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Tsili AC, Alexiou G, Tzoumpa M, Siempis T, Argyropoulou MI. Imaging of Peritoneal Metastases in Ovarian Cancer Using MDCT, MRI, and FDG PET/CT: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024; 16:1467. [PMID: 38672549 PMCID: PMC11048266 DOI: 10.3390/cancers16081467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
This review aims to compare the diagnostic performance of multidetector CT (MDCT), MRI, including diffusion-weighted imaging, and FDG PET/CT in the detection of peritoneal metastases (PMs) in ovarian cancer (OC). A comprehensive search was performed for articles published from 2000 to February 2023. The inclusion criteria were the following: diagnosis/suspicion of PMs in patients with ovarian/fallopian/primary peritoneal cancer; initial staging or suspicion of recurrence; MDCT, MRI and/or FDG PET/CT performed for the detection of PMs; population of at least 10 patients; surgical results, histopathologic analysis, and/or radiologic follow-up, used as reference standard; and per-patient and per-region data and data for calculating sensitivity and specificity reported. In total, 33 studies were assessed, including 487 women with OC and PMs. On a per-patient basis, MRI (p = 0.03) and FDG PET/CT (p < 0.01) had higher sensitivity compared to MDCT. MRI and PET/CT had comparable sensitivities (p = 0.84). On a per-lesion analysis, no differences in sensitivity estimates were noted between MDCT and MRI (p = 0.25), MDCT and FDG PET/CT (p = 0.68), and MRI and FDG PET/CT (p = 0.35). Based on our results, FDG PET/CT and MRI are the preferred imaging modalities for the detection of PMs in OC. However, the value of FDG PET/CT and MRI compared to MDCT needs to be determined. Future research to address the limitations of the existing studies and the need for standardization and to explore the cost-effectiveness of the three imaging modalities is required.
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Affiliation(s)
- Athina C. Tsili
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 45110 Ioannina, Greece; (M.T.); (M.I.A.)
| | - George Alexiou
- Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 45110 Ioannina, Greece;
| | - Martha Tzoumpa
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 45110 Ioannina, Greece; (M.T.); (M.I.A.)
| | - Timoleon Siempis
- ENT Department, Ulster Hospital, Upper Newtownards Rd., Dundonald, Belfast BT16 1RH, UK;
| | - Maria I. Argyropoulou
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 45110 Ioannina, Greece; (M.T.); (M.I.A.)
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Lee EYP, Philip Ip PC, Tse KY, Kwok ST, Chiu WK, Ho G. PET/Computed Tomography Transformation of Oncology: Ovarian Cancers. PET Clin 2024; 19:207-216. [PMID: 38177053 DOI: 10.1016/j.cpet.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Over the last quarter of a century, fluorine-18-fluorodeoxyglucose (FDG) PET/computed tomography (CT) has revolutionized the diagnostic algorithm of ovarian cancer, impacting on the initial disease evaluation including staging and surgical planning, treatment response assessment and prognostication, to the most important role in detection of recurrent disease. The role of FDG PET/CT is expanding with the adoption of new therapeutic agents. Other non-FDG tracers have been explored with fibroblast activation protein inhibitor being promising. Novel tracers may provide the basis for future theragnostic work. This article will review the evolution and impact of PET/CT in ovarian cancer management.
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Affiliation(s)
- Elaine Yuen Phin Lee
- Department of Diagnostic Radiology, School of Clinical Medicine, University of Hong Kong, Room 406, Block K, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China.
| | - Pun Ching Philip Ip
- Department of Pathology, School of Clinical Medicine, University of Hong Kong, Room 019, 7/F, Block T, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Ka Yu Tse
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of Hong Kong, 6/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Shuk Tak Kwok
- Department of Obstetrics and Gynaecology, 6/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Wan Kam Chiu
- Department of Obstetrics and Gynaecology, United Christian Hospital, 5/F, Block S, Kwun Tong, Kowloon, Hong Kong, China
| | - Grace Ho
- Department of Radiology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
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3
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Lee EYP, Ip PPC, Tse KY, Chiu KWH, Chu MMY, Chai YK, Wu PY, Law JYP, Kwok ST, Chiu WK, Ngan HYS. Prospective validation of the role of PET/CT in detecting disease after neoadjuvant chemotherapy in advanced ovarian cancer. Eur Radiol 2024:10.1007/s00330-024-10674-y. [PMID: 38460014 DOI: 10.1007/s00330-024-10674-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/22/2024] [Accepted: 02/14/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES The study aimed to compare the diagnostic accuracies of 2-[18F]FDG PET/CT and contrast-enhanced CT (ceCT) after neoadjuvant chemotherapy (NACT) in advanced ovarian cancer (OC). MATERIALS AND METHODS This study consisted historical observational cohort and prospective validation cohort. Patients with newly diagnosed stage III-IV OC scheduled for NACT were recruited, with imaging performed after three to six cycles of NACT before interval debulking surgery. Nineteen regions in the abdominopelvic cavity were scored for the presence and absence of disease, referenced to the intra-operative findings or histological specimens. Diagnostic metrics were compared using McNemar's test. RESULTS In the historical cohort (23 patients, age 58 ± 13), 2-[18F]FDG PET had an overall accuracy (Acc) 82%, sensitivity (Sen) 38%, specificity (Spe) 97%, positive predictive value (PPV) 79% and negative predictive value (NPV) 82%; ceCT had an overall Acc 86%, Sen 64%, Spe 93%, PPV 75% and NPV 89%. In the prospective cohort (46 patients, age 59 ± 9), 2-[18F] FDG PET had an overall Acc 87%, Sen 48%, Spe 98%, PPV 84% and NPV 88%; ceCT had an overall Acc 89%, Sen 66%, Spe 95%, PPV 77% and NPV 91%. No significant difference was demonstrated between the two imaging modalities (p > 0.05). High false-negative rates were observed in the right subdiaphragmatic space, omentum, bowel mesentery and serosa. High omental metabolic uptake after NACT was associated with histological non-responders (p < 0.05). CONCLUSION 2-[18F]FDG PET/CT had no additional value over ceCT with comparable diagnostic accuracy in detecting disease after NACT in advanced OC. CLINICAL RELEVANCE STATEMENT 2-[18F]FDG PET/CT is not superior to contrast-enhanced CT in determining disease after neoadjuvant chemotherapy in advanced ovarian cancer; contrast-enhanced CT should be suffice for surgical planning before interval debulking surgery. KEY POINTS • Additional value of 2-[18F]FDG PET/CT over contrast-enhanced CT is undefined in detecting disease after neoadjuvant chemotherapy. • 2-[18F]FDG PET/CT has comparable diagnostic accuracy compared to contrast-enhanced CT. • Contrast-enhanced CT will be suffice for surgical planning after neoadjuvant chemotherapy.
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Affiliation(s)
- Elaine Yuen Phin Lee
- Department of Diagnostic Radiology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Room 406, Block K, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
| | - Philip Pun Ching Ip
- Department of Pathology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Ka Yu Tse
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Keith Wan Hang Chiu
- Department of Diagnostic Radiology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Room 406, Block K, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
| | - Mandy Man Yee Chu
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Yu Ka Chai
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong, China
| | - Philip Yuguang Wu
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Jessica Yun Pui Law
- Department of Obstetrics and Gynecology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Shuk Tak Kwok
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Wan Kam Chiu
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong, China
| | - Hextan Yuen Sheung Ngan
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
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Meucci R, Prosperi D, Lauri C, Campagna G, Nayak P, Garaci F, Signore A. Peritoneal Carcinomatosis of Malignant Gynecological Origin: A Systematic Review of Imaging Assessment. J Clin Med 2024; 13:1254. [PMID: 38592669 PMCID: PMC10932285 DOI: 10.3390/jcm13051254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/06/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
This systematic review, conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, aims to comprehensively assess the current state of the art of imaging modalities for the evaluation of peritoneal carcinomatosis arising from malignant gynecological origins, with a focus on ovarian and endometrial cancers. A systematic search of relevant databases was performed, adhering to predetermined inclusion and exclusion criteria. Studies reporting the use of computed tomography (CT), magnetic resonance imaging (MRI), fluorodeoxyglucose (FDG) positron emission tomography (PET), PET/CT, and PET/MRI in the assessment of peritoneal carcinomatosis from gynecological malignancies were included. The review encompasses an overview of selected studies, highlighting the strengths and limitations of each imaging modality in diagnosing and characterizing peritoneal carcinomatosis. Overall, a wide variability in the reported accuracy of different imaging techniques emerges from literature, mainly due to the type of the study, technical issues, and patient characteristics. Although a meta-analysis could not be performed due to a scarcity of data, this systematic review provides valuable insights into the several imaging approaches used in peritoneal carcinomatosis of gynecological origin. The findings aim to inform clinical decision making and guide future research endeavors in this critical aspect of gynecological oncology.
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Affiliation(s)
- Rosaria Meucci
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, “Sapienza” University, 00189 Rome, Italy; (C.L.); (G.C.); (P.N.); (A.S.)
- U.O.C. Diagnostic Imaging, PTV Policlinico “Tor Vergata” University, Viale Oxford 81, 00133 Rome, Italy;
| | - Daniela Prosperi
- Nuclear Medicine Unit, University Hospital Sant’Andrea, 00189 Rome, Italy;
| | - Chiara Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, “Sapienza” University, 00189 Rome, Italy; (C.L.); (G.C.); (P.N.); (A.S.)
| | - Giuseppe Campagna
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, “Sapienza” University, 00189 Rome, Italy; (C.L.); (G.C.); (P.N.); (A.S.)
| | - Pallavi Nayak
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, “Sapienza” University, 00189 Rome, Italy; (C.L.); (G.C.); (P.N.); (A.S.)
- Department of Medical and Surgical Sciences and Translational Medicine, Ph.D. School in Translational Medicine and Oncology, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Francesco Garaci
- U.O.C. Diagnostic Imaging, PTV Policlinico “Tor Vergata” University, Viale Oxford 81, 00133 Rome, Italy;
| | - Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, “Sapienza” University, 00189 Rome, Italy; (C.L.); (G.C.); (P.N.); (A.S.)
