Skip to main content
SpringerLink
Log in
Book cover

Nuclear Oncology pp 1021–1046Cite as

Diagnostic Applications of Nuclear Medicine: Ovarian Cancer

  • Reference work entry
  • First Online:

  • 2004 Accesses

Abstract

Ovarian malignancies are a leading cause of death in women in the United States and a significant health issue for women worldwide. Anatomic imaging with ultrasound, computed tomography, and magnetic resonance is a main tool for the diagnosis, staging, and follow-up of recurrent disease; however, it lacks biologic information. Nuclear imaging, primarily positron emission tomography (PET) with 2-deoxy-2-[18F]fluoro-d-glucose ([18F]FDG), has been increasingly used for the detection of cancer. Encouraging data have emerged in recent years that support the use of [18F]FDG PET in a variety of clinical settings in ovarian cancer management.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   949.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Abbreviations

[18F]FDG:

2-[18F]fluoro-2-deoxy-D-glucose

AJCC:

American Joint Committee on Cancer

BRCA1:

Breast cancer type 1 susceptibility protein

BRCA2:

Breast cancer type 2 susceptibility protein

CA-125 U/mL:

A tumor-associated marker for ovarian cancer (also known as carbohydrate antigen 125 or mucin 16)

CT:

X-ray computed tomography

CTce:

Contrast-enhanced computed tomography

FIGO:

International Federation of Obstetrics and Gynecology

GLUT:

Glucose transporter family

LBMI:

Large bowel mesentery implants

LI:

Labeling index

M:

Metastasis status according to the AJCC/UICC TNM staging system

MIB-1:

Marker of cell proliferation based on an antibody against an epitope of the nuclear protein different from that recognized by the Ki-67 antibody

MRI:

Magnetic resonance imaging

MTV:

Metabolic tumor volume

N:

Lymph node status according to the AJCC/UICC TNM staging system

NPV:

Negative predictive value

PET:

Positron emission tomography

PET/CT:

Positron emission tomography/computed tomography

PFS:

Progression-free survival

PPV:

Positive predictive value

RO:

Right ovary

SLL:

Second look laparotomy

SUV:

Standardized uptake value

SUVmax :

Standardized uptake value at point of maximum

T:

Tumor status according to the AJCC/UICC TNM staging system

TAHBSO:

Total abdominal hysterectomy with bilateral salpingo oophorectomy

TLG:

Total lesion glycolysis

TNM:

AJCC staging system based on parameters “T” (tumor status), “N” (lymph node status), and “M” (distant metastasis status)

TVUS:

Transvaginal ultrasound

UICC:

Union Internationale Contre le Cancer (International Union Against Cancer)

US:

Ultrasonography

References

  1. American Cancer Society. 2016. http://www.cancer.org

  2. Chi DBR, Rubin SC, et al. Gynecologic malignancies. In: CLR P, Hoskins WJ, Wagman LD, editors. Cancer management: a multidisciplinary approach. Melville: PRR Inc; 1999. p. 361–430.

    Google Scholar 

  3. Young RC, Fuks FZ, Hoskins WJ. Cancer of the ovary. In: Devita VT, editor. Cancer: principles and practice of oncology. Philadelphia: J. B Lippincott Co.; 2011.

    Google Scholar 

  4. http://www.FIGO.org

  5. Prat J. Staging classification for cancer of the ovary, fallopian tube, and peritoneum. Int J Gynaecol Obstet. 2014;124(1):1–5.

    Article  PubMed  Google Scholar 

  6. NCCN. Practice guidelines: ovarian cancer. 2016. https://www.nccn.org/professionals/physician_gls/f_guidelines.asp

  7. Morgan Jr RJ, et al. Ovarian cancer, version 1.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2016;14(9):1134–63.

    Article  PubMed  Google Scholar 

  8. Subhas N, et al. Imaging of pelvic malignancies with in-line FDG PET-CT: case examples and common pitfalls of FDG PET. Radiographics. 2005;25(4):1031–43.

    Article  PubMed  Google Scholar 

  9. Fenchel S, et al. Asymptomatic adnexal masses: correlation of FDG PET and histopathologic findings. Radiology. 2002;223(3):780–8.

    Article  PubMed  Google Scholar 

  10. Grab D, et al. Classification of asymptomatic adnexal masses by ultrasound, magnetic resonance imaging, and positron emission tomography. Gynecol Oncol. 2000;77(3):454–9.

    Article  CAS  PubMed  Google Scholar 

  11. Tanizaki Y, et al. Diagnostic value of preoperative SUVmax on FDG-PET/CT for the detection of ovarian cancer. Int J Gynecol Cancer. 2014;24(3):454–60.

