Performance of Multiparametric Functional Imaging to Assess Peritoneal Tumor Burden in Ovarian Cancer

Abstract

Purpose The aim of the study was to evaluate the clinical utility of pretreatment 18F-FDG PET/CT with quantitative evaluation of peritoneal metabolic cartography in relation to staging laparoscopy for ovarian carcinomatosis. Patients and Methods A retrospective review of prospectively collected data from 84 patients with FIGO (International Federation of Gynecology and Obstetrics) stage IIIC to IV ovarian cancer was carried out. All patients had a double-blinded 18F-FDG PET/CT review. Discriminant capacity of metabolic parameters to identify peritoneal carcinomatosis in the 13 abdominal regions according to the peritoneal cancer index was estimated with area under the receiver operating characteristic curve (AUC). Results The metabolic parameter showing the best trade-off between sensitivity and specificity to predict peritoneal extension compared with peritoneal cancer index score was the metabolic tumor volume (MTV), with a Spearman ρ equal to 0.380 (P < 0.001). The AUC of MTV to diagnose peritoneal involvement in the upper abdomen (regions 1, 2, and 3) ranged from 0.740 to 0.765. MTV AUC values were lower in the small bowel regions (9–12), ranging from 0.591 to 0.681, and decreased to 0.487 in the pelvic region 6. 18F-FDG PET/CT also improved the detection of extra-abdominal disease, upstaging 35 patients (41.6%) from stage IIIC to IV compared with CT alone and leading to treatment modification in more than one third of patients. Conclusions 18F-FDG PET/CT metrics are highly accurate to reflect peritoneal tumor burden, with variable diagnostic value depending on the anatomic region. MTV is the most representative metabolic parameter to assess peritoneal tumor extension.

The Search for New 2-18F-FDG PET/CT Imaging Biomarkers in Advanced Ovarian Cancer Patients

“…A recently published study by Mallet et al 8 assessed the clinical utility of pretreatment 2- 18 F-FDG PET/CT applying a quantitative evaluation of peritoneal metabolic mapping compared with laparoscopic staging in ovarian cancer patients with peritoneal carcinomatosis as the primary objective. The secondary objective of this study was to analyze the performance of 2- 18 F-FDG PET/CT for detecting extra-abdominal metastases.…”

Imaging of Peritoneal Metastases in Ovarian Cancer Using MDCT, MRI, and FDG PET/CT: A Systematic Review and Meta-Analysis

“…Following a review of the titles and abstracts, 187 studies were selected as potentially relevant, and their references were cross-checked. Thirty-three publications eventually fulfilled the inclusion criteria and were selected for quantitative synthesis (Table 2) [26,27,30,42,44,. The flow chart of the selection process is shown in Figure 2.…”

“…The hypermetabolic activity of PMs increases their conspicuity using FDG PET/CT. CT and FDG PET/CT are considered equivalent alternatives for the detection of recurrent OC [1, 17,30,[36][37][38][39][40][41][42][43][44]. Based on the results of a recently published meta-analysis, FDG PET/CT had high diagnostic accuracy, with 88% sensitivity and 89% specificity in the detection of recurrent OC [45].…”

Preoperative PET/CT score can predict incomplete resection after debulking surgery for advanced serous ovarian cancer better than CT score, MTV, tumor markers and hematological markers

“…The study of Schmidt et al 21 showed that [ 18 F]FDG PET/CT had the highest specificity for the detection of peritoneal carcinomatosis in ovarian cancer compared with multidetector CT and MRI, and whole‐body FDG PET/CT may be more accurate for the detection of supradiaphragmatic metastases. Mallet et al 22 indicated that [ 18 F]FDG PET/CT metabolic parameters were highly accurate in predicting peritoneal metastases, and [ 18 F]FDG PET/CT improved the detection of extra‐abdominal lesions, leading to treatment modification in a significant proportion of patients compared with CT. Van ‘t Sant et al 23 found that PET/CT and (DW)MRI had a comparable overall diagnostic value in detecting peritoneal metastases. Rubini et al 24 reported that the sensitivity, specificity and accuracy of [ 18 F]FDG PET/CT in the identification of peritoneal carcinomatosis in patients with ovarian cancer were 78.6%, 91.3% and 84.3%, respectively; for CT with contrast enhancement (CECT), they were 53.6%, 60.9% and 56.9%, respectively.…”