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Allahqoli L, Hakimi S, Laganà AS, Momenimovahed Z, Mazidimoradi A, Rahmani A, Fallahi A, Salehiniya H, Ghiasvand MM, Alkatout I. 18F-FDG PET/MRI and 18F-FDG PET/CT for the Management of Gynecological Malignancies: A Comprehensive Review of the Literature. J Imaging 2023; 9:223. [PMID: 37888330 PMCID: PMC10607780 DOI: 10.3390/jimaging9100223] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE Positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro- D-glucose integrated with computed tomography (18F-FDG PET/CT) or magnetic resonance imaging (18F-FDG PET/MRI) has emerged as a promising tool for managing various types of cancer. This review study was conducted to investigate the role of 18F- FDG PET/CT and FDG PET/MRI in the management of gynecological malignancies. SEARCH STRATEGY We searched for relevant articles in the three databases PubMed/MEDLINE, Scopus, and Web of Science. SELECTION CRITERIA All studies reporting data on the FDG PET/CT and FDG PET MRI in the management of gynecological cancer, performed anywhere in the world and published exclusively in the English language, were included in the present study. DATA COLLECTION AND ANALYSIS We used the EndNote software (EndNote X8.1, Thomson Reuters) to list the studies and screen them on the basis of the inclusion criteria. Data, including first author, publication year, sample size, clinical application, imaging type, and main result, were extracted and tabulated in Excel. The sensitivity, specificity, and diagnostic accuracy of the modalities were extracted and summarized. MAIN RESULTS After screening 988 records, 166 studies published between 2004 and 2022 were included, covering various methodologies. Studies were divided into the following five categories: the role of FDG PET/CT and FDG-PET/MRI in the management of: (a) endometrial cancer (n = 30); (b) ovarian cancer (n = 60); (c) cervical cancer (n = 50); (d) vulvar and vagina cancers (n = 12); and (e) gynecological cancers (n = 14). CONCLUSIONS FDG PET/CT and FDG PET/MRI have demonstrated potential as non-invasive imaging tools for enhancing the management of gynecological malignancies. Nevertheless, certain associated challenges warrant attention.
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Affiliation(s)
- Leila Allahqoli
- Ministry of Health and Medical Education, Tehran 1467664961, Iran
| | - Sevil Hakimi
- Faculty of Nursing and Midwifery, Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz 516615731, Iran;
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Zohre Momenimovahed
- Department of Midwifery and Reproductive Health, Qom University of Medical Sciences, Qom 3716993456, Iran;
| | - Afrooz Mazidimoradi
- Neyriz Public Health Clinic, Shiraz University of Medical Sciences, Shiraz 7134845794, Iran;
| | - Azam Rahmani
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran 141973317, Iran;
| | - Arezoo Fallahi
- Department of Public Health, Faculty of Health, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran;
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand 9717853076, Iran;
| | - Mohammad Matin Ghiasvand
- Department of Computer Engineering, Amirkabir University of Technology (AUT), Tehran 1591634311, Iran;
| | - Ibrahim Alkatout
- University Hospitals Schleswig-Holstein, Campus Kiel, Kiel School of Gynaecological Endoscopy, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany;
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Chandra R, Kumari S, Bhatla N, Kumar R, Tiwari A, Sachani H, Kumar L. Role of Positron Emission Tomography/Computed Tomography in Epithelial Ovarian Cancer. Indian J Nucl Med 2023; 38:366-375. [PMID: 38390547 PMCID: PMC10880854 DOI: 10.4103/ijnm.ijnm_42_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/03/2022] [Accepted: 05/19/2022] [Indexed: 02/24/2024] Open
Abstract
Ovarian cancer (OC) is the most lethal gynecological malignancy with majority of cases diagnosed in advanced stages and associated with high morbidity and mortality. Positron emission tomography/computed tomography (PET/CT) has emerged as an integral part of the management of several nongynecological cancers. We used PubMed search engine using MeSH words "ovarian cancer" and "PET/CT" and reviewed the current status of PET/CT in epithelial OC. Its application related to ovarian tumor including adnexal mass evaluation, baseline staging, as a triaging tool for upfront surgery or neoadjuvant chemotherapy, for response assessment and prognostication, and for relapse detection and treatment planning has been highlighted. we highlight the current guidelines and newer upcoming PET modalities and radiotracers.
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Affiliation(s)
- Rudrika Chandra
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sarita Kumari
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, Division of Diagnostic Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abhinav Tiwari
- Department of Medicine, Base Hospital, Delhi Cantt, India
| | - Hemant Sachani
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
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Hashimoto C, Shigeta S, Shimada M, Shibuya Y, Ishibashi M, Kageyama S, Sato T, Tokunaga H, Takase K, Yaegashi N. Diagnostic Performance of Preoperative Imaging in Endometrial Cancer. Curr Oncol 2023; 30:8233-8244. [PMID: 37754512 PMCID: PMC10527880 DOI: 10.3390/curroncol30090597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/26/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Endometrial cancer is one of the most common gynecological malignancies. Because the findings mentioned in radiogram interpretation reports issued by diagnostic radiologists influence treatment strategies, we aimed to evaluate the diagnostic accuracy of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) interpretation results in clinically relevant settings. METHODS The clinical records of patients diagnosed with endometrial cancer treated at Tohoku University Hospital from January 2012 to December 2021 were reviewed. The preoperative and pathologically estimated cancer stages were compared based on the results mentioned in the radiogram interpretation report. RESULTS The preoperative and postoperative cancer stages were concordant in 70.0% of the patients. By contrast, the cancer stage was underdiagnosed and overdiagnosed in 21.7% and 8.2% of the patients, respectively. The sensitivities of MRI for deep myometrial invasion, cervical stromal invasion, vaginal invasion, and adnexal metastasis were 65.1%, 58.2%, 33.3%, and 18.4%, respectively. The sensitivity and specificity for pelvic lymph node metastasis using a combination of CT and MRI were 40.9% and 98.4%, respectively. Those for para-aortic lymph node metastases using CT were 37.0% and 99.5%, respectively. CONCLUSIONS The low sensitivity observed in this study clarified the limitations of preoperative diagnostic performance in current clinical practice.
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Affiliation(s)
- Chiaki Hashimoto
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (C.H.)
| | - Shogo Shigeta
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (C.H.)
| | - Muneaki Shimada
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (C.H.)
- Advanced Research Center for Innovations in Next-Generation Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8573, Japan
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8573, Japan
| | - Yusuke Shibuya
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (C.H.)
| | - Masumi Ishibashi
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (C.H.)
| | - Sakiko Kageyama
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Tomomi Sato
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Hideki Tokunaga
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (C.H.)
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (C.H.)
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8
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Lee S, Surabhi VR, Kassam Z, Chang KJ, Kaur H. Imaging of colon and rectal cancer. Curr Probl Cancer 2023:100970. [PMID: 37330400 DOI: 10.1016/j.currproblcancer.2023.100970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
Colon and rectal cancer imaging has traditionally been performed to assess for distant disease (typically lung and liver metastases) and to assess the resectability of the primary tumor. With technological and scientific advances in imaging and the evolution of treatment options, the role of imaging has expanded. Radiologists are now expected to provide a precise description of primary tumor invasion extent, including adjacent organ invasion, involvement of the surgical resection plane, extramural vascular invasion, lymphadenopathy, and response to neoadjuvant treatment, and to monitor for recurrence after clinical complete response.
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Affiliation(s)
- Sonia Lee
- Department of Radiological Sciences, University of California, Irvine, CA.
| | - Venkateswar R Surabhi
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zahra Kassam
- Department of Medical Imaging, Schulich School of Medicine, Western University, St Joseph's Hospital, London, Ontario, Canada
| | - Kevin J Chang
- Department of Radiology, Boston University Medical Center, Boston, MA
| | - Harmeet Kaur
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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9
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Pinto P, Burgetova A, Cibula D, Haldorsen IS, Indrielle-Kelly T, Fischerova D. Prediction of Surgical Outcome in Advanced Ovarian Cancer by Imaging and Laparoscopy: A Narrative Review. Cancers (Basel) 2023; 15:cancers15061904. [PMID: 36980790 PMCID: PMC10047411 DOI: 10.3390/cancers15061904] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Maximal-effort upfront or interval debulking surgery is the recommended approach for advanced-stage ovarian cancer. The role of diagnostic imaging is to provide a systematic and structured report on tumour dissemination with emphasis on key sites for resectability. Imaging methods, such as pelvic and abdominal ultrasound, contrast-enhanced computed tomography, whole-body diffusion-weighted magnetic resonance imaging and positron emission tomography, yield high diagnostic performance for diagnosing bulky disease, but they are less accurate for depicting small-volume carcinomatosis, which may lead to unnecessary explorative laparotomies. Diagnostic laparoscopy, on the other hand, may directly visualize intraperitoneal involvement but has limitations in detecting tumours beyond the gastrosplenic ligament, in the lesser sac, mesenteric root or in the retroperitoneum. Laparoscopy has its place in combination with imaging in cases where ima-ging results regarding resectability are unclear. Different imaging models predicting tumour resectability have been developed as an adjunctional objective tool. Incorporating results from tumour quantitative analyses (e.g., radiomics), preoperative biopsies and biomarkers into predictive models may allow for more precise selection of patients eligible for extensive surgery. This review will discuss the ability of imaging and laparoscopy to predict non-resectable disease in patients with advanced ovarian cancer.
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Affiliation(s)
- Patrícia Pinto
- Department of Gynecology, Portuguese Institute of Oncology Francisco Gentil, 1099-023 Lisbon, Portugal
- First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
| | - Andrea Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
| | - David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
| | - Ingfrid S Haldorsen
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, 5009 Bergen, Norway
- Section of Radiology, Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway
| | - Tereza Indrielle-Kelly
- Department of Obstetrics and Gynaecology, Burton and Derby Hospitals NHS Trust, Derby DE13 0RB, UK
| | - Daniela Fischerova
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
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10
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Rupa R, Prema R, Popat PB, Manchanda S, Venkatesh K, Chandramohan A, Subbian A, Rangarajan B. Imaging Recommendations for Diagnosis, Staging, and Management of Ovarian and Fallopian Tube Cancers. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
AbstractOvarian malignancy the third most common gynecological malignancy and is the leading cause of death in women. Non-specific clinical presentation delays the diagnosis, and they often present in the advanced stage of disease. No imaging modality is recommended for screening as there is no significant mortality reduction. Ultrasound (USG) is usually the initial modality in suspected ovarian mass. MRI is recommended for the characterization of indeterminate ovarian or adnexal mass on USG. CT abdomen and pelvis with oral and IV contrast is the recommended imaging modality in staging the disease, predicting the resectability and in selecting the patients who would benefit from neoadjuvant chemotherapy. Early ovarian cancers are staged by post-surgical histology and undergo upfront surgery. Advanced disease benefit by neoadjuvant chemotherapy and less morbidity by interval cytoreduction where image-guided biopsy is performed for histological diagnosis. Follow-up recommendations are based on tumor histology. CT/PET CT is recommended for diagnosing recurrence.
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Affiliation(s)
- Renganathan Rupa
- Department of Diagnostic and Interventional Radiology, Division of Breast and Women's Imaging and Interventions, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India
| | - Renganathan Prema
- Department of Diagnostic and Interventional Radiology, Division of Breast and Women's Imaging and Interventions, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India
| | | | - Smita Manchanda
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kasi Venkatesh
- Department of Diagnostic and Interventional Radiology, Division of Abdominal Imaging and ablative therapies, Kovai Medical Center and Hospitals, Coimbatore, India
| | - Anuradha Chandramohan
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Anbukkani Subbian
- Department of Gynecological Oncology, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India
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11
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Daoud T, Sardana S, Stanietzky N, Klekers AR, Bhosale P, Morani AC. Recent Imaging Updates and Advances in Gynecologic Malignancies. Cancers (Basel) 2022; 14:cancers14225528. [PMID: 36428624 PMCID: PMC9688526 DOI: 10.3390/cancers14225528] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/31/2022] [Accepted: 11/09/2022] [Indexed: 11/12/2022] Open
Abstract
Gynecologic malignancies are among the most common cancers in women worldwide and account for significant morbidity and mortality. Management and consequently overall patient survival is reliant upon early detection, accurate staging and early detection of any recurrence. Ultrasound, Computed Tomography (CT), Magnetic resonance imaging (MRI) and Positron Emission Tomography-Computed Tomography (PET-CT) play an essential role in the detection, characterization, staging and restaging of the most common gynecologic malignancies, namely the cervical, endometrial and ovarian malignancies. Recent advances in imaging including functional MRI, hybrid imaging with Positron Emission Tomography (PET/MRI) contribute even more to lesion specification and overall role of imaging in gynecologic malignancies. Radiomics is a neoteric approach which aspires to enhance decision support by extracting quantitative information from radiological imaging.
