151
Quiz
What is your diagnosis?
Figure 1. Metastatic lesion in the xyphoid bone Address for Correspondence: Cemil Yaman, Department of Gynecology and Obstetrics, General Hospital of Linz, Karankenhausstr. 9 4020 Linz, Akh-Linz, Austria Phone: 00436644219600 e.mail: [email protected] ©Copyright 2012 by the Turkish-German Gynecological Education and Research Foundation - Available online at www.jtgga.org doi:10.5152/jtgga.2012.18
152
Yaman et al. Quiz
J Turkish-German Gynecol Assoc 2012; 13: 151-2
Among the gynecological cancers, ovarian cancer is the leading cause of death. According to estimates of the American Cancer Society, ovarian cancer accounts for 3% of new cases of female malignancies and 5% of cancer-related deaths in 2009 in the United States (1). Imaging, especially ultrasound and CT, has become a critical part of the evaluation of patients with ovarian cancer. The diagnosis of recurrent ovarian cancer can be difficult, and variable sensitivities and specificities have been reported for positron emission tomography (PET). 18 F-Fluoro-deoxyglucose (FDG) PET/CT has become a critical tool for the preoperative evaluation of women with primary ovarian cancer and for postoperative follow-up assessment for evidence of recurrence in these patients. (a) To assess the accuracy of FDG-PET/CT in distinguishing malignant from benign pelvic lesions, compared to transvaginal ultrasonography (TVUS) and (b) to establish the role of wholebody FDG-PET/CT, compared to contrast-enhanced computed tomography (CT), in staging patients with ovarian cancer, Castelluci et al. (2) examined fifty consecutive patients with pelvic lesions. The sensitivity, specificity, NPV, PPV and accuracy of FDG-PET/CT were 87%, 100%, 81%, 100% and 92%, respectively, compared with 90%, 61%, 78%, 80% and 80%, respectively, for TVUS. In staging ovarian cancer, FDG-PET/CT results were concordant with final pathological staging in 22/32 (69%) patients, while the CT results were concordant in 17/32 (53%) patients. CT incorrectly downstaged four out of six stage IV patients by missing distant metastases in the liver, pleura, mediastinum and in the left supraclavicular lymph nodes, which were correctly detected by FDG-PET/CT. Based on these results, they concluded that FDG-PET/CT provides additional value to TVUS for the differential diagnosis of benign from malignant pelvic lesions, and to CT for the staging of ovarian cancer patients. Thrall et al. (3) reported on a retrospective chart review on 39 ovarian cancer patients who underwent a total of 59 FDG-PET/ CT scans. Twenty-four FDG-PET/CT scans were performed in 22 patients with previously negative or indeterminate CT scans, but rising CA-125 levels, providing a sensitivity of 90% for localizing disease. Nine FDG-PET/CT in eight patients with clinical symptoms of recurrence, but normal CA-125 levels, detected all three patients who had recurrent disease confirmed within 6 months of follow-up. In addition, four FDG-PET/CT scans performed as a routine follow-up with no clinical evidence of recurrent disease were truly negative in all cases. Fourteen FDG-PET/CT scans in 12 patients with recurrent disease already identified by conventional CT imaging were useful in guiding
treatment decisions such as radiation therapy, surgery or chemotherapy by confirming the recurrence and more precisely localizing the site(s) of disease. FDG-PET/CT helped to avoid surgery in four patients who had additional disease detected in unresectable anatomic areas. A total of 51 FDG-PET/CT scans were performed in the patients described above with an overall sensitivity and specificity of 94.5% and 100%, respectively. Eight FDG-PET/CT scans in five patients performed for the assessment of treatment response following chemotherapy or radiation were useful as the disease was not clearly visualized by conventional CT imaging at baseline. According to these data, the authors concluded that FDG-PET/CT has the greatest utility in determining suspected ovarian cancer recurrence, particularly in patients with rising CA-125 levels and negative conventional imaging. FDG-PET/CT was specifically helpful in optimizing the selection of patients for site-specific treatment, including radiation treatment planning, and aided in the selection of optimal surgical candidates. These findings were also confirmed by other studies (4-6). Cemil Yaman, Helmut Huber, Dietmar Haas, Peter Oppelt Department of Obstetrics and Gynecology, Akh-linz, Krankenhausstr. Linz, Austria
References 1. 2.
3. 4.
5.
6.
