MD Anderson's Cancer Center Support Grant (NCI P30 CA016672); by the MD Anderson Cancer Center James E. Anderson Distinguished Professorship in Nuclear Medicine (to Dr. Macapinlac); by the Society of Nuclear Medicine and Molecular Imaging 2012/2014 Wagner-Torizuka Fellowship (to Dr. Takeuchi); and by the Ann Rife Cox Chair in Gynecology (to Dr. Coleman).
Acknowledgments
We thank the staff at MD Anderson Cancer Center for their assistance and especially Ms. Richelle D. Millican, Supervisor, Diagnostic Imaging, for data collection. This report was edited by Stephanie Deming in the Department of Scientific Publications at The University of Texas MD Anderson Cancer Center.
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2016, Gynecologic OncologyCitation Excerpt :Radiologic studies including CT or F-FDG PET/CT are also an option. The accuracy and clinical impact of 18F-FDG PET/CT after initial treatment in patients with low-grade serous cancer has been recently published by Takeuchi et al. [55]. 48 patients were included in the analysis, 39 with recurrent disease and 9 without recurrence.
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