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12
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Boria F, Chiva L, Carbonell M, Gutierrez M, Sancho L, Alcazar A, Coronado M, Hernández Gutiérrez A, Zapardiel I. 18F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18F-FDG PET/CT) predictive score for complete resection in primary cytoreductive surgery. Int J Gynecol Cancer 2022; 32:ijgc-2022-003883. [PMID: 36137576 DOI: 10.1136/ijgc-2022-003883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To 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. METHODS We 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. RESULTS A 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. CONCLUSIONS In 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.
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Affiliation(s)
- Felix Boria
- Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Madrid, Spain
| | - Luis Chiva
- Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | - Maria Carbonell
- Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
| | | | - Lidia Sancho
- Nuclear Medicine, Clinica Universidad de Navarra, Madrid, Spain
| | - Andres Alcazar
- Radiology Department, Clinica Universidad de Navarra, Madrid, Spain
| | - Monica Coronado
- Nuclear Medicine, La Paz University Hospital, Madrid, University, Spain
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13
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Nougaret S, Sadowski E, Lakhman Y, Rousset P, Lahaye M, Worley M, Sgarbura O, Shinagare AB. The BUMPy road of peritoneal metastases in ovarian cancer. Diagn Interv Imaging 2022; 103:448-459. [PMID: 36155744 DOI: 10.1016/j.diii.2022.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022]
Abstract
Ovarian cancer is the most common cause of death due to gynecologic malignancies, with more than 70% of patients presenting with advanced stage disease at the time of diagnosis. The extent and distribution of tumor guide primary treatment selection and clinical management. While primary cytoreductive surgery with complete tumor resection improves survival, patients with extensive peritoneal disease may benefit from neoadjuvant chemotherapy first to reduce tumor burden followed by interval cytoreductive surgery. Imaging plays an essential role in triaging patients including selecting patients who may benefit from neoadjuvant chemotherapy before cytoreductive surgery. Interestingly, there are no universally established criteria to predict resectability and local practices depend on local guidelines and surgeon preferences. Nevertheless, certain anatomical tumor locations are known to be difficult to resect and are associated with suboptimal cytoreduction or require special surgical considerations. This review discusses the recent advances in the initial management of patients with ovarian cancer, a practical approach to the assessment and communication of peritoneal metastases locations on CT and MRI. It also explores recent advances in genomics profiling and radiomics that may influence the initial management of these patients.
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Affiliation(s)
- Stephanie Nougaret
- Department of Radiology, IRCM, Montpellier Cancer Research Institute, 34090 Montpellier, France; INSERM, U1194, University of Montpellier, 34295 Montpellier, France.
| | - Elizabeth Sadowski
- Departments of Radiology, Obstetrics and Gynecology, University of Wisconsin, WI 53726, United States
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Pascal Rousset
- Department of Radiology, Centre Hospitalier Lyon-Sud, Pierre-Benite 69495, France
| | - Max Lahaye
- Department of Radiology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, 1066 CX, Amsterdam, the Netherlands
| | - Michael Worley
- Department of Surgery, Dana-Farber Cancer Institute, Boston, MA 02115, United States
| | - Olivia Sgarbura
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier, F-34298, France; Department of Surgical Oncology, Cancer Institute Montpellier (ICM), University of Montpellier, Montpellier, France
| | - Atul B Shinagare
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA 02215, United States; Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, United States
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14
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Fernandes MC, Nikolovski I, Long Roche K, Lakhman Y. CT of Ovarian Cancer for Primary Treatment Planning: What the Surgeon Needs to Know- Radiology In Training. Radiology 2022; 304:516-526. [PMID: 35608442 PMCID: PMC9434813 DOI: 10.1148/radiol.212737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 11/11/2022]
Abstract
A 60-year-old woman presented with intermittent abdominal pain, an elevated serum CA-125 level, and an abnormal CT examination and was ultimately diagnosed with advanced-stage high-grade serous ovarian cancer. Key tumor locations on CT scans that should be highlighted by the radiologist to guide treatment selection are discussed.
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Affiliation(s)
- Maria Clara Fernandes
- From the Department of Radiology (M.C.F., I.N., Y.L.) and Gynecologic
Service, Department of Surgery (K.L.R.), Memorial Sloan Kettering Cancer Center,
1275 York Ave, New York, NY 10065
| | - Ines Nikolovski
- From the Department of Radiology (M.C.F., I.N., Y.L.) and Gynecologic
Service, Department of Surgery (K.L.R.), Memorial Sloan Kettering Cancer Center,
1275 York Ave, New York, NY 10065
| | - Kara Long Roche
- From the Department of Radiology (M.C.F., I.N., Y.L.) and Gynecologic
Service, Department of Surgery (K.L.R.), Memorial Sloan Kettering Cancer Center,
1275 York Ave, New York, NY 10065
| | - Yulia Lakhman
- From the Department of Radiology (M.C.F., I.N., Y.L.) and Gynecologic
Service, Department of Surgery (K.L.R.), Memorial Sloan Kettering Cancer Center,
1275 York Ave, New York, NY 10065
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15
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Prospective Comparison of the Performance of MRI Versus CT in the Detection and Evaluation of Peritoneal Surface Malignancies. Cancers (Basel) 2022; 14:cancers14133179. [PMID: 35804951 PMCID: PMC9264985 DOI: 10.3390/cancers14133179] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/30/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The performance of MRI versus CT in the detection and evaluation of peritoneal surface malignancies (PSM) remains unclear in the current literature. Our study is the first prospective study in an Asian center comparing the two imaging modalities, validated against intra-operative findings. Methods: A total of 36 patients with PSM eligible for CRS-HIPEC underwent both MRI and CT scans up to 6 weeks before the operation. The scans were assessed for the presence and distribution of PSM and scored using the peritoneal cancer index (PCI), which were compared against PCI determined at surgery. Results: Both MRI and CT were 100% sensitive and specific in detecting the overall presence of PSM. Across all peritoneal regions, the sensitivity and specificity for PSM detection was 49.1% and 93.0% for MRI, compared to 47.8% and 95.1% for CT (p = 0.76). MRI was more sensitive than CT for small bowel disease, although the difference did not reach statistical significance. Comparing PCI on imaging with intra-operative PCI, the mean difference was found to be −3.4 ± 5.4 (p < 0.01) for MRI, and −3.9 ± 4.1 (p < 0.01) for CT. The correlation between imaging and intra-operative PCI was poor, with a concordance coefficient of 0.76 and 0.79 for MRI and CT, respectively. Within individual peritoneal regions, there was also poor agreement between imaging and intra-operative PCI for both modalities, other than in regions 1 and 3. Conclusion: MRI and CT are comparable in the detection and evaluation of PSM. While sensitive in the overall detection of PSM, they are likely to underestimate the true disease burden.
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16
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Tsili AC, Naka C, Argyropoulou MI. Multidetector computed tomography in diagnosing peritoneal metastases in ovarian carcinoma. Acta Radiol 2021; 62:1696-1706. [PMID: 33334121 DOI: 10.1177/0284185120980006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Multidetector computed tomography (MDCT) of the abdomen is currently the imaging examination of choice for the staging and follow-up of ovarian carcinoma (OC). Peritoneal metastases (PMs) represent the most common pathway for the metastatic spread of OC. MDCT scanners, due to several advantages-including increased volume coverage, reduced scanning time, acquisition of thin slices and creation of multiplanar reformations, and three-dimensional reconstructions-provide useful information regarding the early and accurate detection of PMs. Detailed mapping of peritoneal carcinomatosis is feasible, with improved detection of sub-centimeter peritoneal implants and thorough evaluation of curved peritoneal surfaces.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Christina Naka
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
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17
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Mimoun C, Paoletti X, Gaillard T, Crestani A, Benifla JL, Mezzadri M, Bendifallah S, Touboul C, Bricou A, Dabi Y, Canlorbe G, Kerbage Y, Lavoué V, Ouldamer L, Lecointre L, Coutant C, Fauconnier A, Rouzier R, Huchon C. Using a new diagnostic tool to predict lymph node metastasis in advanced epithelial ovarian cancer leads to simple lymphadenectomy decision rules: A multicentre study from the FRANCOGYN group. PLoS One 2021; 16:e0258783. [PMID: 34665839 PMCID: PMC8525770 DOI: 10.1371/journal.pone.0258783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to develop a new diagnostic tool to predict lymph node metastasis (LNM) in patients with advanced epithelial ovarian cancer undergoing primary cytoreductive surgery. MATERIALS AND METHOD The FRANCOGYN group's multicenter retrospective ovarian cancer cohort furnished the patient population on which we developed a logistic regression model. The prediction model equation enabled us to create LNM risk groups with simple lymphadenectomy decision rules associated with a user-friendly free interactive web application called shinyLNM. RESULTS 277 patients from the FRANCOGYN cohort were included; 115 with no LNM and 162 with LNM. Three variables were independently and significantly (p<0.05) associated with LNM in multivariate analysis: pelvic and/or para-aortic LNM on CT and/or PET/CT (p<0.00), initial PCI ≥ 10 and/or diaphragmatic carcinosis (p = 0.02), and initial CA125 ≥ 500 (p = 0.02). The ROC-AUC of this prediction model after leave-one-out cross-validation was 0.72. There was no difference between the predicted and the observed probabilities of LNM (p = 0.09). Specificity for the group at high risk of LNM was 83.5%, the LR+ was 2.73, and the observed probability of LNM was 79.3%; sensitivity for the group at low-risk of LNM was 92.0%, the LR- was 0.24, and the observed probability of LNM was 25.0%. CONCLUSION This new tool may prove useful for improving surgical planning and provide useful information for patients.
