paywalled: Computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with ovarian cancer: A meta-analysis

Computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with ovarian cancer: A meta-analysis

Abstract 

Objectives

To compare the diagnostic performances of computed tomography (CT), magnetic resonance (MR) imaging, and positron emission tomography (PET or PET/CT) for detection of metastatic lymph nodes in patients with ovarian cancer.

Methods

Relevant studies were identified with MEDLINE and EMBASE from January 1990 to July 2010. We estimated the weighted summary sensitivities, specificities, OR (odds ratio), and summary receiver operating characteristic (sROC) curves of each imaging technique and conducted pair-wise comparisons using the two-sample Z-test. Meta-regression, subgroup analysis, and funnel plots were also performed to explain the between-study heterogeneity.

Results

Eighteen eligible studies were included, with a total of 882 patients. PET or PET/CT was a more accurate modality (sensitivity, 73.2%; specificity, 96.7%; OR [odds ratio], 90.32). No significant difference was detected between CT (sensitivity, 42.6%; specificity, 95.0%; OR, 19.87) and MR imaging (sensitivity, 54.7%; specificity, 88.3%; OR, 12.38). Meta-regression analyses and subgroup analyses revealed no statistical difference. Funnel plots with marked asymmetry suggested a publication bias.

Conclusion

FDG-PET or FDG-PET/CT is more accurate than CT and MR imaging in the detection of lymph node metastasis in patients with ovarian cancer.

paywalled: (March 2012) Impact of FDG-PET and -PET/CT imaging in the clinical decision-making of ovarian carcinoma: an evidence-based approach.

Impact of FDG-PET and -PET/CT imaging in the clinical decision-making of ovarian carcinoma: an evidence-based approach

Abstract

The most definitive role of fluorodeoxyglucose (FDG)-PET/computed tomography (CT) at present is surveillance and detecting recurrence in patients who have completed primary therapy but demonstrate a rising serum tumor marker (e.g., CA-125 levels). In this scenario, PET/CT demonstrates high sensitivity and accuracy in detecting lesions that are otherwise challenging, and appears superior (with less interobserver variability) compared with CT alone. Despite the fact that peritoneal deposits may be missed by PET/CT, the overall performance is better than CT alone. FDG-PET does not play a significant additional role in the primary diagnosis of ovarian cancers; however, the role of combined PET/CT modality has recently begun to be re-explored for initial disease staging, particularly because PET/CT can pick up small unsuspected lesions and thereby provide a better disease assessment of the whole body in a single examination. The baseline PET/CT also subserves an important role for future monitoring of therapy response. Therapy monitoring by PET could help to optimize neoadjuvant therapy protocols and to avoid ineffective therapy in nonresponders early in its course, although PET/CT has cost-effectiveness issues that need further evaluation. The prognostic value of FDG-PET/CT has been investigated in the following areas: in the preoperative setting to predict optimal cytoreduction; to assess the value of a positive FDG-PET following primary surgery; and when employed as a replacement for second-look laparotomy following completion of primary surgery and chemotherapy. The data, although promising, are still sparse in all the three domains for a definite recommendation.

 

paywalled: Low-dose non-enhanced CT versus full-dose contrast-enhanced CT in integrated PET/CT scans for diagnosing ovarian cancer recurrence

Low-dose non-enhanced CT versus full-dose contr... [Eur J Radiol. 2012] - PubMed - NCBI

 Abstract

OBJECTIVE:

To evaluate low-dose non-enhanced CT (ldCT) and full-dose contrast-enhanced CT (ceCT) in integrated (18)F-fluorodeoxyglucose (FDG)-PET/CT studies for restaging of ovarian cancer.

MATERIALS AND METHODS:

One hundred and twenty women who had undergone treatment for ovarian cancer underwent a conventional PET/CT scans with ldCT, and then ceCT. Two observers interpreted and decided in consensus on the PET/ldCT and PET/ceCT images by a 3-point scale (N: negative, E: equivocal, P: positive) per patient and lesion site. Final diagnoses were obtained by histopathological examinations, or clinical follow-up for at least 6 months.

RESULTS:

Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/ceCT was 86.9% (40/46), 95.9% (71/74), and 92.5% (111/120), respectively, whereas those of PET/ldCT were 78.3% (36/46), 95.0% (70/74), and 88.3% (106/120), respectively. All sensitivity, specificity, and accuracy significantly differed between two methods ...... The scales of detecting 104 recurrent lesion sites were N:14, E:6, P:84 for PET/ceCT, and N:15, E:17, P:72 for PET/ldCT, respectively. Eleven equivocal and one negative regions by PET/ldCT were correctly interpreted as positive by PET/ceCT.

CONCLUSION:

PET/ceCT is a more accurate imaging modality with higher confidence for assessing ovarian cancer recurrence than PET/ldCT.

abstract: Common patterns in 558 diagnostic radiology errors

Common patterns in 558 diagnostic radiology errors:

Abstract

Introduction: As a Quality Improvement initiative our department has held regular discrepancy meetings since 2003. We performed a retrospective analysis of the cases presented and identified the most common pattern of error.

Methods: A total of 558 cases were referred for discussion over 92 months, and errors were classified as perceptual or interpretative. The most common patterns of error for each imaging modality were analysed, and the misses were scored by consensus as subtle or non-subtle.