    Article  PubMed  Google Scholar 

  12. Castellucci P, et al. Diagnostic accuracy of 18F-FDG PET/CT in characterizing ovarian lesions and staging ovarian cancer: correlation with transvaginal ultrasonography, computed tomography, and histology. Nucl Med Commun. 2007;28(8):589–95.

    Article  CAS  PubMed  Google Scholar 

  13. Kitajima K, et al. FDG-PET/CT for diagnosis of primary ovarian cancer. Nucl Med Commun. 2011;32(7):549–53.

    Article  PubMed  Google Scholar 

  14. Lerman H, et al. Normal and abnormal 18F-FDG endometrial and ovarian uptake in pre- and postmenopausal patients: assessment by PET/CT. J Nucl Med. 2004;45(2):266–71.

    PubMed  Google Scholar 

  15. Yun M, et al. Physiologic 18F-FDG uptake in the fallopian tubes at mid cycle on PET/CT. J Nucl Med. 2010;51(5):682–5.

    Article  PubMed  Google Scholar 

  16. Iyer, V.R., Lee S.I., MRI, CT, and PET/CT for ovarian cancer detection and adnexal lesion characterization. AJR Am J Roentgenol, 2010. 194(2) 311–321.

    Google Scholar 

  17. Hubner KF, et al. Assessment of primary and metastatic ovarian cancer by positron emission tomography (PET) using 2-[18F]deoxyglucose (2-[18F]FDG). Gynecol Oncol. 1993;51(2):197–204.

    Article  CAS  PubMed  Google Scholar 

  18. Schroder W, et al. The role of 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG PET) in diagnosis of ovarian cancer. Int J Gynecol Cancer. 1999;9(2):117–22.

    Article  PubMed  Google Scholar 

  19. Yoshida Y, et al. Incremental benefits of FDG positron emission tomography over CT alone for the preoperative staging of ovarian cancer. AJR Am J Roentgenol. 2004;182(1):227–33.

    Article  PubMed  Google Scholar 

  20. Kurokawa T, et al. Expression of GLUT-1 glucose transfer, cellular proliferation activity and grade of tumor correlate with [F-18]-fluorodeoxyglucose uptake by positron emission tomography in epithelial tumors of the ovary. Int J Cancer. 2004;109(6):926–32.

    Article  CAS  PubMed  Google Scholar 

  21. Hynninen J, et al. A prospective comparison of integrated FDG-PET/contrast-enhanced CT and contrast-enhanced CT for pretreatment imaging of advanced epithelial ovarian cancer. Gynecol Oncol. 2013;131(2):389–94.

    Article  PubMed  Google Scholar 

  22. Dauwen H, et al. PET/CT in the staging of patients with a pelvic mass suspicious for ovarian cancer. Gynecol Oncol. 2013;131(3):694–700.

    Article  CAS  PubMed  Google Scholar 

  23. Yamamoto Y, et al. Preoperative evaluation of pelvic masses with combined 18F-fluorodeoxyglucose positron emission tomography and computed tomography. Int J Gynaecol Obstet. 2008;102(2):124–7.

    Article  PubMed  Google Scholar 

  24. Zytoon AA, et al. High impact of FDG-PET/CT in diagnostic strategies for ovarian cancer. Acta Radiol. 2013;54(3):340–8.

    Article  PubMed  Google Scholar 

  25. Nam EJ, et al. Diagnosis and staging of primary ovarian cancer: correlation between PET/CT, Doppler US, and CT or MRI. Gynecol Oncol. 2010;116(3):389–94.

    Article  PubMed  Google Scholar 

  26. Michielsen K, et al. Whole-body MRI with diffusion-weighted sequence for staging of patients with suspected ovarian cancer: a clinical feasibility study in comparison to CT and FDG-PET/CT. Eur Radiol. 2014;24(4):889–901.

    Article  PubMed  Google Scholar 

  27. Risum S, et al. Does the use of diagnostic PET/CT cause stage migration in patients with primary advanced ovarian cancer? Gynecol Oncol. 2010;116(3):395–8.

    Article  CAS  PubMed  Google Scholar 

  28. Risum S, et al. The diagnostic value of PET/CT for primary ovarian cancer – a prospective study. Gynecol Oncol. 2007;105(1):145–9.

    Article  PubMed  Google Scholar 

  29. Kitajima K, et al. Diagnostic accuracy of integrated FDG-PET/contrast-enhanced CT in staging ovarian cancer: comparison with enhanced CT. Eur J Nucl Med Mol Imaging. 2008;35(10):1912–20.