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Affiliation(s)
- Camille Mimoun
- Department of Gynecology and Obstetrics, Lariboisière University Hospital, AP-HP, Paris, France
- Research Unit EA 7285 "Risk and Safety in Clinical Medicine for Women and Perinatal Health", UVSQ, Montigny-Le-Bretonneux, France
- Department of Surgical Oncology, Curie Institute, Saint-Cloud, France
- * E-mail:
| | | | - Thomas Gaillard
- Department of Surgical Oncology, Curie Institute, Saint-Cloud, France
| | - Adrien Crestani
- Department of Gynecology and Obstetrics, Lariboisière University Hospital, AP-HP, Paris, France
| | - Jean-Louis Benifla
- Department of Gynecology and Obstetrics, Lariboisière University Hospital, AP-HP, Paris, France
| | - Matthieu Mezzadri
- Department of Gynecology and Obstetrics, Lariboisière University Hospital, AP-HP, Paris, France
| | - Sofiane Bendifallah
- Department of Gynecology and Obstetrics, Tenon University Hospital, AP-HP, Paris, France
| | - Cyril Touboul
- Department of Gynecology and Obstetrics, Tenon University Hospital, AP-HP, Paris, France
| | - Alexandre Bricou
- Department of Obstetrics, Gynecology and Reproductive Medicine, CH Jean Verdier, AP-HP, Bondy, France
| | - Yohann Dabi
- Department of Gynecology and Obstetrics, CHIC, Créteil, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Yohan Kerbage
- Department of Gynecologic Surgery, Jeanne de Flandre Hospital, CHU of Lille, Loos, France
| | | | - Lobna Ouldamer
- Department of Obstetrics and Gynecology, Bretonneau Hospital, CHU of Tours, Tours, France
| | - Lise Lecointre
- Department of Obstetrics and Gynecology, University Hospital Center, Strasbourg, France
| | - Charles Coutant
- Department of Surgical Oncology, Georges-François Leclerc Cancer Center, Dijon, France
| | - Arnaud Fauconnier
- Department of Obstetrics and Gynecology, Poissy-St Germain Hospital, Poissy, France
| | - Roman Rouzier
- Department of Surgical Oncology, Curie Institute, Saint-Cloud, France
- INSERM U900 STAMPM Team, Saint Cloud, France
| | - Cyrille Huchon
- Department of Gynecology and Obstetrics, Lariboisière University Hospital, AP-HP, Paris, France
- Research Unit EA 7285 "Risk and Safety in Clinical Medicine for Women and Perinatal Health", UVSQ, Montigny-Le-Bretonneux, France
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18
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Mallet E, Angeles MA, Cabarrou B, Chardin D, Viau P, Frigenza M, Navarro AS, Ducassou A, Betrian S, Martínez-Gómez C, Tanguy Le Gac Y, Chantalat E, Motton S, Ferron G, Barranger E, Gabiache E, Martinez A. Performance of Multiparametric Functional Imaging to Assess Peritoneal Tumor Burden in Ovarian Cancer. Clin Nucl Med 2021; 46:797-806. [PMID: 34238796 DOI: 10.1097/rlu.0000000000003785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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.
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Affiliation(s)
- Estelle Mallet
- From the Department of Surgical Oncology, Centre Antoine Lacassagne, Nice
| | | | - Bastien Cabarrou
- Biostatistics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse
| | - David Chardin
- Department of Nuclear Medicine, Centre Antoine Lacassagne
| | - Philippe Viau
- Department of Nuclear Medicine, Centre Hospitalier Universitaire de Nice
| | - Mélanie Frigenza
- Department of Gynecological Surgery, Centre Hospitalier Universitaire de Nice, Nice
| | | | | | - Sarah Betrian
- Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse
| | | | - Yann Tanguy Le Gac
- Department of Gynecology, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole
| | - Elodie Chantalat
- Department of Gynecology, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole
| | - Stéphanie Motton
- Department of Gynecology, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole
| | | | - Emanuel Barranger
- From the Department of Surgical Oncology, Centre Antoine Lacassagne, Nice
| | - Erwan Gabiache
- Nuclear Medicine Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
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19
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Preoperative CT or PET/CT to Assess Pelvic and Para-Aortic Lymph Node Status in Epithelial Ovarian Cancer? A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11101748. [PMID: 34679446 PMCID: PMC8534764 DOI: 10.3390/diagnostics11101748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 11/27/2022] Open
Abstract
Background: In advanced epithelial ovarian cancer (EOC), the LION trial restricted lymphadenectomy indication to patients with suspect lymph nodes before and during surgery. Preoperative imaging is used to assess lymph node status, and particularly CT and PET/CT. The aim of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of preoperative CT and PET/CT to detect lymph node metastasis (LNM) in patients with EOC; Methods: Databases were searched from January 1990 to May 2019 for studies that evaluated the diagnostic accuracy of preoperative CT and PET/CT to detect LNM in patients with EOC with histology as the gold standard. Pooled diagnostic accuracy was calculated using bivariate random-effects models and hierarchical summary receiver operating curve (HSROC). This study is registered with PROSPERO number CRD42020179214; Results: A total of five studies were included in the meta-analysis: four articles concerned preoperative CT and four articles concerned preoperative PET/CT, involving 106 and 138 patients, respectively. For preoperative CT, pooled sensitivity was 0.47 95% CI [0.20–0.76], pooled specificity was 0.99 95% CI [0.75–1.00] and area under the curve (AUC) of the HSROC was 0.91 95% CI [0.88–0.93]. For preoperative PET/CT, pooled sensitivity was 0.81 95% CI [0.61–0.92], pooled specificity was 0.96 95% CI [0.91–0.99] and AUC of the HSROC was 0.97 95% CI [0.95–0.98]; Conclusions: PET/CT has a very high diagnostic accuracy, especially for specificity, to detect LNM in EOC and should be realized systematically, additionally to CT recommended to evaluate peritoneal spread, in the preoperative staging of patients with an advanced disease.
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20
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Gabiache E, Chantalat E, Zerdoud S, Martinez A, Ferron G. Lateral Hepatic Fissure Peritoneal Carcinomatosis as a Pitfall for Hepatic Metastasis of Advanced Ovarian Cancer. Clin Nucl Med 2021; 46:e424-e427. [PMID: 34186543 DOI: 10.1097/rlu.0000000000003675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 52-year-old woman previously treated for a stage IIIc high-grade ovarian serous carcinoma presented right upper quadrant abdominal pain, 3 years after extended surgery and chemotherapy. Abdominal CT, MRI, and 18F-FDG PET/CT showed a right hepatic mass, consistent for lone recurrence nearby the hepatic lateral fissure. Preoperative and histologic examination identified a peritoneal lateral fissure lesion. The patient underwent atypic segment 5 segmentectomy. She has been disease-free for 3 years now. Advanced ovarian cancer can be responsible for perihepatic sulcus lesions, such as this right fissure lesion. They should not be mistaken for inoperable parenchyma metastases.
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Affiliation(s)
- Erwan Gabiache
- From the Department of Nuclear Medicine, Institut Claudius Regaud-Institut Universitaire du Cancer de Toulouse-Oncopole
| | - Elodie Chantalat
- Gynecology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole
| | - Slimane Zerdoud
- From the Department of Nuclear Medicine, Institut Claudius Regaud-Institut Universitaire du Cancer de Toulouse-Oncopole
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21
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Feng Z, Liu S, Ju X, Chen X, Li R, Bi R, Wu X. Diagnostic accuracy of 18F-FDG PET/CT scan for peritoneal metastases in advanced ovarian cancer. Quant Imaging Med Surg 2021; 11:3392-3398. [PMID: 34341717 DOI: 10.21037/qims-20-784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 03/03/2021] [Indexed: 12/14/2022]
Abstract
Background To assess the diagnostic accuracy of 18F-FDG PET/CT to determine the Eisenkop score and peritoneal cancer index (PCI) in correlation with surgical findings. Methods Forty-three patients underwent preoperative 18F-FDG PET/CT scan, followed by primary cytoreductive surgery for advanced ovarian cancer between September 2015 and February 2018. Clinical data were prospectively collected, including intraoperative assessment (with Eisenkop and PCI scores) and surgical results. The sensitivity, specificity, and accuracy were calculated at each anatomical site. The Eisenkop score, PCI score, and tumor volume of PET/CT scans were compared with surgical findings. Results A total of 32 (74.4%) patients were diagnosed with stage III, and 11 (25.6%) patients were stage IV. Among these individuals, 19 (44.2%) patients had no residual disease after primary surgery. The median [range] Eisenkop score on PET/CT scans and surgical findings were 5 [1-13] and 6 [2-13], respectively. PET/CT scans correctly predicted the Eisenkop score with high sensitivity (84.2%), specificity (87.0%), and accuracy (85.1%). The diagnostic accuracy of PET/CT scans for PCI scores was lower (78.5%), with 72.7% sensitivity and 84.9% specificity. Preoperative PET/CT scans might underestimate tumor volume compared with surgical findings. Conclusions 18F-FDG PET/CT scans accurately predicted peritoneal metastases in advanced ovarian cancer before surgery using Eisenkop score.
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Affiliation(s)
- Zheng Feng
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shuai Liu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China.,Center for Biomedical Imaging, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Molecular Imaging Probes, Fudan University, Shanghai, China
| | - Xingzhu Ju
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaojun Chen
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ruimin Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Rui Bi
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaohua Wu
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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22
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Ai Y, Zhang J, Jin J, Zhang J, Zhu H, Jin X. Preoperative Prediction of Metastasis for Ovarian Cancer Based on Computed Tomography Radiomics Features and Clinical Factors. Front Oncol 2021; 11:610742. [PMID: 34178617 PMCID: PMC8222738 DOI: 10.3389/fonc.2021.610742] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 04/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background There is urgent need for an accurate preoperative prediction of metastatic status to optimize treatment for patients with ovarian cancer (OC). The feasibility of predicting the metastatic status based on radiomics features from preoperative computed tomography (CT) images alone or combined with clinical factors were investigated. Methods A total of 101 OC patients who underwent primary debulking surgery were enrolled. Radiomics features were extracted from the tumor volumes contoured on CT images with LIFEx package. Mann-Whitney U tests, least absolute shrinkage selection operator (LASSO), and Ridge Regression were applied to select features and to build prediction models. Univariate and regression analysis were applied to select clinical factors for metastatic prediction. The performance of models generated with radiomics features alone, clinical factors, and combined factors were evaluated and compared. Results Nine radiomics features were screened out from 184 extracted features to classify patients with and without metastasis. Age and cancer antigen 125 (CA125) were the two clinical factors that were associated with metastasis. The area under curves (AUCs) for the radiomics signature, clinical factors model, and combined model were 0.82 (95% CI, 0.66-0.98; sensitivity = 0.90, specificity = 0.70), 0.83 (95% CI, 0.67-0.95; sensitivity = 0.71, specificity = 0.8), and 0.86 (95% CI, 0.72-0.99, sensitivity = 0.81, specificity = 0.8), respectively. Conclusions Radiomics features alone or radiomics features combined with clinical factors are feasible and accurate enough to predict the metastatic status for OC patients.
