Elevated CA 125 serum levels and epithelial ovarian cancer metastatic to retroperitoneal lymph nodes

Elevations in CA 125 levels have been reported in approximately 80% of patients with epithelial ovarian cancer. Studies demonstrate that elevations of CA 125 at the time of second-look procedures correlate with the presence of tumor in 100% of cases. Two cases are reported with elevated CA 125 in which clinical examination and noninvasive studies with CAT scans failed to demonstrate tumor. In both cases laparotomy was performed because of the elevation of CA 125. Although intraabdominal exploration did not reveal the source of the CA 125 elevation, extensive retroperitoneal dissection demonstrated microscopic tumor in retrocaval lymph nodes in both cases. The ability to monitor patients with CA 125 is demonstrated and the importance of elevated antigen levels emphasized. Benign conditions associated with falsely positive CA 125 are discussed.     

The impact of PET/CT in the management of recurrent ovarian cancer

OBJECTIVES: To evaluate the impact of PET/CT on the restaging and management of recurrent ovarian cancer. METHODS: From January 2002 to July 2003, all women undergoing either surveillance or investigation of possible recurrent ovarian cancer at the Centre for Molecular Imaging, The Peter MacCallum Cancer Centre, were invited to take part in a prospective evaluation of the clinical impact of PET/CT. RESULTS: Fifty-six women having 66 scans were available for analysis. All patients had at least 12months follow-up after the PET/CT unless they died before that time. Apart from one equivocal scan, all scans performed in women with a CA125 higher than 35IU/ml had a positive PET/CT. PET/CT altered the known disease distribution in 40 scans (64%). Overall, PET/CT showed less disease in six scans (9%) and more disease in 34 scans (52%). Regardless of the value of CA125, PET/CT identified a sub group of women with apparently localized disease or no definite evidence of disease. This group showed improved survival compared with women shown to have systemic disease. PET/CT resulted in a major change of management plan in 34 patients (58%). CONCLUSION: PET/CT modifies the assessment of the distribution of recurrent ovarian cancer and alters patient management in a substantial proportion of patients. PET/CT appears to offer prognostic information.     

Clinically occult recurrent ovarian cancer: patient selection for secondary cytoreductive surgery using combined PET/CT

OBJECTIVE: The aim of this study was to evaluate the utility of combined positron emission tomography/computed tomography (PET/CT) for identifying ovarian cancer tumor masses > or =1 cm in patients with clinically occult recurrent disease by conventional CT imaging. METHODS: Twenty-two patients with epithelial ovarian cancer, rising serum CA125 levels, and negative or equivocal conventional CT imaging > or =6 months after primary therapy underwent combined PET/CT imaging followed by surgical reassessment. Fisher's exact test was used to measure the ability of PET/CT to predict macroscopic disease > or =1 cm. RESULTS: The median patient age was 55 years, and 91% of patients had FIGO Stage IIIC/IV disease. The median increase in serum CA125 was 24 U/ml (range 10 to 330 U/ml). Conventional CT was reported as negative (n = 15) or equivocal (n = 7) in all cases. Eighteen patients were ultimately found to harbor recurrent ovarian cancer measuring > or =1 cm at the time of surgery, with a median maximal tumor diameter of 2.3 cm (range 1.5 to 3.2 cm). The overall patient-based accuracy of PET/CT in detecting recurrent disease > or =1 cm was 81.8%, with a sensitivity of 83.3% and positive predictive value of 93.8% (P = 0.046). Of patients with recurrent ovarian cancer > or =1 cm, complete cytoreduction to no gross residual tumor was accomplished in 72.2%. CONCLUSION: PET/CT imaging demonstrates high sensitivity and positive predictive value in identifying potentially resectable, macroscopic recurrent ovarian cancer among patients with biochemical evidence of recurrence and negative or equivocal conventional CT findings. In appropriately selected patients, early identification of macroscopic recurrent disease may facilitate complete surgical cytoreduction.     

Involvement of pelvic lymph nodes in ovarian cancer

In contrast to earlier operating standards some authors have in the past few years, also removed pelvic lymphnodes when ovarian cancer was diagnosed. From 26 of our patients suffering from ovarian cancer, one third proved to have positive lymphnodes, when pelvic lymphonodectomy was carried out. Our data, along with-data from other authors, were reviewed and included in a statistical evaluation.     