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009; 59: 225-49. [CrossRef] Castellucci P, Perrone AM, Picchio M, Ghi T, Farsad M, Nanni C, et al. Diagnostic accuracy of 18F-FDG PET/CT in characterizing ovarian lesions and staging ovarian cancer: correlation with transvaginal ultrasonography, computed tomography, and histology. Nucl Med Commun 2007; 28: 589-95. [CrossRef] Thrall MM, DeLoia JA, Gallion H, Avril N. Clinical use of combined positron emission tomography and computed tomography (FDG-PET/CT) in recurrent ovarian cancer. Gynecol Oncol 2007; 105: 17-22. [CrossRef] Nanni C, Rubello D, Farsad M, De Iaco P, Sansovini M, Erba P, et al. (18) F-FDG PET/CT in the evaluation of recurrent ovarian cancer: a prospective study on forty-one patients. Eur J Surg Oncol 2005; 31: 792-7. [CrossRef] Torizuka T, Nobezawa S, Kanno T, Futatsubashi M, Yoshikawa E, Okada H, et al. Ovarian cancer recurrence: role of whole-body positron emission tomography using 2-[fluorine-18]-fluoro-2-deoxyD-glucose. Eur J Nucl Med Mol Imaging 2002; 29: 797-803. [CrossRef] Chung HH, Kang WJ, Kim JW, Park NH, Song YS, Chung JK, et al. Role of [18F]FDG PET/CT in the assessment of suspected recurrent ovarian cancer: correlation with clinical or histological findings. Eur J Nucl Med Mol Imaging 2007; 34: 480-6. [CrossRef]
ADVISORY BOARD OF THIS ISSUE (June 2012) Aylin Pelin Çil Bahar Müezzinoğlu Banu Bingöl Banu Dane Candan İltemir Duvan Cem Atabekoğlu Cem Fıçıcıoğlu
Çağatay Taşkıran Ebru Çelik Eray Çalışkan Erhan Şimşek Fuat Demirci Gazi Yıldırım Harika Bodur Öztürk
Mehmet Osmanagaoğlu Mehmet Tunç Canda Mekin Sezik Mert Kazandı Mesut Öktem Murat Ulukuş Niyazi Aşkar
Oluş Api Özlem Özdeğirmenci Ulun Uluğ Yaprak Engin Üstün Yılmaz Güzel
Copyright of Journal of the Turkish-German Gynecological Association is the property of Aves Yayincilik Ltd. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Quiz
What is your diagnosis?
Figure 1. Metastatic lesion in the xyphoid bone Address for Correspondence: Cemil Yaman, Department of Gynecology and Obstetrics, General Hospital of Linz, Karankenhausstr. 9 4020 Linz, Akh-Linz, Austria Phone: 00436644219600 e.mail: [email protected] ©Copyright 2012 by the Turkish-German Gynecological Education and Research Foundation - Available online at www.jtgga.org doi:10.5152/jtgga.2012.18
152
Yaman et al. Quiz
J Turkish-German Gynecol Assoc 2012; 13: 151-2
Among the gynecological cancers, ovarian cancer is the leading cause of death. According to estimates of the American Cancer Society, ovarian cancer accounts for 3% of new cases of female malignancies and 5% of cancer-related deaths in 2009 in the United States (1). Imaging, especially ultrasound and CT, has become a critical part of the evaluation of patients with ovarian cancer. The diagnosis of recurrent ovarian cancer can be difficult, and variable sensitivities and specificities have been reported for positron emission tomography (PET). 18 F-Fluoro-deoxyglucose (FDG) PET/CT has become a critical tool for the preoperative evaluation of women with primary ovarian cancer and for postoperative follow-up assessment for evidence of recurrence in these patients. (a) To assess the accuracy of FDG-PET/CT in distinguishing malignant from benign pelvic lesions, compared to transvaginal ultrasonography (TVUS) and (b) to establish the role of wholebody FDG-PET/CT, compared to contrast-enhanced computed tomography (CT), in staging patients with ovarian cancer, Castelluci et al. (2) examined fifty consecutive patients with pelvic lesions. The sensitivity, specificity, NPV, PPV and accuracy of FDG-PET/CT were 87%, 100%, 81%, 100% and 92%, respectively, compared with 90%, 61%, 78%, 80% and 80%, respectively, for TVUS. In staging ovarian cancer, FDG-PET/CT results were concordant with final pathological staging in 22/32 (69%) patients, while the CT results were concordant in 17/32 (53%) patients. CT incorrectly downstaged four out of six stage IV patients by missing distant metastases in the liver, pleura, mediastinum and in the left supraclavicular lymph nodes, which were correctly detected by FDG-PET/CT. Based on these results, they concluded that FDG-PET/CT