Is ascites a sensible predictive sign of peritoneal involvement in patients with ovarian carcinoma?: our experience with FDG-PET/CT Poster No.: C-1019 Congress: ECR 2013 Type: Scientific Exhibit Authors: J. San Roman 1, M. Hovsepian 1, M. A. Brisco 1, D. Elias 2, F. Keywords: DOI: G. SEPULVEDA HERMOSILLA 1 ; 1 Buenos Aires/AR, 2 Ciudad Autonoma de Buenos Aires/AR Metastases, Cancer, Molecular imaging, Diagnostic procedure, PET-CT, Genital / Reproductive system female, Abdomen, Oncology 10.1594/ecr2013/C-1019 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 7
Purpose Ascites has been regarded as the most frequent sign of peritoneal carcinomatosis in patients evaluated with CT [1, 2]. Our objective was to determine the value of ascites as a predictive sign of peritoneal involvement in ovarian carcinoma patients studied with FDG-PET/CT. Currently, FDG PET/CT is considered the examination of choice for ovarian carcinoma staging [3, 4]. Methods and Materials From January 2010 to June 2012 we retrospectively analyzed the results of FDG-PET/ CT examinations in 66 consecutive patients in follow up for ovarian carcinoma confirmed by surgery and histology. Two trained radiologist jointly analyzed the result of FDG-PET/CT studies. The presence or absence of ascites and peritoneal implants were recorded in all cases. Peritoneal involvement was considered positive when two or more hypermetabolic peritoneal implants of different sizes or at least one pelvic mass like implant bigger than 2 cm were found on FDG-PET/CT. Results The mean age of the women was 54 years (range 31-83 years). In 43 of 66 patients (65.1%) evaluated, hypermetabolic peritoneal implants were observed: 33 had two or more implants (Figure 1 and 2) and 10 had pelvic mass like implant (Figure 3). In other 8 patients (12.1%), FDG-PET/CT detected secondary lesions in other locations, without peritoneal involvement, and in the rest 15 patients (22.7%) no abnormalities were found. In the group of 43 patients with hypermetabolic peritoneal implants, ascites (Figure 4) was detected in 7 patients (16.3%), but not in the rest (Table 1). Page 2 of 7
In our study ascites as a predictive sign of peritoneal implants had a sensibility of 16.3% and a specificity of 100%, with a positive predictive value of 100% and a negative predictive value of 39%. Images for this section: Fig. 1: Female (60 y). Ovarian carcinoma. Total abdominal hysterectomy with salpingooophorectomy (2010) and chemotherapy. During follow up CA-125 and CA-19.9 levels increase. PET/CT shows high F-18 FDG uptake in multiple peritoneal implants (red arrows) without ascites. Fig. 2: Female (61 y). Ovarian carcinoma. Total abdominal hysterectomy with salpingooophorectomy (2011) and chemotherapy. Retroperitoneal adenopathies in follow up Page 3 of 7
CT and normal CA-125 values. PET/CT shows increase F-18 FDG uptake in multiple peritoneal implants and retroperitoneal adenopathies (red arrows), without ascites. Fig. 3: Female (45 y). Ovarian carcinoma. Total abdominal hysterectomy with salpingooophorectomy (2005) and chemotherapy. During follow up CA-125 increase. PET/CT shows high F-18 FDG uptake in a pelvic mass like implant (red arrow), without ascites. Fig. 4: Female (59 y). Ovarian carcinoma. Total abdominal hysterectomy with salpingooophorectomy (2011) and chemotherapy. During follow up CA-125 increase. PET/CT shows high F-18 FDG uptake in multiple peritoneal implants (red arrows) surrounding the liver and in the peritoneal cavitiy with ascites (yellow arrow). Page 4 of 7
Table 1: In the group of 43 patients with hypermetabolic peritoneal implants, ascites was only detected in 7 patients (16.30%), but not in the rest (87.70%). Page 5 of 7
Conclusion The peritoneal cavity is a common site of metastatic spread for many malignancies and most patients with ovarian carcinoma have peritoneal implants during the course of disease [5]. In the past, ascites has been regarded as the most frequent sign of peritoneal carcinomatosis in patients evaluated with CT [1, 2]. It has been reported that peritoneal implants without ascites may be a frequent finding [6]. In our series, peritoneal implants were detected without evidence of ascites in the majority of patients with ovarian carcinoma evaluated with FDG PET/CT and the sensibility of ascites as a predictive sign of peritoneal involvement was poor (16.2%). Although ascites is a valuable sign of peritoneal carcinomatosis, it was only present in a limited number of cases (7 out of 43 patients). Nowadays, PET/CT has become the gold standard [4, 7] for the staging of patients with ovarian carcinoma because of its better sensibility and may explain the difference with previous reports in patients evaluated with CT only [8]. References 1. Coakley FV, Cho PH, Gougoutas CA, et al. Peritoneal metastases: detection with spiral CT in patients with ovarian cancer. Radiology 2002; 223:495-499. 2. Shen-Gunther J, Mannel RS. Ascites as a predictor of ovarian malignancy. Gynecol Oncol 2002; 87(1):77-83. 3. Turlakow A, Yeung HW, Sanchez Salmon A, et al. Peritoneal carcinomatosis: role of 18F-FDG PET. J Nucl Med 2003; 44:1407-1412. 4. Prakash P, Cronin CG, Blake MA. Role of PET/CT in ovarian cancer. AJR 2010; 194:W464-W470. 5. Buy JN, Moss AA, Ghossian MA, et al. Peritoneal implants from ovarian tumors: CT findings. Radiology 1988; 169:691-694. 6. Saida Y, Tsunoda HS, Itai Y, et al. Peritoneal implants without ascites: preoperative CT diagnosis in colon carcinoma patients. Radiat Med 1994; 12(5): 221-224. 7. Anthony MP, Khong PL, Zhang J. Spectrum of18f-fdg PET/CT appearances in peritoneal disease. AJR 2009; 193:W523:W529. 8. Yoshida Y, Kurokawa T, Kawahara K, et al. Incremental benefits of FDG Positron Emission Tomography over CT alone for the preoperative staging of ovarian cancer. AJR 2004; 182:227-233. Page 6 of 7
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