The value of FDG PET/CT, ultrasound and CT in diagnosing recurrent ovarian carcinoma

The diagnosis of recurrent ovarian cancer can be complicated and variable sensitivities, specificities and accuracies have been reported for integrated positron emission tomography and computed tomography (PET/CT). The aim of the study was to evaluate the sensitivity, specificity and accuracy of PET/CT, ultrasound and CT in the diagnosing recurrent ovarian cancer. MATERIALS AND METHODS: 27 women in the follow-up after cytoreductive surgery and chemotherapy of ovarian cancer, underwent ultrasound, CT and PET/CT to assess for possible recurrence. RESULTS: Recurrence of ovarian cancer was detected in 22 patients (laparotomy or cytology of ascites or pleural effusion). 5 disease-free patients were followed-up for 8-14 months. FDG-PET, ultrasound and CT had sensitivities of 81,82%, 45,45%, 55.56%, specificities of 60%, 60%, 60% and accuracies 77,78%, 48,15%, 52,17% respectively. CONCLUSIONS: 1. FDG PET/CT is a useful technique to in diagnosing recurrent ovarian cancer. 2. PET/CT depicts/detects recurrent ovarian cancer with higher diagnostic accuracy comparing to the standard imaging and provides the chance to detect disease at an earlier stage during follow-up.     

卡铂腹腔化疗腹膜后淋巴结内的药物浓度

对２３例卵巢恶性肿瘤患者，分别于术前不同时间进行腹腔穿刺并灌注卡铂（３００ｍｇ／ｍ￣２），手术清扫腹膜后淋巴结，同时切取盆腔腹膜和髂外淋巴结周围脂肪结缔组织各１ｇ，用无火焰原子吸收光谱法分别测定上述３种组织的总铂浓度，并监测３例患者给药后２４小时内的血浆总铂浓度，以及观察化疗后腹膜后淋巴结的病理改变。结果显示，腹膜后淋巴结内总铂浓度在腹腔给药后１２小时达到高峰，峰值为１３．４±１．９～２１．６±７．８μｇ／ｇ。腹主动脉旁淋巴结、盆腔淋巴结、淋巴结周围脂肪结缔组织和盆腔腹膜总铂浓度的药时曲线下面积（ＡＵＣ＿（０～２４ｈ））分别为２１６．８±９．２、２４６．４±３２．９、１１５．６±４０．９和１３５１．３±６９６．５μｇ·ｈ／ｇ。血浆总铂浓度的峰值及ＡＵＣ＿（０～２４ｈ）分别为６．７±１．０μｇ／Ｌ和６１．５±２．４μｇ·ｈ／Ｌ。提示卡铂腹腔给药分布于腹膜后淋巴结组织中的药物浓度较血药浓度明显为高。病理检查可见化疗后的腹膜后淋巴结有变性改变。     

PET/CT in the staging of patients with a pelvic mass suspicious for ovarian cancer

Objective

To prospectively assess the value of PET/CT for staging, diagnosis and operability of ovarian cancer, with special attention to the peritoneal spread.

Methods

From June 2009 to March 2011, 69 patients with suspicion of having an ovarian cancer underwent an ¹⁸ F-FDG PET/CT. To identify the diagnostic value of PET/CT, the results were compared with the findings at diagnostic laparoscopy and/or debulking surgery.

Results

There were 56 patients with malignant tumors and 13 with benign tumors. We observed a sensitivity and specificity of 93% and 77%, respectively for malignant tumors with PET/CT. CT alone had a sensitivity and specificity of 96% and 38%, respectively. The overall FIGO classification evaluation for PET/CT and CT were the same. For the evaluation of metastases, the sensitivity of PET/CT was worse, while the specificity was better than CT. Retroperitoneal lymph node metastases were diagnosed better with PET/CT, while there was no difference for peritoneal spread and for the intestines. PET/CT detected another unknown primary tumor in 3 (4.3%) cases.

Conclusion

PET/CT is better than CT in detecting retroperitoneal lymph node metastases, but not for peritoneal metastases.     

Diagnosis of recurrent uterine cervical cancer: PET versus PET/CT: a systematic review and meta-analysis

Objective

The aim of this work was to assess and compare the overall value of stand-alone FDG PET and PET/CT in diagnosing recurrent cervical cancer with a meta-analysis.

Methods

All the English published studies which addressed the use of PET whether interpreted with or without the use of CT for the diagnosis of recurrent cervical cancer were collected. Methodological quality of the included studies was evaluated. Pooled sensitivity and specificity were calculated, summary receiver operating characteristics (SROC) curve analysis was used to compare the diagnostic ability of stand-alone PET and PET/CT.

Result

A total of 18 studies were included in this meta-analysis, with a total of 762 subjects. Pooled sensitivity and specificity of PET and PET/CT were 0.91 (95 % CI 0.87–0.94) and 0.94 (95 % CI 0.89–0.97), and 0.92 (95 % CI 0.91–0.94) and 0.84 (95 % CI 0.74–0.91), respectively. The areas under the SROC curve (AUCs) of PET and PET/CT were 0.9610 and 0.9491, respectively. There was no statistical significance between the AUC of PET and PET/CT (P > 0.05).

Conclusion

Both PET and PET/CT have good performance in the detection of recurrent cervical cancer. However, interpreted CT images may have limited additional value on PET in detecting recurrent cervical cancer.     

