¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) predictive score for complete resection in primary cytoreductive surgery

Abstract

ObjectiveTo assess the value of preoperative 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan, combined with clinical variables, in predicting complete cytoreduction in selected patients with advanced ovarian cancer.MethodsWe carried out a multicenter, observational, retrospective study evaluating patients who underwent primary cytoreductive surgery for advanced ovarian cancer in two Spanish centers between January 2017 and January 2022. Inclusion criteria were histological confirmation of invasive epithelial ovarian carcinoma; preoperative International Federation of Gynecology and Obstetrics (FIGO) stage III or IV; upfront cytoreductive surgery; and 18F-FDG PET/CT performed 1 month prior to surgery. A modified 18F-FDG PET/CT peritoneal cancer index score was calculated for all patients. Clinical variables and preoperative 18F-FDG PET/CT findings were analyzed and a multivariate model was constructed. A predictive score based on the odds ratio of the variables was calculated to determine patient selection.ResultsA total of 45 patients underwent primary cytoreductive surgery. Complete resection was achieved in 36 (80%) patients. On multivariate analysis, two clinical variables (age ≥58 years and American Society of Anesthesiology score ≥3) and two preoperative 18F-FDG PET/CT scan findings (presence of extra-abdominal lymph node involvement and modified peritoneal cancer index value of 6 or more) were associated with gross residual disease. For this multivariate model predictive of non-complete cytoreduction, the area under the curve was 0.881. A predictive value of ≥5 was the most predictive cut-off for gross residual disease. Complete resection rate was 91.7% in patients with a score of ≤4 and 33.3% in patients with a score of ≥5 points on the predictive score.ConclusionsIn selected patients, a predictive score value ≥5 may be consider as a cut-off point for triaging patients to diagnostic laparoscopy before the primary surgery or neoadjuvant chemotherapy.

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

“…The main advantage of the technique is the whole-body coverage. FDG PET/CT can detect small PMs; evaluate all peritoneal compartments, even those inaccessible during surgery, such as the subdiaphragmatic peritoneal surfaces and the bowel mesentery; better assess ascites; and discriminate nodular peritoneal implants from the intestinal loops [1, 5,17,30,[36][37][38][39][40][41][42][43][44]63,[67][68][69][93][94][95][96][97][98][99][100][101]. The present review showed that FDG PET/CT had the highest detection rates in the central abdomen (AR0), the right hypochondrium (AR1), and the pelvis (AR5-7).…”

“…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].…”

Concordance of Radiological, Laparoscopic and Laparotomic Scoring to Predict Complete Cytoreduction in Women with Advanced Ovarian Cancer

“…Extensive involvement of these anatomical areas can be a clear limit to complete cytoreduction. Moreover, previous studies have investigated the PCI score evaluated using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), although regions corresponding to the small bowel have the lowest accuracy [33]. Laparoscopy, conversely, allows a direct visualization of the small bowel surface and the identification of diffuse carcinosis at this level.…”