Metabolic markers derived from 18 F-FDG PET/CT in suspected recurrent ovarian carcinoma: predictive value for disease burden and prognosis.

Abstract

Objective: This study aims to assess the role of 18 F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) in suspected recurrent ovarian carcinoma. Several clinical and PET parameters were assessed to evaluate disease burden and prognosis.

Methods: We did a single-center, retrospective study in patients with suspected recurrent ovarian carcinoma who underwent 18 F-FDG PET/CT. The disease burden on the scan was evaluated. We calculated several semiquantitative markers, including standard uptake values (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Survival analysis was done with clinical parameters, CA-125 levels, disease distribution, and metabolic markers.

Results: Fifty-two patients were included in the study. Half of the patients had suspected recurrence within 12 months of primary diagnosis. PET/CT scan suggested disease in 35 (67.3%) patients. Multiple metastatic sites were noted in 21 (40.4%) patients. Extra-abdominal metastases were seen in 15 (28.8%) patients. Eight patients had 18 F-FDG avid disease despite a low CA-125 level (<35 IU). Young patients (<50 years), extra-abdominal disease, multiple metastases, and higher restaging were associated with poor outcomes. Meanwhile, treatment history, CA-125 level, and post-PET/CT treatment had no significant effect on survival. MTV@40% SUV (>17.21) and TLG@40% SUV (>68.7) had the sensitivity of 87.5% and 75% for predicting disease outcome.

Conclusion: Recurrent ovarian carcinoma commonly presents with multiple metastasis and extra-abdominal metastases. 18 F-FDG PET/CT-guided patterns of disease distribution were significant markers for poor prognosis. Disease burden on PET/CT-derived semiquantitative parameters was associated with poor outcomes.