Preoperative 18F-FDG PET/CT in the management of advanced epithelial ovarian cancer

Objective

The introduction of 18-FDG-PET/CT during preoperative evaluation of patients with epithelial ovarian cancer (EOC) has led to an increase of the detection of extra-abdominal metastases. However, the clinical impact of this upstage remains unclear.

Methods

Patients with suspected advanced EOC underwent 18-FDG-PET/CT within two weeks prior to debulking surgery.

Results

Between 2006 and 2011 95 patients met the inclusion criteria. Based on the concordance or the discrepancy of clinical and PET/CT stage, patients were divided into 3 groups (A: clinical and PET III; B: clinical III and PET IV; C: clinical and PET IV). Twenty-five patients were upstaged from FIGO stage III to stage IV by PET/CT. The proportion of patients who achieved a residual tumor < 1 cm in group B and C was similar, whereas it was significantly lower compared to group A. Similarly, complete response to adjuvant chemotherapy was achieved more frequently in patients in group A. PFS was similar in the three groups (17, 17 and 12 months in group A, B and C), as well as OS (51, 41 and 35 months).

Conclusions

PET/CT is able to detect distant metastases in EOC patients. The presence of extra-abdominal disease probably indicates a more aggressive disease which also shows a lower response to standard chemotherapy. However, upstaged patients have a similar prognosis compared to stage III patients, probably because intra-abdominal disease is more likely to lead patients to death. This might also explain why residual tumor is the most important prognostic factor for advanced EOC patients.     

Clinical significance of enlarged cardiophrenic lymph nodes in advanced ovarian cancer: Implications for survival

Objective

Advanced ovarian cancer (OC) commonly spreads to cardiophrenic lymph nodes (CPLNs), and is often visible on preoperative imaging. We investigated the prognostic significance of abnormal CPLNs in OC detected by preoperative CT scans using three different definitions.

Pattern and impact of metastatic cardiophrenic lymph nodes in advanced epithelial ovarian cancer

Background

Cardiophrenic lymph nodes (CPLN) define FIGO stage IVB disease. We evaluate the pattern of CPLN metastases, their prognostic impact and the potential role of CPLN resection in patients with epithelial ovarian cancer (EOC).

Cytoreductive surgery for recurrent ovarian cancer

PURPOSE OF REVIEW: The issue facing clinicians managing ovarian cancer has evolved over the past three decades from treatment for cure and subsequently palliation, to prolongation of survival for most patients. The purpose of this paper is to review the data, rationale, and issues surrounding cytoreductive surgery in recurrent ovarian cancer and its potential role in this new paradigm shift. RECENT FINDINGS: Abundant retrospective series report prolongation of survival with secondary cytoreductive surgery in recurrent ovarian cancer. Selection bias, publication bias, and subsequent therapies, however, are confounding factors for survival. As management of ovarian cancer has recently evolved to a treatment of a 'chronic disease', surgery (which has a definite role in primary therapy) should be considered. SUMMARY: No prospective randomized studies have been performed to date, and therefore adoption of this method of management has been limited. The absence of good data leaves clinicians without clear direction on how to best manage patients. Patients with favorable characteristics such as a long disease-free interval, good performance status, a single or few small intra-abdominal recurrences may benefit from secondary cytoreduction. A prospective randomized study is needed.     

Region-based diagnostic performance of multidetector CT for detecting peritoneal seeding in ovarian cancer patients

Purpose  

To determine the accuracy of multi-detector CT (MDCT) compared with the surgical findings, such as peritoneal seeding and metastatic lymph nodes, in ovarian cancer patients.     

靶向治疗在复发性卵巢癌治疗中的应用

复发与耐药是卵巢癌治疗失败的主要原因之一。近20年来,手术、化疗及放疗的发展在改善复发性卵巢癌预后方面发挥的作用有限。靶向治疗以肿瘤细胞在分子水平的特征性改变为作用靶点,发挥抗肿瘤的作用。近10年来,有大量临床研究对靶向药物治疗复发性卵巢癌的疗效与副反应进行了评价,并取得了一定的成果。     

Whole-body PET with (fluorine-18)-2-deoxyglucose for detecting recurrent ovarian carcinoma. Initial report.

OBJECTIVE: To investigate positron emission tomography (PET) with (fluorine-18)-2-deoxyglucose (FDG) for detecting recurrent ovarian carcinoma. STUDY DESIGN: Wholebody FDG-PET scanning was performed on five patients before surgical exploration. All five patients were suspected of having recurrence based upon clinical findings and underwent surgery after scanning. RESULTS: In all five patients, PET images demonstrated increased FDG uptake in a distribution that correlated with surgical-pathologic findings (100%); computer tomography can detect 60% of such patients with malignant disease. Two cases with unexplained elevated serum CA-125 had lesions localized by PET. CONCLUSION: Recurrence of ovarian carcinoma was clearly imaged with FDG-PET and was confirmed by surgical pathology. FDG-PET might be a fairly effective tool for detecting recurrent ovarian carcinoma.