FDG-PET/CT for diagnosis of primary ovarian cancer

Abstract

Background and aim To evaluate the diagnostic value of integrated ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) to discriminate malignant from benign ovarian tumors. Methods One hundred and eight women suspected of having ovarian cancer underwent preoperative FDG-PET/CT scans. FDG uptake was quantified by calculating the maximum standardized uptake value (SUV_max) of each tumor. The receiver operating characteristic curve was drawn to determine the optimal cut-off values of SUV_max that would best discriminate between benign and malignant tumors. Histopathologic results served as the reference standard. We assessed the association between SUV_max and with International Federation of Gynecology and Obsterics stage in borderline and malignant tumors, using one-factor analysis of variance and an unpaired t test with Bonferoni correction. Results The SUV_max of benign (n=26), borderline (n=12) and malignant (n=73) lesions was 2.00±1.02, 2.72±1.04, and 7.55±4.29, respectively. Although there were significant differences between benign and malignant, and borderline and malignant lesions (Pmax cutoff of 2.55, the sensitivity, specificity and accuracy of FDG-PET/CT scanning to detect malignant or borderline tumors were 82.4, 76.9, and 81.1%, respectively. The SUV_max of stage I (n=35), stage II (n=8), stage III (n=34) and stage IV (n=8) was 3.59±2.32, 5.18±1.34, 8.72±2.69, and 15.05±3.77, respectively, and significant differences were observed between SUV_max values and the various International Federation of Gynecology and Obsterics stage (P<0.0001). Conclusion FDG-PET/CT scanning has a high diagnostic value in differentiating between malignant and benign tumors, and a low diagnostic value in differentiating between borderline and benign tumors.