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Affiliation(s)
- Yao Ai
- Department of Radiotherapy Center, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jindi Zhang
- Department of Gynecology, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Juebin Jin
- Department of Medical Engineering, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ji Zhang
- Department of Radiotherapy Center, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haiyan Zhu
- Department of Gynecology, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Gynecology, Shanghai First Maternal and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiance Jin
- Department of Radiotherapy Center, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of Basic Medical Science, Wenzhou Medical University, Wenzhou, China
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23
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Prahm KP, Høgdall CK, Karlsen MA, Christensen IJ, Novotny GW, Høgdall E. MicroRNA characteristics in epithelial ovarian cancer. PLoS One 2021; 16:e0252401. [PMID: 34086724 PMCID: PMC8177468 DOI: 10.1371/journal.pone.0252401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 05/14/2021] [Indexed: 01/23/2023] Open
Abstract
The purpose of the current study was to clarify differences in microRNA expression according to clinicopathological characteristics, and to investigate if miRNA profiles could predict cytoreductive outcome in patients with FIGO stage IIIC and IV ovarian cancer. Patients enrolled in the Pelvic Mass study between 2004 and 2010, diagnosed and surgically treated for epithelial ovarian cancer, were used for investigation. MicroRNA was profiled from tumour tissue with global microRNA microarray analysis. Differences in miRNA expression profiles were analysed according to histologic subtype, FIGO stage, tumour grade, type I or II tumours and result of primary cytoreductive surgery. One microRNA, miR-130a, which was found to be associated with serous histology and advanced FIGO stage, was also validated using data from external cohorts. Another seven microRNAs (miR-34a, miR-455-3p, miR-595, miR-1301, miR-146-5p, 193a-5p, miR-939) were found to be significantly associated with the clinicopathological characteristics (p ≤ 0.001), in our data, but mere not similarly significant when tested against external cohorts. Further validation in comparable cohorts, with microRNA profiled using newest and similar methods are warranted.
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Affiliation(s)
- Kira Philipsen Prahm
- Department of Pathology, Molecular unit, Danish Cancer Biobank, Herlev University Hospital, Herlev, Denmark
- Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- * E-mail:
| | - Claus Kim Høgdall
- Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mona Aarenstrup Karlsen
- Department of Pathology, Molecular unit, Danish Cancer Biobank, Herlev University Hospital, Herlev, Denmark
- Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ib Jarle Christensen
- Department of Pathology, Molecular unit, Danish Cancer Biobank, Herlev University Hospital, Herlev, Denmark
| | - Guy Wayne Novotny
- Department of Pathology, Molecular unit, Danish Cancer Biobank, Herlev University Hospital, Herlev, Denmark
| | - Estrid Høgdall
- Department of Pathology, Molecular unit, Danish Cancer Biobank, Herlev University Hospital, Herlev, Denmark
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24
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Current update on malignant epithelial ovarian tumors. Abdom Radiol (NY) 2021; 46:2264-2280. [PMID: 34089360 DOI: 10.1007/s00261-021-03081-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 01/16/2023]
Abstract
Epithelial ovarian cancer (EOC) represents the most frequently occurring gynecological malignancy, accounting for more than 70% of ovarian cancer deaths. Preoperative imaging plays an important role in assessing the extent of disease and guides the next step in surgical decision-making and operative planning. In this article, we will review the multimodality imaging features of various subtypes of EOC. We will also discuss the role of imaging in the staging, management, and surveillance of EOC.
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25
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Diagnostic performance of PET/CT and PET/MR in the management of ovarian carcinoma-a literature review. Abdom Radiol (NY) 2021; 46:2323-2349. [PMID: 33175199 DOI: 10.1007/s00261-020-02847-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/25/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022]
Abstract
Ovarian cancer is a challenging disease. It often presents at an advanced stage with frequent recurrence despite optimal management. Accurate staging and restaging are critical for improving treatment outcomes and determining the prognosis. Imaging is an indispensable component of ovarian cancer management. Hybrid imaging modalities, including positron emission tomography/computed tomography (PET/CT) and PET/magnetic resonance imaging (MRI), are emerging as potential non-invasive imaging tools for improved management of ovarian cancer. This review article discusses the role of PET/CT and PET/MRI in ovarian cancer.
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26
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Vieira AC, Antunes N, Damasceno E, Ramalho M, Esteves S, Vaz F, Félix A, Cunha TM. Ovarian carcinoma in patients with BRCA mutation - a correlation between the growing pattern of peritoneal implants evaluated by CT/MRI and the genotype BRCA1 and BRCA2. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00183-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Ovarian cancer is the leading cause of death from gynecologic cancer. The risk of developing ovarian cancer is significantly increased in patients that carry a genetic mutation of tumor suppressor gene BRCA1 or BRCA2. The majority of BRCA-associated ovarian/fallopian tube cancers are high-grade serous carcinomas (HGSC). The recognition of patterns of disease is crucial to identify distinctive imaging features that could be useful for predicting prognosis and therapeutic response.
Results
An institutional review board-approved retrospective study was performed and included 34patients (23 BRCA-mutated and 11 BRCA wild-type) with HGSC FIGO III/IV who underwent pre-operative or pre-chemotherapy contrast-enhanced CT/MRI of the abdomen and pelvis between January 2003 and December 2017. Three radiologists independently reviewed the imaging studies and looked for qualitative features of the primary tumor and peritoneal metastases (nodular versus infiltrative pattern). Two pathologists also assessed the histopathologic characteristics of the surgical specimens, with emphasis on the growth pattern of metastatic deposits (expansive/nodular and infiltrative) and inflammatory infiltrate (intra- and/or peritumoral).
No significant associations were found between the different groups of patients (BRCA1-mutant HGSC, BRCA2-mutant HGSC. and BRCA wild-type) and CT/MRI features of ovarian tumors, morphology of peritoneal metastasis, and pathologic characteristics.
Conclusion
Identification of specific imaging and pathologic features is important to pursue an optimal personalized cancer treatment strategy and to develop precision medicine in the future.
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27
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Glycolytic phenotypes in an evaluation of ovarian carcinoma based on carcinogenesis and BRCA mutation. Eur J Radiol 2020; 133:109391. [PMID: 33171356 DOI: 10.1016/j.ejrad.2020.109391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 10/15/2020] [Accepted: 10/29/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUNDS Recently, a dualistic carcinogenesis model of ovarian cancer has emerged. We aimed to investigate differences in the glycolytic phenotypes of type I and type II ovarian carcinoma on the basis of FDG uptake and in the pathological features according to tumour grade and histology. MATERIALS AND METHODS In total, 386 epithelial ovarian carcinoma patients underwent debulking surgery, and the histopathological results of the patients were retrospectively reviewed from 2003 to 2017. Among these patients, 170 patients had histopathological data that were available due to primary cytoreductive surgery and could be analysed regarding FDG avidity in type I and type II ovarian cancer. The FDG uptake of the tumour (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were analysed according to the tumour grade, histology and type of ovarian carcinogenesis (type I and II) and prognosis. RESULTS Among the 386 patients, there was a significant difference in SUVmax among ovarian cancer subtypes. There was a significant increase in SUVmax as the tumour grade increased (8.08 ± 0.63, 10.5 ± 0.40, and 12.7 ± 0.38 for grades I, II and III, respectively, Kruskal-Wallis test, p < 0.0001). Among the 90 type I and 80 type II ovarian carcinoma patients, there was a significant difference in SUVmax (type I and II, 9.47 ± 0.54 and 12.97 ± 0.70, respectively, Mann-Whitney test, p = 0.0003). However, no significant change in SUVmax was observed between BRCA-positive and BRCA-negative patients (N = 80, 13.8 ± 5.78 and 12.4 ± 6.30, Student's t-test, p = 0.3075). Among clinicopathologic and metabolic parameters, type of ovarian cancer, MTV and CA125 were significant factors in the prediction of recurrence. CONCLUSIONS The glycolytic phenotype was related to tumour grade and histological subtype, with significant differences between type I and II ovarian cancer. SUVmax of the ovarian cancer would be considered in the differentiation of type I and II ovarian cancer.
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An H, Chiu KWH, Tse KY, Ngan HYS, Khong PL, Lee EYP. The Value of Contrast-Enhanced CT in the Detection of Residual Disease After Neo-Adjuvant Chemotherapy in Ovarian Cancer. Acad Radiol 2020; 27:951-957. [PMID: 31629627 DOI: 10.1016/j.acra.2019.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/01/2019] [Accepted: 09/10/2019] [Indexed: 12/22/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the diagnostic performance of contrast-enhanced computed tomography (CT) in predicting residual disease following neo-adjuvant chemotherapy (NACT) in stage III/IV ovarian cancer. MATERIALS AND METHODS This was a retrospective observational cohort study including consecutive patients with primary stage III/IV ovarian cancer who received NACT before interval debulking surgery. CT findings before interval debulking surgerywere correlated with histological/surgical findings. Diagnostic characteristics were calculated on patient-based and lesion-based analyses. False negative results on peritoneal carcinomatosis detection were correlated with lesion size and site. RESULTS On patient-based analysis, CT (n = 58) had a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 92.16%, 57.14%, 94.00%, 50.00%, and 87.93%. On lesion-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 63.01%, 73.47%, 82.51%, 50.00%, and 66.51%. False negative results were associated with lesion size (p < 0.001). The diagnostic performance of CT on the detection of peritoneal carcinomatosis was low at the subdiaphragmatic spaces, bowel serosa and mesentery (p < 0.001). CONCLUSION CT had low negative predictive value in determining residual disease following NACT on both patient-based and lesion-based analyses, especially for non-measurable lesions and at the subdiaphragmatic spaces, bowel serosa and mesentery.
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Affiliation(s)
- He An
- Department of Diagnostic Radiology, Queen Mary Hospital, University of Hong Kong, Room 406, Block K, Pok Fu Lam Road, Hong Kong
| | - Keith W H Chiu
- Department of Diagnostic Radiology, Queen Mary Hospital, University of Hong Kong, Room 406, Block K, Pok Fu Lam Road, Hong Kong
| | - K Y Tse
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Hextan Y S Ngan
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Pek-Lan Khong
- Department of Diagnostic Radiology, Queen Mary Hospital, University of Hong Kong, Room 406, Block K, Pok Fu Lam Road, Hong Kong
| | - Elaine Y P Lee
- Department of Diagnostic Radiology, Queen Mary Hospital, University of Hong Kong, Room 406, Block K, Pok Fu Lam Road, Hong Kong.
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29
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Abstract
OBJECTIVE. This article discusses the emerging roles of 18F-FDG PET/CT and DWI in the assessment of peritoneal carcinomatosis in ovarian carcinoma from diagnostic accuracy to disease prognostication with gross pathologic correlation. CONCLUSION. PET/CT and DWI have incremental clinical values over conventional modalities with high predictive values of incomplete cytoreduction in ovarian carcinoma. The respective quantitative metrics offer evaluation of tumor burden with prognostic value in ovarian carcinoma.
