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

Preliminary results

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

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)103-107
Number of pages5
JournalTumori
Volume102
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

Fingerprint

Ovarian Neoplasms
Positron-Emission Tomography
Positron Emission Tomography Computed Tomography
Sensitivity and Specificity
Mesentery
Fibroma
Fluorodeoxyglucose F18
Ovarian epithelial cancer
Patient Selection
Carcinoma
Liver

Keywords

  • FDG-PET/CT
  • Ovarian cancer
  • Primary cytoreduction surgery

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

FDG-PET/CT to predict optimal primary cytoreductive surgery in patients with advanced ovarian cancer : Preliminary results. / Alessi, Alessandra; Martinelli, Fabio; Padovano, Barbara; Serafini, Gianluca; Lorusso, Domenica; Lorenzoni, Alice; Ditto, Antonino; Lecce, Francesca; Mira, Marta; Donfrancesco, Cristina; Raspagliesi, Francesco; Crippa, Flavio.

In: Tumori, Vol. 102, No. 1, 01.01.2016, p. 103-107.

Research output: Contribution to journalArticle

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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.",
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author = "Alessandra Alessi and Fabio Martinelli and Barbara Padovano and Gianluca Serafini and Domenica Lorusso and Alice Lorenzoni and Antonino Ditto and Francesca Lecce and Marta Mira and Cristina Donfrancesco and Francesco Raspagliesi and Flavio Crippa",
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T2 - Preliminary results

AU - Alessi, Alessandra

AU - Martinelli, Fabio

AU - Padovano, Barbara

AU - Serafini, Gianluca

AU - Lorusso, Domenica

AU - Lorenzoni, Alice

AU - Ditto, Antonino

AU - Lecce, Francesca

AU - Mira, Marta

AU - Donfrancesco, Cristina

AU - Raspagliesi, Francesco

AU - Crippa, Flavio

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N2 - 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.

AB - 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.

KW - FDG-PET/CT

KW - Ovarian cancer

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