FDG-PET/CT for diagnosis of primary ovarian cancer.
ABSTRACT To evaluate the diagnostic value of integrated 18F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) to discriminate malignant from benign ovarian tumors.
One hundred and eight women suspected of having ovarian cancer underwent preoperative FDG-PET/CT scans. FDG uptake was quantified by calculating the maximum standardized uptake value (SUV max) of each tumor. The receiver operating characteristic curve was drawn to determine the optimal cut-off values of SUV max that would best discriminate between benign and malignant tumors. Histopathologic results served as the reference standard. We assessed the association between SUV max and with International Federation of Gynecology and Obstetrics stage in borderline and malignant tumors, using one-factor analysis of variance and an unpaired t test with Bonferoni correction.
The SUV max of benign (n=26), borderline (n=12) and malignant (n=73) lesions was 2.00 ± 1.02, 2.72 ± 1.04, and 7.55 ± 4.29, respectively. Although there were significant differences between benign and malignant, and borderline and malignant lesions (P<0.0001), there was no significant difference between benign and borderline lesions. Using an SUV max cutoff of 2.55, the sensitivity, specificity and accuracy of FDG-PET/CT scanning to detect malignant or borderline tumors were 82.4, 76.9, and 81.1%, respectively. The SUV max of stage I (n=35), stage II (n=8), stage III (n=34) and stage IV (n=8) was 3.59 ± 2.32, 5.18 ± 1.34, 8.72 ± 2.69, and 15.05 ± 3.77, respectively, and significant differences were observed between SUV max values and the various International Federation of Gynecology and Obstetrics stage (P<0.0001).
FDG-PET/CT scanning has a high diagnostic value in differentiating between malignant and benign tumors, and a low diagnostic value in differentiating between borderline and benign tumors.
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ABSTRACT: This aim of this study was to evaluate the relationship between hexokinase II expression and chemoresistance in epithelial ovarian cancer. One hundred and eleven paraffin-embedded specimens from patients with epithelial ovarian cancer were immunohistochemically stained for hexokinase II. Subsequently, the association between hexokinase II overexpression and clinicopathologic characteristics including chemoresistance was assessed. Survival analyses were also performed for evaluating the prognostic value of hexokinase II overexpression. Tumor recurrence within 6 months after termination of first-line chemotherapy was considered to indicate chemoresistance. Hexokinase II overexpression was associated with chemoresistance (p = 0.029) and was an independent risk factor for chemoresistance [odds ratio (OR) 3.37; 95 % confidence interval (CI) 1.07-10.62; p = 0.038] along with non-optimal debulking surgery (OR 4.93; 95 % CI 1.43-16.98; p = 0.011). Hexokinase II overexpression was significantly associated with decreased progression-free survival (p = 0.002) and showed a similar trend for overall survival (p = 0.101). Cox regression analysis revealed that hexokinase II overexpression was an independent prognostic factor for early recurrence (hazard ratio 2.63; 95 % CI 1.40-4.92; p = 0.002). Our findings suggest that hexokinase II overexpression is associated with short progression-free survival, which could be associated with chemoresistance in epithelial ovarian cancer.Clinical and Experimental Medicine 08/2013; · 2.83 Impact Factor
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ABSTRACT: The objective of this study was to investigate the preoperative diagnostic value of F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography and computed tomography (PET/CT) in patients with ovarian cancer. One hundred sixty patients suspected of having malignant ovarian tumors were included in this study. All patients underwent FDG-PET/CT scans before operation, and the maximum standardized uptake value (SUVmax) of the primary tumor was measured. We evaluated the diagnostic accuracy of SUVmax for detecting malignancy and its relationship with histological findings. Postoperative pathological diagnoses showed that 67 were malignant, 14 were borderline malignant, and 79 were benign tumors. With the use of a cutoff SUVmax of 2.9 obtained from the receiver operating characteristic curve analysis, the sensitivity, specificity, positive predictive value, and negative predictive value for detecting malignancy were 80.6%, 94.6%, 91.5%, and 87.1%, respectively. Positive FDG accumulation (SUVmax ≥ 2.9) was shown in 89.5% of serous adenocarcinoma and in 92.3% of endometrioid adenocarcinoma. In contrast, lower frequencies of positive FDG accumulation were shown in clear cell adenocarcinoma (54.5%), mucinous adenocarcinoma (66.7%), and metastatic carcinoma (66.7%), and the median SUVmax of these 3 histological types were significantly lower than those of serous and endometrioid types. In addition, a positive FDG accumulation was shown in all patients with malignant transformation of mature cystic teratoma. Finally, of the 14 borderline malignant tumors, only 2 (14.3%) showed positive FDG accumulation. The SUVmax on FDG-PET/CT is useful for differentiating ovarian cancer from borderline or benign tumor with a high specificity and positive predictive value. However, our data also demonstrated a lower FDG uptake value in clear cell or mucinous histological finding, suggesting that SUVmax may vary depending on the tumor histological subtype.International Journal of Gynecological Cancer 01/2014; · 1.94 Impact Factor
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ABSTRACT: To prospectively assess the value of PET/CT for staging, diagnosis and operability of ovarian cancer, with special attention to the peritoneal spread. From June 2009 till March 2011, 69 patients with suspicion of having an ovarian cancer underwent an (18)F-FDG PET/CT. To identify the diagnostic value of PET/CT, the results were compared with the findings at diagnostic laparoscopy and/or debulking surgery. There were 56 patients with malignant tumors and 13 with benign tumors. We observed a sensitivity and specificity of 93% and 77%, respectively for malignant tumors with PET/CT. CT alone had a sensitivity and specificity of 96% and 38%, respectively. The overall FIGO classification evaluation for PET/CT and CT were the same. For the evaluation of metastases, the sensitivity of PET/CT was worse, while the specificity was better than CT. Retroperitoneal lymph node metastases were diagnosed better with PET/CT, while there was no difference for peritoneal spread and for the intestines. PET/CT detected another unknown primary tumor in 3 (4.3%) cases. PET/CT is better than CT in detecting retroperitoneal lymph node metastases, but not for peritoneal metastases.Gynecologic Oncology 08/2013; · 3.93 Impact Factor