provides additional value to TVUS for the differential diagnosis of benign from malignant pelvic lesions, and to CT for the staging of ovarian cancer patients. Thrall et al. (3) reported on a retrospective chart review on 39 ovarian cancer patients who underwent a total of 59 FDG-PET/ CT scans. Twenty-four FDG-PET/CT scans were performed in 22 patients with previously negative or indeterminate CT scans, but rising CA-125 levels, providing a sensitivity of 90% for localizing disease. Nine FDG-PET/CT in eight patients with clinical symptoms of recurrence, but normal CA-125 levels, detected all three patients who had recurrent disease confirmed within 6 months of follow-up. In addition, four FDG-PET/CT scans performed as a routine follow-up with no clinical evidence of recurrent disease were truly negative in all cases. Fourteen FDG-PET/CT scans in 12 patients with recurrent disease already identified by conventional CT imaging were useful in guiding
treatment decisions such as radiation therapy, surgery or chemotherapy by confirming the recurrence and more precisely localizing the site(s) of disease. FDG-PET/CT helped to avoid surgery in four patients who had additional disease detected in unresectable anatomic areas. A total of 51 FDG-PET/CT scans were performed in the patients described above with an overall sensitivity and specificity of 94.5% and 100%, respectively. Eight FDG-PET/CT scans in five patients performed for the assessment of treatment response following chemotherapy or radiation were useful as the disease was not clearly visualized by conventional CT imaging at baseline. According to these data, the authors concluded that FDG-PET/CT has the greatest utility in determining suspected ovarian cancer recurrence, particularly in patients with rising CA-125 levels and negative conventional imaging. FDG-PET/CT was specifically helpful in optimizing the selection of patients for site-specific treatment, including radiation treatment planning, and aided in the selection of optimal surgical candidates. These findings were also confirmed by other studies (4-6). Cemil Yaman, Helmut Huber, Dietmar Haas, Peter Oppelt Department of Obstetrics and Gynecology, Akh-linz, Krankenhausstr. Linz, Austria
References 1. 2.
3. 4.
5.
6.
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009; 59: 225-49. [CrossRef] Castellucci P, Perrone AM, Picchio M, Ghi T, Farsad M, Nanni C, et al. Diagnostic accuracy of 18F-FDG PET/CT in characterizing ovarian lesions and staging ovarian cancer: correlation with transvaginal ultrasonography, computed tomography, and histology. Nucl Med Commun 2007; 28: 589-95. [CrossRef] Thrall MM, DeLoia JA, Gallion H, Avril N. Clinical use of combined positron emission tomography and computed tomography (FDG-PET/CT) in recurrent ovarian cancer. Gynecol Oncol 2007; 105: 17-22. [CrossRef] Nanni C, Rubello D, Farsad M, De Iaco P, Sansovini M, Erba P, et al. (18) F-FDG PET/CT in the evaluation of recurrent ovarian cancer: a prospective study on forty-one patients. Eur J Surg Oncol 2005; 31: 792-7. [CrossRef] Torizuka T, Nobezawa S, Kanno T, Futatsubashi M, Yoshikawa E, Okada H, et al. Ovarian cancer recurrence: role of whole-body positron emission tomography using 2-[fluorine-18]-fluoro-2-deoxyD-glucose. Eur J Nucl Med Mol Imaging 2002; 29: 797-803. [CrossRef] Chung HH, Kang WJ, Kim JW, Park NH, Song YS, Chung JK, et al. Role of [18F]FDG PET/CT in the assessment of suspected recurrent ovarian cancer: correlation with clinical or histological findings. Eur J Nucl Med Mol Imaging 2007; 34: 480-6. [CrossRef]
ADVISORY BOARD OF THIS ISSUE (June 2012) Aylin Pelin Çil Bahar Müezzinoğlu Banu Bingöl Banu Dane Candan İltemir Duvan Cem Atabekoğlu Cem Fıçıcıoğlu
Çağatay Taşkıran Ebru Çelik Eray Çalışkan Erhan Şimşek Fuat Demirci Gazi Yıldırım Harika Bodur Öztürk
Mehmet Osmanagaoğlu Mehmet Tunç Canda Mekin Sezik Mert Kazandı Mesut Öktem Murat Ulukuş Niyazi Aşkar
Oluş Api Özlem Özdeğirmenci Ulun Uluğ Yaprak Engin Üstün Yılmaz Güzel
Copyright of Journal of the Turkish-German Gynecological Association is the property of Aves Yayincilik Ltd. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
