A Treatment Selection Protocol for Recurrent Ovarian Cancer Patients: The Role of FDG-PET/CT and Staging Laparoscopy

Abstract

Objective: To investigate the best diagnostic and staging strategy for recurrent ovarian cancer. Methods: The negative predictive value, specificity, positive predictive value, sensitivity, and accuracy rates of the fluorine-18-fluorodeoxyglucose positive emission tomography computed tomography (FDG-PET/CT) and staging laparoscopy in identifying surgically treatable/untreatable patients are assessed in a consecutive series of 70 recurrent ovarian cancer cases. Moreover, the diagnostic performance of each staging procedure in the evaluation of the number of nodules is analyzed. Results: The negative predictive value of the FDG-PET/CT was 83.3%, whereas the positive predictive value was 76.9%. Specificity was 55.6%, whereas sensitivity was 93.0%. Accuracy rate was 78.6%. Negative predictive value, specificity, positive predictive value, sensitivity, and accuracy rate of staging laparoscopy were 88.9, 64.0, 80.8, 95.0 and 83.1%, respectively. Combined radiological and laparoscopic evaluation showed a negative predictive value of 88.9%, a specificity of 59.3%, a positive predictive value of 78.8%, a sensitivity of 95.3%, and an accuracy rate of 81.4%. The number of nodules identified by FDG-PET/CT corresponded in only 23 patients (40.3%) at laparotomy, whereas 15 of 30 patients were correctly diagnosed (50.0%) by staging laparoscopy. Conclusions: The combination of FDG-PET/CT and staging laparoscopy has a significant effect on the multimodal approach to the population of patients with recurrent ovarian cancer. Such techniques should be considered complementary, because of the potential of each one to identify a different setting of the disease.

Cytoreductive surgery plus HIPEC in platinum-sensitive recurrent ovarian cancer patients: A case–control study on survival in patients with two year follow-up

“…All Cases were submitted to complete blood work (blood count, tests blood chemistry, urine analysis and Ca125 serum levels), FDG-PET/CT scan and staging-laparoscopy (S-LPS) to exclude extra-abdominal disease and to assess the chances of optimal cytoreduction [12].…”

Laparoscopic Splenectomy as Quaternary Cytoreduction for Isolated Parenchymal Splenic Recurrence of Epitelial Tubo-Ovarian Cancer: Report of a Case and Literature Review

“…Staging laparoscopy has proved to offer a reliable evaluation of occult peritoneal carcinosis, and a good prediction of the possibility of optimal cytoreduction in primary and recurrent ETOC patients [24,25,26]. Conversely, retroperitoneal and intraparenchymal localizations of disease may be missed by laparoscopic exploration.…”

“…Such techniques should be considered complementary because of the potential of each one to identify a different setting of the disease [25]. …”

Minimally Invasive Surgical Procedures for Patients with Advanced and Recurrent Ovarian Cancer

“…It has been shown that an objective evaluation of the complete debulking is available for primary advanced cases utilizing a laparoscopic predictive index score (40)(41). In addition, the inclusion of S-LPS can reduce the risk of explorative laparotomies to about 10%, with respect to 20% and 30% obtained with the classical criteria of evaluation of response.…”

“…The explanation to this, could be the presence of radiological artifacts due to the effects of chemotherapy, such as adherences or fibrosis secondary to tumor shrinkage, which would probably alter the diagnostic performances of conventional images. The laparoscopic predictive score of surgical outcome www.intechopen.com has been shown to be reliable in selected group of patients (41)(42). The laparoscopic parameters meeting the inclusion criteria have been mesenteral retraction, bowel and stomach infiltration, and superficial liver metastases.…”