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30
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Tsoi TT, Chiu KWH, Chu MY, Ngan HYS, Lee EYP. Metabolic active peritoneal sites affect tumor debulking in ovarian and peritoneal cancers. J Ovarian Res 2020; 13:61. [PMID: 32434520 PMCID: PMC7238625 DOI: 10.1186/s13048-020-00662-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 05/07/2020] [Indexed: 12/02/2022] Open
Abstract
Rationale and objectives To evaluate the impact of metabolic parameters in the peritoneal cavity on the likelihood of achieving complete tumor debulking in patients with ovarian and peritoneal cancers. Materials and methods Forty-nine patients with ovarian and peritoneal cancers were included, who underwent pre-operative 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT). The immediate surgical outcome was dichotomized into complete and incomplete tumor debulking. 18F-FDG PET/CT was qualitatively and quantitatively assessed by scrutinizing 15 anatomical sites for the presence of peritoneal carcinomatosis (PC). Patient-based and site-based diagnostic characteristics were described. Metabolic parameters (SUVmax, metabolic tumor volume and total lesion glycolysis) and the number of 18F-FDG avid peritoneal sites were evaluated between the two groups. Receiver operating curve (ROC) analysis was performed to determine the optimal cut-off value in predicting incomplete tumor debulking. Results Twenty-seven out of the 49 patients had PC and 11 had incomplete debulking. Patient-based and site-based accuracies for detection of PC were 87.8 and 97.6%, respectively. The number of 18F-FDG avid peritoneal sites was significantly different between complete and incomplete debulking groups (0.6 ± 0.8 versus 2.3 ± 1.7 sites respectively, p = 0.001), and the only independent significant risk factor among other metabolic parameters tested (odd ratio = 2.983, 95% CI 1.104–8.062) for incomplete tumor debulking with an optimal cut-off value of ≥4 (AUC = 0.816). Conclusion The number of 18F-FDG avid peritoneal sites increased the risk of incomplete tumor debulking after surgery and potentially useful in assisting treatment stratification in patients with ovarian and peritoneal cancers.
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Affiliation(s)
- Tung Tung Tsoi
- Department of Diagnostic Radiology, Queen Mary Hospital, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Pokfulam Road, Hong Kong, Hong Kong
| | - Keith W H Chiu
- Department of Diagnostic Radiology, Queen Mary Hospital, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Pokfulam Road, Hong Kong, Hong Kong
| | - M Y Chu
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, 6/F, Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong, Hong Kong
| | - Hextan Y S Ngan
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, 6/F, Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong, Hong Kong
| | - Elaine Y P Lee
- Department of Diagnostic Radiology, Queen Mary Hospital, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Pokfulam Road, Hong Kong, Hong Kong.
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31
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Gu B, Xia L, Ge H, Liu S. Preoperative PET/CT score can predict complete resection in advanced epithelial ovarian cancer: a prospective study. Quant Imaging Med Surg 2020; 10:743-753. [PMID: 32269933 DOI: 10.21037/qims.2020.02.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background To assess the ability of preoperative positron emission tomography/computed tomography (PET/CT) scans to predict postoperative residual disease in advanced epithelial ovarian cancer (AEOC). Methods Thirty-one women with suspected AEOC were enrolled in our prospective study before surgery from July 2016 to December 2017. Complete resection was determined as no residual disease (R0) after surgery. A PET/CT scan was obtained within 2 weeks before surgery in our hospital. The PET score was the sum of each score of the radiological criteria from Suidan's model. The correlations between the PET score and tumor burden and surgical complexity were evaluated by Pearson correlation analysis. T-test or Fisher's exact test was used to compare differences in the variables between the complete and incomplete resection groups. Receiver operating characteristic (ROC) curve analysis was performed to assess the accuracy of the PET score for predicting complete postoperative resection. Results The median [range] of PET score was 2 [0-8], and the PET score in 20 (65%) patients was less than 3. Complete resection was achieved in 11 (35.5%) patients after surgery, including 10 (90.91%) with low PET scores and only 1 (9.09%) with a high score. The PET score had a significant positive correlation with tumor burden [Eisenkop: r=0.603, P<0.001; peritoneal cancer index (PCI): r=0.522, P=0.003] but not with surgery complexity (Aletti: r=0.291, P=0.113). Patients with lower PET scores (P=0.046) and tumor burdens (Eisenkop: P=0.013; PCI: P=0.012) had higher rates of complete resection. The PET score and tumor burden were effective for predicting complete resection. The AUCPET, AUCEisenkop, and AUCPCI were 0.797 (95% CI: 0.633-0.961, P=0.01), 0.847 (95% CI: 0.707-0.988, P=0.003), and 0.811 (95% CI: 0.653-0.969, P=0.007), respectively. However, surgery complexity was not useful for assessing complete resection. Conclusions The preoperative PET score can noninvasively reflect tumor burden and helps predict complete resection after surgery in AEOC patients.
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Affiliation(s)
- Bingxin Gu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Center for Biomedical Imaging, Fudan University, Shanghai 200032, China.,Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai 200032, China
| | - Lingfang Xia
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Huijuan Ge
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Shuai Liu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Center for Biomedical Imaging, Fudan University, Shanghai 200032, China.,Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai 200032, China
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32
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Diagnostic performance of imaging for the detection of peritoneal metastases: a meta-analysis. Eur Radiol 2020; 30:3101-3112. [DOI: 10.1007/s00330-019-06524-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/27/2019] [Accepted: 10/17/2019] [Indexed: 02/06/2023]
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33
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Bae H, Jung DC, Lee JY, Nam EJ, Kang WJ, Oh YT. Patterns of initially overlooked recurrence of peritoneal lesions in patients with advanced ovarian cancer on postoperative multi-detector row CT. Acta Radiol 2019; 60:1713-1720. [PMID: 31081339 DOI: 10.1177/0284185119842832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Heejin Bae
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Chul Jung
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Yun Lee
- Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Jun Kang
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Taik Oh
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
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34
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Kemppainen J, Hynninen J, Virtanen J, Seppänen M. PET/CT for Evaluation of Ovarian Cancer. Semin Nucl Med 2019; 49:484-492. [DOI: 10.1053/j.semnuclmed.2019.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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35
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Han S, Woo S, Suh CH, Lee JJ. Performance of pre-treatment ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography for detecting metastasis in ovarian cancer: a systematic review and meta-analysis. J Gynecol Oncol 2019; 29:e98. [PMID: 30207106 PMCID: PMC6189439 DOI: 10.3802/jgo.2018.29.e98] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 08/07/2018] [Accepted: 08/20/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE We describe a systematic review and meta-analysis of the performance of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) for detecting metastasis in ovarian cancer. METHODS MEDLINE and Embase were searched for diagnostic accuracy studies that used ¹⁸F-FDG PET or PET/CT for pre-treatment staging, using surgical findings as the reference standard. Sensitivities and specificities were pooled and plotted in a hierarchic summary receiver operating characteristic plot. Potential causes of heterogeneity were explored through sensitivity analyses. RESULTS Eight studies with 594 patients were included. The overall pooled sensitivity and specificity for metastasis were 0.72 (95% confidence interval [CI]=0.61-0.81) and 0.93 (95% CI=0.85-0.97), respectively. There was considerable heterogeneity in sensitivity (I²=97.57%) and specificity (I²=96.74%). In sensitivity analyses, studies that used laparotomy as the reference standard showed significantly higher sensitivity and specificity (0.77; 95% CI=0.67-0.87 and 0.96; 95% CI=0.92-0.99, respectively) than those including diagnostic laparoscopy (0.62; 95% CI=0.46-0.77 and 0.84; 95% CI=0.69-0.99, respectively). Higher specificity was shown in studies that confirmed surgical findings by pathologic evaluation (0.95; 95% CI=0.90-0.99) than in a study without pathologic confirmation (0.69; 95% CI=0.24-1.00). Studies with a lower prevalence of the FDG-avid subtype showed higher specificity (0.97; 95% CI=0.94-1.00) than those with a greater prevalence (0.89; 95% CI=0.80-0.97). CONCLUSION Pre-treatment ¹⁸F-FDG PET/CT shows moderate sensitivity and high specificity for detecting metastasis in ovarian cancer. With its low false-positive rate, it can help select surgical approaches or alternative treatment options.
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Affiliation(s)
- Sangwon Han
- Meta-analysis for Imaging studies on Diagnostic Accuracy and prognosiS (MIDAS) group.,Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungmin Woo
- Meta-analysis for Imaging studies on Diagnostic Accuracy and prognosiS (MIDAS) group.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Chong Hyun Suh
- Meta-analysis for Imaging studies on Diagnostic Accuracy and prognosiS (MIDAS) group.,Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Jin Lee
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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36
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Hacker NF. Neoadjuvant chemotherapy for advanced epithelial ovarian cancer. Who really benefits? Aust N Z J Obstet Gynaecol 2019; 57:585-587. [PMID: 29210052 DOI: 10.1111/ajo.12737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Neville F Hacker
- Gynaecological Cancer Centre, Royal Hospital for Women, University of New South Wales, Sydney, Australia
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37
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Esteves FP, Amorim BJ, Martello M, Matushita CS, Gomes GDV, Brito AET, Bernardo WM. Relapsed ovarian cancer - diagnosis using 18F-FDG PET/CT; 4. Rev Assoc Med Bras (1992) 2019; 65:509-517. [DOI: 10.1590/1806-9282.65.4.509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2018] [Indexed: 11/22/2022] Open
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Kang SK, Reinhold C, Atri M, Benson CB, Bhosale PR, Jhingran A, Lakhman Y, Maturen KE, Nicola R, Pandharipande PV, Salazar GM, Shipp TD, Simpson L, Small W, Sussman BL, Uyeda JW, Wall DJ, Whitcomb BP, Zelop CM, Glanc P. ACR Appropriateness Criteria ® Staging and Follow-Up of Ovarian Cancer. J Am Coll Radiol 2019; 15:S198-S207. [PMID: 29724422 DOI: 10.1016/j.jacr.2018.03.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/12/2022]
Abstract
In the management of epithelial ovarian cancers, imaging is used for cancer detection and staging, both before and after initial treatment. The decision of whether to pursue initial cytoreductive surgery for ovarian cancer depends in part on accurate staging. Contrast-enhanced CT of the abdomen and pelvis (and chest where indicated) is the current imaging modality of choice for the initial staging evaluation of ovarian cancer. Fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT and MRI may be appropriate for problem-solving purposes, particularly when lesions are present on CT but considered indeterminate. In patients who achieve remission, clinical suspicion for relapse after treatment prompts imaging evaluation for recurrence. Contrast-enhanced CT is the modality of choice to assess the extent of recurrent disease, and fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT is also usually appropriate, as small metastatic foci may be identified. If imaging or clinical examination confirms a recurrence, the extent of disease and timing of disease recurrence then determines the choice of treatments, including surgery, chemotherapy, and radiation therapy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Stella K Kang
- Principal Author, New York University Medical Center, New York, New York.
| | | | - Mostafa Atri
- Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | - Anuja Jhingran
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yulia Lakhman
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Refky Nicola
- State University of New York Upstate Medical University, Syracuse, New York
| | | | | | - Thomas D Shipp
- Brigham & Women's Hospital, Boston, Massachusetts; American Congress of Obstetricians and Gynecologists
| | - Lynn Simpson
- Columbia University, New York, New York; American Congress of Obstetricians and Gynecologists
| | - William Small
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois
| | - Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont
| | | | | | - Bradford P Whitcomb
- Tripler Army Medical Center, Honolulu, Hawaii; Society of Gynecologic Oncology
| | - Carolyn M Zelop
- Valley Hospital, Ridgewood, New Jersey, and NYU School of Medicine, New York, New York; American Congress of Obstetricians and Gynecologists
| | - Phyllis Glanc
- Specialty Chair, Sunnybrook Health Sciences Centre Bayview Campus, Toronto, Ontario, Canada
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Low RN, Barone RM, Rousset P. Peritoneal MRI in patients undergoing cytoreductive surgery and HIPEC: History, clinical applications, and implementation. Eur J Surg Oncol 2019; 47:65-74. [PMID: 30852063 DOI: 10.1016/j.ejso.2019.02.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/15/2019] [Accepted: 02/22/2019] [Indexed: 11/26/2022] Open
Abstract
MR imaging provides considerable advantages in the evaluation of patients with peritoneal metastases. A standardized peritoneal MRI protocol, including diffusion-weighted and gadolinium-enhanced sequences, allows an efficient exploration of small peritoneal tumors that are often missed on other imaging tests. In experienced hands, a dedicated reading allows producing a quantitative and qualitative evaluation of lesional localization to better assist surgeons in the selection of candidates for curative surgery by evaluating the possibility of complete resection, and to plan the surgical procedure. Based on a close collaboration between oncologic surgeon and radiologist, MRI provides a powerful tool for accurate preoperative imaging in patients being considered for curative surgery but also in their surveillance to detect an early recurrence.
