The role of 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG PET) in diagnosis of ovarian cancer

Abstract

We evaluated the clinical significance of 18F-FDG PET to detect malignant ovarian neoplasms and tumor spread. 40 patients (median age: 57.5 years) underwent laparotomy because of clinical suspicion of malignant ovarian tumors or recurrent disease. The results of the preoperatively performed PET were correlated with the postoperative histologic diagnosis and the intraoperatively assessed tumor spread. In 10 of 40 patients benign tumors were found, among which a tubo-ovarian abscess was the only one diagnosed as false positive. 4/30 malignant neoplasms did not originate from the coelomic epithelium, but all were correctly recognized as malignant tumors by PET, as was recurrent ovarian cancer in 12 patients. Out of 14 primary ovarian carcinomas, 2 borderline tumors and 1 well-differentiated adenocarcinoma FIGO stage I were not correctly identified. Considering the tumor type, sensitivity, and specificity were 90%, calculating for the positive and negative predictive value 96% and 75%, respectively, and 90% for the diagnostic accuracy. Those statistical parameters were slightly lower for PET detection of lymph node metastasis and peritoneal carcinomatosis. Although its diagnostic accuracy may vary depending on the clinical application, 18F-FDG PET is basically a suitable method for detecting ovarian malignancies, particularly in patients with relapsed ovarian carcinoma.

GLUT1 mRNA and Protein Expression in Ovarian Borderline Tumors and Cancer

“…The observed correlation between increased GLUT1 expression, increased glycolysis and an intracellular accumulation of 2-fluoro-deoxy- D -glucose (FDG) in tumor cells might represent the biological basis for 18 F-FDG positron emission tomography [24]. As the results of clinical studies show, there is, in particular, an indication in relapse diagnosis suggesting this examination technique in the case of patients with ovarian carcinoma [25]. …”

“…Furthermore, it has been shown that GLUT3 is expressed selectively in several human tumors such as brain neoplasms or non-small cell lung carcinoma [22, 23]. In ovarian cancer, increased glucose uptake demonstrated by positron emission tomographic studies [24] suggests a pathophysiological role of glucose metabolism and the different GLUT isoforms [25]. Recently, first reports on GLUT1 expression in ovarian cancer have suggested this glucose transporter to be overexpressed and related to aggressive tumor biological behavior [26, 27].…”

The Role of 18F-FDG PET in Assessing Therapy Response in Cancer of the Cervix and Ovaries

“…Abnormal marker levels often precede clinical and radiologic signs of disease recurrence. 18 F-FDG PET has been shown to be limited in the diagnosis of cancer of the ovaries (28)(29)(30)(31)(32)(33)(34)(35). Physiologic 18 F-FDG uptake observed in the ovaries of women of reproductive age even after hysterectomy is reasonably common and may be mistaken for pathologic uptake.…”

Aportación de la Tomografía por Emisión de Positrones (PET) al manejo de los tumores malignos de ovario y útero

“…La PET obtiene unas cifras de sensibilidad comparables a las de la TAC (50-90%), pero con mayor especificidad (60-80%) (Tabla I). No obstante, es incapaz de detectar la mayor parte de los tumores en estadio I y aquellos de malignidad "borderline", al correlacionarse la captación de FDG con el grado histológico 19,21 . Además, se pueden producir falsos positivos en lesiones benignas tales como endometriosis, tumores quísticos, teratomas, schwanomas, enfermedades inflamatorio-infecciosas y hemorragias del cuerpo lúteo.…”

“…Es sabido, además, que la TAC y la RM no pueden descartar implantes peritoneales de pequeño tamaño. La PET obtiene en estos casos una sensibilidad y especificidad del 50-78% y 86-95% 19,24 , respectivamente, cifras superiores a las obtenidas por las téc-nicas convencionales. Frecuentemente se escapan a la detección lesiones microscópicas o micronodulares 24,29 .…”