Combined PET/CT for detecting recurrent ovarian cancer limited to retroperitoneal lymph nodes

Robert E. Bristow, Robert L. Giuntoli, Harpreet K. Pannu, Richard D. Schulick, Elliot K Fishman, Richard L. Wahl

Research output: Contribution to journalArticle

Abstract

Objective. To evaluate the utility of combined positron emission tomography/computed tomography (PET/CT) for detecting recurrent epithelial ovarian cancer limited to retroperitoneal adenopathy. Methods. Fourteen patients (median age = 53 years) with rising serum CA125 levels, and negative or equivocal conventional CT imaging ≥ 6 months after primary therapy were retrospectively identified as having recurrent disease limited to retroperitoneal lymph nodes by combined PET/CT and underwent surgical reassessment of targeted nodal basins. Fisher's Exact Test was used to measure the ability of PET/CT to predict isolated retroperitoneal nodal disease. Results. The median increase in serum CA125 from baseline nadir was 14 U/ml (range = 2-76 U/ml). There were 29 target nodes in 15 nodal basins identified with increased metabolic uptake on combined PET/CT. Eleven patients (78.6%) had recurrent ovarian cancer in retroperitoneal lymph nodes targeted by PET/CT. Of 143 nodes retrieved, 59 contained recurrent ovarian cancer (median nodal diameter = 2.5 cm, range = 0.8-5.2 cm). For all target nodal basins, the sensitivity, specificity, positive and negative predictive values, and accuracy for recurrent ovarian cancer in dissected lymph nodes were: 40.7% (24/59), 94.0% (79/84), 82.8% (24/29), 69.3% (79/114), and 72.0% (103/143) (P <0.001). PET/CT failed to identify microscopic disease in 59.3% of pathologically positive nodes. Conclusion. Combined PET/CT demonstrates high positive predictive value in identifying recurrent ovarian cancer in retroperitoneal lymph nodes when conventional CT findings are negative or equivocal. The high incidence of occult disease within the target nodal basins suggests that regional lymphadenectomy may be necessary for complete secondary cytoreduction of recurrent disease.

Original languageEnglish (US)
Pages (from-to)294-300
Number of pages7
JournalGynecologic Oncology
Volume99
Issue number2
DOIs
StatePublished - Nov 2005

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Ovarian Neoplasms
Lymph Nodes
Positron Emission Tomography Computed Tomography
Lymph Node Excision
Serum
Sensitivity and Specificity
Incidence

Keywords

  • Computed tomography
  • Positron emission tomography
  • Serum CA125

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Combined PET/CT for detecting recurrent ovarian cancer limited to retroperitoneal lymph nodes. / Bristow, Robert E.; Giuntoli, Robert L.; Pannu, Harpreet K.; Schulick, Richard D.; Fishman, Elliot K; Wahl, Richard L.

In: Gynecologic Oncology, Vol. 99, No. 2, 11.2005, p. 294-300.

Research output: Contribution to journalArticle

Bristow, Robert E. ; Giuntoli, Robert L. ; Pannu, Harpreet K. ; Schulick, Richard D. ; Fishman, Elliot K ; Wahl, Richard L. / Combined PET/CT for detecting recurrent ovarian cancer limited to retroperitoneal lymph nodes. In: Gynecologic Oncology. 2005 ; Vol. 99, No. 2. pp. 294-300.
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abstract = "Objective. To evaluate the utility of combined positron emission tomography/computed tomography (PET/CT) for detecting recurrent epithelial ovarian cancer limited to retroperitoneal adenopathy. Methods. Fourteen patients (median age = 53 years) with rising serum CA125 levels, and negative or equivocal conventional CT imaging ≥ 6 months after primary therapy were retrospectively identified as having recurrent disease limited to retroperitoneal lymph nodes by combined PET/CT and underwent surgical reassessment of targeted nodal basins. Fisher's Exact Test was used to measure the ability of PET/CT to predict isolated retroperitoneal nodal disease. Results. The median increase in serum CA125 from baseline nadir was 14 U/ml (range = 2-76 U/ml). There were 29 target nodes in 15 nodal basins identified with increased metabolic uptake on combined PET/CT. Eleven patients (78.6{\%}) had recurrent ovarian cancer in retroperitoneal lymph nodes targeted by PET/CT. Of 143 nodes retrieved, 59 contained recurrent ovarian cancer (median nodal diameter = 2.5 cm, range = 0.8-5.2 cm). For all target nodal basins, the sensitivity, specificity, positive and negative predictive values, and accuracy for recurrent ovarian cancer in dissected lymph nodes were: 40.7{\%} (24/59), 94.0{\%} (79/84), 82.8{\%} (24/29), 69.3{\%} (79/114), and 72.0{\%} (103/143) (P <0.001). PET/CT failed to identify microscopic disease in 59.3{\%} of pathologically positive nodes. Conclusion. Combined PET/CT demonstrates high positive predictive value in identifying recurrent ovarian cancer in retroperitoneal lymph nodes when conventional CT findings are negative or equivocal. The high incidence of occult disease within the target nodal basins suggests that regional lymphadenectomy may be necessary for complete secondary cytoreduction of recurrent disease.",
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T1 - Combined PET/CT for detecting recurrent ovarian cancer limited to retroperitoneal lymph nodes