Results: Of 558 diagnostic errors, 447 (80%) were perceptual and 111 (20%) were interpretative errors. Plain radiography and computed tomography (CT) scans were the most frequent imaging modalities accounting for 246 (44%) and 241 (43%) of the total number of errors, respectively. In the plain radiography group 120 (49%) of the errors occurred in chest X-ray reports with perceptual miss of a lung nodule occurring in 40% of this subgroup. In the axial and appendicular skeleton missed fractures occurred most frequently, and metastatic bone disease was overlooked in 12 of 50 plain X-rays of the pelvis or spine. The majority of errors within the CT group were in reports of body scans with the commonest perceptual errors identified including 16 missed significant bone lesions, 14 cases of thromboembolic disease and 14 gastrointestinal tumours. Of the 558 errors, 312 (56%) were considered subtle and 246 (44%) non-subtle.

Conclusion: Diagnostic errors are not uncommon and are most frequently perceptual in nature. Identification of the most common patterns of error has the potential to improve the quality of reporting by improving the search behaviour of radiologists.

Complete response with pegylated liposomal doxorubicin as a second-line therapy in metastatic ovarian carcinosarcoma: Significance of assessment of the response by FDG-PET 10.1016/j.gynor.2012.02.004 : Gynecologic Oncology Case Reports

".....Furthermore, our case illustrates that the Response Evaluation Criteria in Solid Tumors (RECIST) metric is unreliable in predicting the histopathological treatment response in carcinosarcomas. In our patient, pathological analyses of the tissue removed during the debulking surgery showed more than 75% pathological necrosis, whereas the CT scan revealed stable disease. Furthermore, changes in tumor size evaluated on the CT scan after the treatment with PLD were poorly correlated with the metabolic changes and the tumoral viability (and outcome). A recent study showed that FDG-PET was significantly more accurate than size-based criteria at assessing the histopathological response to neoadjuvant therapy in high-grade, soft-tissue sarcomas (Evilevitch et al., 2008). In our opinion, FDG-PET should be considered as a modality to monitor the treatment response in patients with carcinosarcoma of the ovary.

In conclusion, our case illustrates that PLD might have a role in the treatment of ovarian carcinosarcoma that should be evaluated in future studies. This case also emphasizes the need to monitor the treatment response in these patients with FDG-PET."

open access: MRI, CT, and PET/CT for Ovarian Cancer Detection and Adnexal Lesion Characterization February 2010

OBJECTIVE. The purpose of this article is to describe the role of MR, CT, and PET/CT in the detection of ovarian cancer and the evaluation of adnexal lesions.

open access: Thoracic metastasis in advanced ovarian cancer: comparison between computed tomography and video-assisted thoracic surgery

Blogger's Note: click on 'pdf' to access full paper

Objective: To determine which computed tomography (CT) imaging features predict pleural malignancy in patients with advanced epithelial ovarian carcinoma (EOC) using video-assisted thoracic surgery (VATS), pathology, and cytology findings as the reference standard.

abstract: Pleural Effusion Detected at CT prior to Primary Cytoreduction for Stage III or IV Ovarian Carcinoma: Effect on Survival

Purpose: To determine the prognostic importance of pleural effusions on preoperative computed tomographic (CT) images in patients with advanced epithelial ovarian cancer.

A systematic review of positron emission tomography (PET) and positron emission tomography/computed tomography (PET/CT) for the diagnosis of breast cancer recurrence

Recurrent Ovarian Cancer: Use of Contrast-enhanced CT and PET/CT to Accurately Localize Tumor Recurrence and to Predict Patients’ Survival1 — Radiology

Abstract

Purpose: To compare accuracy and interobserver variability in the detection and localization of recurrent ovarian cancer with contrast material–enhanced (CE) computed tomography (CT) and positron emission tomography (PET)/CT and determine whether imaging findings can be used to predict survival.

Conclusion: Preliminary data suggest that CE CT and PET/CT may have similar accuracy in detection of recurrent ovarian cancer. Tumor size, number, and SUVmax may have potential as prognostic biomarkers for patients with recurrent ovarian cancer.

abstract: How to follow-up patients with epithelial ovarian cancer : Current Opinion in Oncology

How to follow-up patients with epithelial ovarian cancer
Miller, Rowan E; Rustin, Gordon JS

Abstract

Purpose of review: Despite optimal primary treatment most patients with advanced epithelial ovarian cancer will relapse. This review discusses the controversy regarding surveillance and the timing of treatment for recurrent disease.

Recent findings: Routine physical examination has a limited role in the detection of recurrent ovarian cancer. PET/computed tomography (CT) has been shown to be useful in detecting small volume disease not apparent on traditional imaging in patients with suspected recurrence based on symptoms and/or rising CA125. The results of PET/CT can alter treatment plans and have particular use in guiding site-directed therapy. The benefits of early detection and systemic treatment of recurrence are now in doubt following the presentation of the MRC/EORTC CA125 surveillance trial. The impact on survival of secondary cytoreductive surgery requires more investigation.

Summary: Uncertainties remain in the surveillance and timing of treatment for relapsed disease. Patients should be informed of these uncertainties and become involved in decisions regarding their follow-up.

Vanderbilt First to Use Specialized PET/CT Scan to Uncover Cancerous Tumors

"....The 68Ga-DOTATATE PET/CT scan offers higher resolution and sensitivity locating tumors. Although performed in Europe, this specialized type of radiologic scan has been viewed in the U.S. as offering only limited benefit to a small number of cancer patients. However a recent increase of neuroendocrine cancers seen at Vanderbilt led Walker and his associates to more widely apply usage of this new technology...."