Western Regional Blog – BC, YK, AB, NWT and Nunavut
TAKE-HOME MESSAGE PET/CT imaging does not provide additional information over contrast-enhanced CT for preoperative planning in women with advanced epithelial ovarian cancer undergoing debulking surgery.
A Prospective Comparison of Integrated FDG-PET/Contrast-Enhanced CT and Contrast-Enhanced CT for Pretreatment Imaging of Advanced Epithelial Ovarian Cancer
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 18F-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.
Gynecol. Oncol. 2013 Aug 29;[EPub Ahead of Print], J Hynninen, J Kemppainen, M Lavonius, J Virtanen, J Matomäki, S Oksa, O Carpén, S Grénman, M Seppänen, A Auranen