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Affiliation(s)
- Russell N Low
- Department of Radiology, Sharp Memorial Hospital, 7901 Frost Street, San Diego, CA, 92123, USA.
| | - Robert M Barone
- Department of Surgical Oncology, Sharp Memorial Hospital, 7901 Frost Street, San Diego, CA, 92123, USA.
| | - Pascal Rousset
- Department of Radiology, Centre Hospitalier Lyon Sud, HCL, EMR 3738, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France; Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France.
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Alcázar JL, Caparros M, Arraiza M, Mínguez JÁ, Guerriero S, Chiva L, Jurado M. Pre-operative assessment of intra-abdominal disease spread in epithelial ovarian cancer: a comparative study between ultrasound and computed tomography. Int J Gynecol Cancer 2019; 29:227-233. [DOI: 10.1136/ijgc-2018-000066] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 01/13/2023] Open
Abstract
ObjectiveTo compare the diagnostic performance of ultrasound and computed tomography (CT) for detecting pelvic and abdominal tumor spread in women with epithelial ovarian cancer.MethodsAn observational cohort study of 93 patients (mean age 57.6 years) with an ultrasound diagnosis of adnexal mass suspected of malignancy and confirmed histologically as epithelial ovarian cancer was undertaken. In all cases, transvaginal and transabdominal ultrasound as well as CT scans were performed to assess the extent of the disease within the pelvis and abdomen prior to surgery. The exploration was systematic, analyzing 12 anatomical areas. All patients underwent surgical staging and/or cytoreductive surgery with an initial laparoscopy for assessing resectability. The surgical and pathological findings were considered as the 'reference standard'. Sensitivity and specificity of ultrasound and CT scanning were calculated for the different anatomical areas and compared using the McNemar test. Agreement between ultrasound and CT staging and the surgical stage was estimated using the weighted kappa index.ResultsThe tumorous stage was International Federation of Gynecology and Obstetrics (FIGO) stage I in 26 cases, stage II in 11 cases, stage III in 47 cases, and stage IV in nine cases. Excluding stages I and IIA cases (n=30), R0 (no macroscopic residual disease) was achieved in 36 women (62.2%), R1 (macroscopic residual disease <1 cm) was achieved in 13 women (25.0%), and R2 (macroscopic residual disease >1 cm) debulking surgery occurred in three women (5.8%). Eleven patients (11.8%) were considered not suitable for optimal debulking surgery during laparoscopic assessment. Overall sensitivity of ultrasound and CT for detecting disease was 70.3% and 60.1%, respectively, and specificity was 97.8% and 93.7%, respectively. The agreement between radiological stage and surgical stage for ultrasound (kappa index 0.69) and CT (kappa index 0.70) was good for both techniques. Overall accuracy to determine tumor stage was 71% for ultrasound and 75% for CT.ConclusionDetailed ultrasound examination renders a similar diagnostic performance to CT for assessing pelvic/abdominal tumor spread in women with epithelial ovarian cancer.
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Abstract
MRI provides considerable advantages for imaging of patients with peritoneal tumor. Its inherently superior contrast resolution compared with computed tomography allows MRI to more accurately depict small peritoneal tumors that are often missed on other imaging tests. Combining different contrast mechanisms, including diffusion-weighted MRI and gadolinium-enhanced MRI, provides a powerful tool for preoperative and surveillance imaging in patients being considered for cytoreductive surgery and heated intraperitoneal chemotherapy.
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Affiliation(s)
- Russell N Low
- Department of Radiology, Sharp Memorial Hospital, 7901 Frost Street, San Diego, CA 92123, USA.
| | - Robert M Barone
- Department of Surgical Oncology, Sharp Memorial Hospital, 7901 Frost Street, San Diego, CA 92123, USA
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Concordance of a laparoscopic scoring algorithm with primary surgery findings in advanced stage ovarian cancer. Gynecol Oncol 2018; 151:428-432. [PMID: 30366647 DOI: 10.1016/j.ygyno.2018.10.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/11/2018] [Accepted: 10/16/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To determine the concordance between the laparoscopic scoring assessment and extent of disease identified at primary tumor reductive surgery (TRS) in patients with advanced ovarian cancer. METHODS From April 2013 to June 2017, we prospectively triaged patients with stage IIA to IVB ovarian cancer to laparoscopic scoring assessment. A validated predictive index value (PIV) score (range: 0-14) was assigned. Patients with PIV scores <8 were offered primary surgery and those with score ≥8 received NACT. Patients who underwent primary TRS had a second PIV score based on laparotomy findings. Concordance percentages were calculated between the two scores. Positive predictive value (PPV) was calculated to reflect the performance of the laparoscopic PIV score to predict R0 (complete gross resection) at TRS. RESULTS 226 patients underwent laparoscopic scoring assessment, of which 139 (61.5%) had a PIV score <8 and 81 (35.8%) had a PIV score ≥8. 6 patients (2.7%) were unscoreable. There was 96% overall concordance between PIV scores at laparoscopy and primary TRS. Concordance scores by location were: bowel infiltration 74.7%, mesenteric disease 84.6%, liver surface involvement 86.5%, omental disease 89.7%, diaphragm disease 92.9%, stomach infiltration 94.7%, peritoneal carcinomatosis 94.8%. A laparoscopic PIV score of <8 had a PPV of 85.4% at predicting R0 at primary TRS. CONCLUSIONS Laparoscopic assessment of tumor burden is a feasible tool to predict R0 cytoreduction in patients with advanced ovarian cancer. Concordance between PIV scores at laparoscopy and primary TRS varied by anatomic location, with the lowest concordance seen in predicting bowel infiltration.
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Roze JF, Hoogendam JP, van de Wetering FT, Spijker R, Verleye L, Vlayen J, Veldhuis WB, Scholten RJPM, Zweemer RP. Positron emission tomography (PET) and magnetic resonance imaging (MRI) for assessing tumour resectability in advanced epithelial ovarian/fallopian tube/primary peritoneal cancer. Cochrane Database Syst Rev 2018; 10:CD012567. [PMID: 30298516 PMCID: PMC6517226 DOI: 10.1002/14651858.cd012567.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Ovarian cancer is the leading cause of death from gynaecological cancer in developed countries. Surgery and chemotherapy are considered its mainstay of treatment and the completeness of surgery is a major prognostic factor for survival in these women. Currently, computed tomography (CT) is used to preoperatively assess tumour resectability. If considered feasible, women will be scheduled for primary debulking surgery (i.e. surgical efforts to remove the bulk of tumour with the aim of leaving no visible (macroscopic) tumour). If primary debulking is not considered feasible (i.e. the tumour load is too extensive), women will receive neoadjuvant chemotherapy to reduce tumour load and subsequently undergo (interval) surgery. However, CT is imperfect in assessing tumour resectability, so additional imaging modalities can be considered to optimise treatment selection. OBJECTIVES To assess the diagnostic accuracy of fluorodeoxyglucose-18 (FDG) PET/CT, conventional and diffusion-weighted (DW) MRI as replacement or add-on to abdominal CT, for assessing tumour resectability at primary debulking surgery in women with stage III to IV epithelial ovarian/fallopian tube/primary peritoneal cancer. SEARCH METHODS We searched MEDLINE and Embase (OVID) for potential eligible studies (1946 to 23 February 2017). Additionally, ClinicalTrials.gov, WHO-ICTRP and the reference list of all relevant studies were searched. SELECTION CRITERIA Diagnostic accuracy studies addressing the accuracy of preoperative FDG-PET/CT, conventional or DW-MRI on assessing tumour resectability in women with advanced stage (III to IV) epithelial ovarian/fallopian tube/primary peritoneal cancer who are scheduled to undergo primary debulking surgery. DATA COLLECTION AND ANALYSIS Two authors independently screened titles and abstracts for relevance and inclusion, extracted data and performed methodological quality assessment using QUADAS-2. The limited number of studies did not permit meta-analyses. MAIN RESULTS Five studies (544 participants) were included in the analysis. All studies performed the index test as replacement of abdominal CT. Two studies (366 participants) addressed the accuracy of FDG-PET/CT for assessing incomplete debulking with residual disease of any size (> 0 cm) with sensitivities of 1.0 (95% CI 0.54 to 1.0) and 0.66 (95% CI 0.60 to 0.73) and specificities of 1.0 (95% CI 0.80 to 1.0) and 0.88 (95% CI 0.80 to 0.93), respectively (low- and moderate-certainty evidence). Three studies (178 participants) investigated MRI for different target conditions, of which two investigated DW-MRI and one conventional MRI. The first study showed that DW-MRI determines incomplete debulking with residual disease of any size with a sensitivity of 0.94 (95% CI 0.83 to 0.99) and a specificity of 0.98 (95% CI 0.88 to 1.00) (low- and moderate-certainty evidence). For abdominal CT, the sensitivity for assessing incomplete debulking was 0.66 (95% CI 0.52 to 0.78) and the specificity 0.77 (95% CI 0.63 to 0.87) (low- and low-certainty evidence). The second study reported a sensitivity of DW-MRI of 0.75 (95% CI 0.35 to 0.97) and a specificity of 0.96 (95% CI 0.80 to 1.00) (very low-certainty evidence) for assessing incomplete debulking with residual disease > 1 cm. In the last study, the sensitivity for assessing incomplete debulking with residual disease of > 2 cm on conventional MRI was 0.91 (95% CI 0.59 to 1.00) and the specificity 0.97 (95% CI 0.87 to 1.00) (very low-certainty evidence). Overall, the certainty of evidence was very low to moderate (according to GRADE), mainly due to small sample sizes and imprecision. AUTHORS' CONCLUSIONS Studies suggested a high specificity and moderate sensitivity for FDG-PET/CT and MRI to assess macroscopic incomplete debulking. However, the certainty of the evidence was insufficient to advise routine addition of FDG-PET/CT or MRI to clinical practice..In a research setting, adding an alternative imaging method could be considered for women identified as suitable for primary debulking by abdominal CT, in an attempt to filter out false-negatives (i.e. debulking, feasible based on abdominal CT, unfeasible at actual surgery).
