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Nuclear Medicine |
1 From the School of Medicine, University of Milano-Bicocca, Milan, Italy (S.S., C.M., B.Z., F.F.); Institute for Molecular Imaging and Physiology of the National Research Council of Italy, Milan (S.S., C.M., F.F.); and Departments of Nuclear Medicine (C.M., M.P., F.F.), Gynecology and Obstetrics (G.M., G.A., E.G., R.V.), Pathology (G.T.), and Radiology, University Vita-Salute (A.D.M.), Institute H S.Raffaele, Via Olgettina 60, 20132 Milan, Italy. Received November 7, 2003; revision requested January 15, 2004; revision received February 4; accepted March 2. Address correspondence to F.F. (e-mail: fazio.ferruccio@hsr.it).
PURPOSE: To prospectively evaluate the accuracy of integrated positron emission tomography (PET) and computed tomography (CT) for depiction of persistent ovarian carcinoma after first-line treatment, with use of histologic findings as the reference standard.
MATERIALS AND METHODS: Thirty-one women (mean age, 55.9 years) with ovarian carcinoma treated with primary cytoreductive surgery and followed up with platinum regimen chemotherapy were included. All 31 patients were scheduled for surgical second-look. Before surgical second-look, all patients underwent fluorodeoxyglucose (FDG) PET/CT. At PET/CT, three main categories of persistent disease were considered for data analysis: lymph nodal lesion, peritoneal lesion, and pelvic lesion. In all patients, imaging findings were compared with results of histologic examination after surgical second-look to determine the diagnostic accuracy of PET/CT in the evaluation of disease status. The 
statistic (Cohen ) was used for statistical analysis.
RESULTS: Seventeen (55%) of 31 patients had persistent tumor at histologic analysis after surgical second-look, and fourteen (45%) had no histologically proved tumor. The total number of lesions that was positive for tumor cells at histologic analysis was 41 (lymph nodes, n = 16; peritoneal lesions, n = 21; pelvic lesions, n = 4); maximum diameter of these lesions was 0.3–3.2 cm (mean, 1.7 cm). A correlation was found between PET/CT and histologic analysis ( = 0.48). The overall lesion-based sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT were 78%, 75%, 77%, 89% and 57%, respectively. In the detection of a tumor, a size threshold could be set at 0.5 cm, as this was the largest diameter of a lesion missed at PET/CT.
CONCLUSION: Integrated PET/CT depicts persistent ovarian carcinoma with a high positive predictive value.
© RSNA, 2004
Index terms: Computed tomography (CT), comparative studies, 852.12111 • Dual-modality imaging, PET/CT, comparative studies • Positron emission tomography (PET), comparative studies, 852.12163 • Ovary, CT, 852.12111 • Ovary, neoplasms, 852.39 • Ovary, PET, 852.12163 • Ovary, radionuclide studies, 852.12163
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