AU - Bristow, Robert E.

AU - Giuntoli, Robert L.

AU - Pannu, Harpreet K.

AU - Schulick, Richard D.

AU - Fishman, Elliot K

AU - Wahl, Richard L.

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N2 - Objective. To evaluate the utility of combined positron emission tomography/computed tomography (PET/CT) for detecting recurrent epithelial ovarian cancer limited to retroperitoneal adenopathy. Methods. Fourteen patients (median age = 53 years) with rising serum CA125 levels, and negative or equivocal conventional CT imaging ≥ 6 months after primary therapy were retrospectively identified as having recurrent disease limited to retroperitoneal lymph nodes by combined PET/CT and underwent surgical reassessment of targeted nodal basins. Fisher's Exact Test was used to measure the ability of PET/CT to predict isolated retroperitoneal nodal disease. Results. The median increase in serum CA125 from baseline nadir was 14 U/ml (range = 2-76 U/ml). There were 29 target nodes in 15 nodal basins identified with increased metabolic uptake on combined PET/CT. Eleven patients (78.6%) had recurrent ovarian cancer in retroperitoneal lymph nodes targeted by PET/CT. Of 143 nodes retrieved, 59 contained recurrent ovarian cancer (median nodal diameter = 2.5 cm, range = 0.8-5.2 cm). For all target nodal basins, the sensitivity, specificity, positive and negative predictive values, and accuracy for recurrent ovarian cancer in dissected lymph nodes were: 40.7% (24/59), 94.0% (79/84), 82.8% (24/29), 69.3% (79/114), and 72.0% (103/143) (P <0.001). PET/CT failed to identify microscopic disease in 59.3% of pathologically positive nodes. Conclusion. Combined PET/CT demonstrates high positive predictive value in identifying recurrent ovarian cancer in retroperitoneal lymph nodes when conventional CT findings are negative or equivocal. The high incidence of occult disease within the target nodal basins suggests that regional lymphadenectomy may be necessary for complete secondary cytoreduction of recurrent disease.

AB - Objective. To evaluate the utility of combined positron emission tomography/computed tomography (PET/CT) for detecting recurrent epithelial ovarian cancer limited to retroperitoneal adenopathy. Methods. Fourteen patients (median age = 53 years) with rising serum CA125 levels, and negative or equivocal conventional CT imaging ≥ 6 months after primary therapy were retrospectively identified as having recurrent disease limited to retroperitoneal lymph nodes by combined PET/CT and underwent surgical reassessment of targeted nodal basins. Fisher's Exact Test was used to measure the ability of PET/CT to predict isolated retroperitoneal nodal disease. Results. The median increase in serum CA125 from baseline nadir was 14 U/ml (range = 2-76 U/ml). There were 29 target nodes in 15 nodal basins identified with increased metabolic uptake on combined PET/CT. Eleven patients (78.6%) had recurrent ovarian cancer in retroperitoneal lymph nodes targeted by PET/CT. Of 143 nodes retrieved, 59 contained recurrent ovarian cancer (median nodal diameter = 2.5 cm, range = 0.8-5.2 cm). For all target nodal basins, the sensitivity, specificity, positive and negative predictive values, and accuracy for recurrent ovarian cancer in dissected lymph nodes were: 40.7% (24/59), 94.0% (79/84), 82.8% (24/29), 69.3% (79/114), and 72.0% (103/143) (P <0.001). PET/CT failed to identify microscopic disease in 59.3% of pathologically positive nodes. Conclusion. Combined PET/CT demonstrates high positive predictive value in identifying recurrent ovarian cancer in retroperitoneal lymph nodes when conventional CT findings are negative or equivocal. The high incidence of occult disease within the target nodal basins suggests that regional lymphadenectomy may be necessary for complete secondary cytoreduction of recurrent disease.

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KW - Positron emission tomography

KW - Serum CA125

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