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Affiliation(s)
- Joline F Roze
- UMC Utrecht Cancer CenterDepartment of Gynaecological OncologyUtrechtNetherlands3508 GA
| | - Jacob P Hoogendam
- UMC Utrecht Cancer CenterDepartment of Gynaecological OncologyUtrechtNetherlands3508 GA
| | - Fleur T van de Wetering
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityCochrane NetherlandsPO Box 85500UtrechtNetherlands3508 GA
| | - René Spijker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityCochrane NetherlandsPO Box 85500UtrechtNetherlands3508 GA
| | - Leen Verleye
- Belgian Health Care Knowledge CentreKruidtuinlaan 55BrusselsBelgium1000
| | - Joan Vlayen
- Belgian Health Care Knowledge CentreKruidtuinlaan 55BrusselsBelgium1000
| | - Wouter B Veldhuis
- University Medical Center UtrechtDepartment of RadiologyRoom E01.132PO Box 85500UtrechtNetherlands3508 GA
| | - Rob JPM Scholten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityCochrane NetherlandsPO Box 85500UtrechtNetherlands3508 GA
| | - Ronald P Zweemer
- UMC Utrecht Cancer CenterDepartment of Gynaecological OncologyUtrechtNetherlands3508 GA
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Preoperative omental metastasis-related maximum standardized fluorine-18-fluorodeoxyglucose uptake value can predict chemosensitivity and recurrence in advanced high-grade serous ovarian cancer patients. Nucl Med Commun 2018; 39:761-767. [PMID: 30001265 DOI: 10.1097/mnm.0000000000000865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to explore the clinical and prognostic implication of preoperative fluorine-18-fluorodeoxyglucose uptake value of omental metastasis-related in advanced high-grade serous ovarian cancer patients (HGSC). PATIENTS AND METHODS We retrospectively investigated HGSC patients with omental metastasis (International Federation of Gynecology and Obstetrics stage IIIB-IV) who underwent PET/CT before primary surgery in our hospital between January 2010 and January 2016. All patients were confirmed omental metastasis by postoperative pathology. None of these patients received neoadjuvant chemotherapy. PET/CT parameters, including maximum standardized uptake value of primary ovary tumor (SUVp), omental metastasis (SUVo), and omental metastasis-to-primary tumor (SUVo/p) were measured. The relationships between PET/CT parameters and clinical characteristics were analyzed by t-test. Kaplan-Meier methods and log-rank tests were used to analyze progression-free survival (PFS) in univariate analysis. For multivariate analysis, COX regression analysis was used to assess the prognostic predictive value of PET/CT-derived variables. RESULTS Totally 81 advanced HGSC patients with omental metastasis were enrolled in our study, and 49 (60.5%) patients experienced recurrence and disease progression. The median (range) follow-up time was 18.5 (7-72) months. Older patients showed higher level of SUVo/p (P=0.006). Chemosensitive patients had lower levels of SUVo (P=0.009) and SUVo/p (P<0.001) than those chemoresistant ones. In univariate analysis, patients with better PFS were associated with lower SUVo (P<0.001) and SUVo/p (P<0.001). Multivariate analysis found only SUVo/p was an independent factor for PFS (P=0.006). CONCLUSION Preoperative SUVo/p measured by fluorine-18-fluorodeoxyglucose PET/CT appeared to be an independent predictive factor for recurrence in advanced HGSC patients. Chemosensitive patients had lower omentum-related SUV values than those chemoresistant ones.
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Tumor-to-background ratios of the maximum standardized uptake value could not indicate the prognosis of advanced high-grade serous ovarian cancer patients. Nucl Med Commun 2018. [PMID: 29533344 DOI: 10.1097/mnm.0000000000000798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our study aimed to explore the prognostic influence of tumor-to-background ratios (TBRs) of the maximum standardized uptake value (SUVmax) in advanced high-grade serous ovarian cancer (HGSC) patients. PATIENTS AND METHODS We retrospectively investigated 51 advanced HGSC patients who underwent PET/CT before primary surgery at our hospital between January 2010 and June 2015. None of these patients received neoadjuvant chemotherapy. SUVmax of ovarian tumor (SUVmax-P) and background (SUVmax-B) were measured using a PET/CT workstation. TBR was calculated by SUVmax-P/SUVmax-B. Backgrounds included the liver, mediastinum, and muscle, and TBRs were noted as TBR-L, TBR-Me, and TBR-Mu, respectively. The χ-test was used to analyze the relationships between PET/CT parameters and several clinical features. Progression-free survival and overall survival were analyzed using the Kaplan-Meier method and log-rank tests in univariate analyses. RESULTS The median (range) follow-up duration was 27 (8-61) months. The median (range) PET/CT parameter values were as follows: SUVmax, 11.41 (3.24-24.14), TBR-L, 2.84 (2.08-11.93), TBL-Me, 2.09 (1.33-9.07), and TBR-Mu, 1.04 (0.56-14.02). The patients were categorized into low and high groups by the median values of these parameters above separately. A larger proportion of patients in the high TBR-Me group were chemoresistant compared with the low-value group (P=0.039). Neither the residual disease nor the ascites levels correlated with SUVmax or TBR values. There were no differences in progression-free survival and overall survival between the patients in the high and low TBR level groups. CONCLUSION TBRs of SUVmax were not prognostic indicators for advanced HGSC patients.
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Hynninen J, Laasik M, Vallius T, Kemppainen J, Grönroos S, Virtanen J, Casado J, Hautaniemi S, Grenman S, Seppänen M, Auranen A. Clinical Value of 18 F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Response Evaluation after Primary Treatment of Advanced Epithelial Ovarian Cancer. Clin Oncol (R Coll Radiol) 2018; 30:507-514. [DOI: 10.1016/j.clon.2018.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/09/2018] [Indexed: 01/08/2023]
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Anastasi E, Gigli S, Ballesio L, Angeloni A, Manganaro L. The Complementary Role of Imaging and Tumor Biomarkers
in Gynecological Cancers: An Update of the Literature. Asian Pac J Cancer Prev 2018; 19:309-317. [PMID: 29479951 PMCID: PMC5980913 DOI: 10.22034/apjcp.2018.19.2.309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Gynecological tumors, including endometrial, cervical and ovarian cancer, have increased in incidence over time. The widespread introduction of screening programs and advances in diagnostic imaging methods has lead to a progressive increase in gynecological cancer detection. Accurate diagnosis and proper monitoring of disease remain the primary target for a successful treatment. In the last years, knowledge about cancer biomarkers has considerably increased providing great opportunities for improving cancer detection and treatment. In addition, in the last few years there has been an important development of imaging techniques. Nowadays, a multimodal approach including the evaluation of serum tumor biomarkers combined with imaging techniques, seems to be the best strategy for assessing tumor presence, spread, recurrence, and/or the response to treatment in female cancer patients In this review we provide an overview of the application of biomarkers combined with novel imaging methods and highlight their roles in female cancer diagnosis and follow-up.
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Affiliation(s)
- Emanuela Anastasi
- Department of Molecular Medicine, Sapienza University, Viale Regina Elena 324, 00161 Roma, Italy.
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Marzola MC, Chondrogiannis S, Rubello D. Fludeoxyglucose F 18 PET/CT Assessment of Ovarian Cancer. PET Clin 2018; 13:179-202. [PMID: 29482749 DOI: 10.1016/j.cpet.2017.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ovarian cancer is one of the most common gynecologic cancers and one of the leading causes of cancer death in women. It is often asymptomatic in early stages, and thus most patients are diagnosed when it is of advanced stage. For these reasons, the role of biomarkers and tomographic imaging is crucial. Fludeoxyglucose F 18 PET/CT is a useful imaging modality in different clinical settings of the disease, overcoming some limits of conventional imaging and influencing prognosis and therapeutic approaches. PET/MR imaging is an emerging modality, and its potential role remains to be explored.
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Affiliation(s)
- Maria Cristina Marzola
- Department of Nuclear Medicine PET/CT Centre, S. Maria della Misericordia Hospital, Viale 3 Martiri, 140, Rovigo 45100, Italy.
| | - Sotirios Chondrogiannis
- Department of Nuclear Medicine PET/CT Centre, S. Maria della Misericordia Hospital, Viale 3 Martiri, 140, Rovigo 45100, Italy
| | - Domenico Rubello
- Department of Nuclear Medicine PET/CT Centre, S. Maria della Misericordia Hospital, Viale 3 Martiri, 140, Rovigo 45100, Italy
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Surgery for patients with newly diagnosed advanced ovarian cancer: which patient, when and extent? Curr Opin Oncol 2017; 29:351-358. [PMID: 28614136 DOI: 10.1097/cco.0000000000000387] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Cytoreduction to no residual disease is the mainstay of primary treatment for advanced epithelial ovarian cancer (AdvEOC). This review addresses recent insights on optimal patient selection, timing, and extent of surgery, intended to optimize cytoreduction in patients with AdvEOC. RECENT FINDINGS Clinical guidelines recommend primary cytoreductive surgery (PCS) for AdvEOC patients with a high likelihood of achieving complete cytoreduction with acceptable morbidity. In line with this, preoperative prediction markers such as cancer antigen-125, histologic and genomic factors, innovative imaging modalities, and the performance of a diagnostic laparoscopy have been suggested to improve clinical decision-making with regard to optimal timing of cytoreductive surgery. To determine whether these strategies should be incorporated into clinical practice validation in randomized clinical trials is essential. SUMMARY The past decade has seen a paradigm shift in the number of AvdEOC patients that are being treated with upfront neoadjuvant chemotherapy instead of PCS. However, although neoadjuvant chemotherapy may reduce morbidity at the time of interval cytoreductive surgery, no favorable impact on survival has been demonstrated and it may induce resistance to chemotherapy. Therefore, optimizing patient selection for PCS is crucial. Furthermore, surgical innovations in patients diagnosed with AvdEOC should focus on improving survival outcomes.
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Abstract
[fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG PET CT) has increasing clinical applications supplementing conventional TVUS, CT and MRI imaging in assessing ovarian, cervical and endometrial cancer. The published literature on the applications of 18F-FDG PET CT shows its use can have significant impact on patient management by improving staging of the cancers, influencing patient selection for treatment and in detecting early recurrent disease. However, the increasing clinical use of PET CT does not always align with the guidelines, recommendations or expert opinion in the use of PET CT. This article summarizes the existing evidence base for the established clinical applications and the emerging roles for 18F-FDG PET CT in the common gynaecological malignancies.
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Affiliation(s)
- Priya Narayanan
- 1 Department of Imaging, University College Hospital NHS Trust, London, UK
| | - Anju Sahdev
- 2 Department of Imaging, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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