    Article  PubMed  Google Scholar 

  30. Yuan Y, et al. 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. Eur J Radiol. 2012;81(5):1002–6.

    Article  PubMed  Google Scholar 

  31. Signorelli M, et al. Detection of nodal metastases by 18F-FDG PET/CT in apparent early stage ovarian cancer: a prospective study. Gynecol Oncol. 2013;131(2):395–9.

    Article  PubMed  Google Scholar 

  32. De Iaco P, et al. FDG-PET/CT in advanced ovarian cancer staging: value and pitfalls in detecting lesions in different abdominal and pelvic quadrants compared with laparoscopy. Eur J Radiol. 2011;80(2):e98–103.

    Article  PubMed  Google Scholar 

  33. Schmidt S, et al. Peritoneal carcinomatosis in primary ovarian cancer staging: comparison between MDCT, MRI, and 18F-FDG PET/CT. Clin Nucl Med. 2015;40(5):371–7.

    Article  PubMed  Google Scholar 

  34. Hicks RJ, Ware RE, Lau EW. PET/CT: will it change the way that we use CT in cancer imaging? Cancer Imaging. 2006;6:S52–62.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Fruscio R, et al. Preoperative 18F-FDG PET/CT in the management of advanced epithelial ovarian cancer. Gynecol Oncol. 2013;131(3):689–93.

    Article  PubMed  Google Scholar 

  36. Alessi A, et al. FDG-PET/CT to predict optimal primary cytoreductive surgery in patients with advanced ovarian cancer: preliminary results. Tumori. 2016;102(1):103–7.

    Article  PubMed  Google Scholar 

  37. Risum S, et al. Prediction of suboptimal primary cytoreduction in primary ovarian cancer with combined positron emission tomography/computed tomography – a prospective study. Gynecol Oncol. 2008;108(2):265–70.

    Article  CAS  PubMed  Google Scholar 

  38. Risum S, et al. Positron emission tomography/computed tomography predictors of overall survival in stage IIIC/IV ovarian cancer. Int J Gynecol Cancer. 2012;22(7):1163–9.

    Article  PubMed  Google Scholar 

  39. Delbeke D, Martin WH. Positron emission tomography imaging in oncology. Radiol Clin North Am. 2001;39(5):883–917.

    Article  CAS  PubMed  Google Scholar 

  40. Rusu D, et al. Clinical and Survival Impact of FDG PET in Patients with Suspicion of Recurrent Ovarian Cancer: A 6-Year Follow-Up. Front Med (Lausanne). 2015;2:46.

    Google Scholar 

  41. Dragosavac S, et al. Staging recurrent ovarian cancer with 18FDG PET/CT. Oncol Lett. 2013;5(2):593–7.

    PubMed  Google Scholar 

  42. Rose PG, et al. Positive emission tomography for evaluating a complete clinical response in patients with ovarian or peritoneal carcinoma: correlation with second-look laparotomy. Gynecol Oncol. 2001;82(1):17–21.

    Article  CAS  PubMed  Google Scholar 

  43. Kim CK, et al. Detection of recurrent ovarian cancer at MRI: comparison with integrated PET/CT. J Comput Assist Tomogr. 2007;31(6):868–75.

    Article  PubMed  Google Scholar 

  44. Sanli Y, et al. Diagnostic value of PET/CT is similar to that of conventional MRI and even better for detecting small peritoneal implants in patients with recurrent ovarian cancer. Nucl Med Commun. 2012;33(5):509–15.

    Article  PubMed  Google Scholar 

  45. Limei Z, et al. Accuracy of positron emission tomography/computed tomography in the diagnosis and restaging for recurrent ovarian cancer: a meta-analysis. Int J Gynecol Cancer. 2013;23(4):598–607.

    Article  PubMed  Google Scholar 

  46. Garcia-Velloso MJ, et al. Diagnostic accuracy of FDG PET in the follow-up of platinum-sensitive epithelial ovarian carcinoma. Eur J Nucl Med Mol Imaging. 2007;34(9):1396–405.

    Article  PubMed  Google Scholar 

  47. Gu P, et al. CA 125, PET alone, PET-CT, CT and MRI in diagnosing recurrent ovarian carcinoma: a systematic review and meta-analysis. Eur J Radiol. 2009;71(1):164–74.

    Article  PubMed  Google Scholar 

  48. Iagaru AH, et al. 18F-FDG PET/CT evaluation of patients with ovarian carcinoma. Nucl Med Commun. 2008;29(12):1046–51.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Murakami M, et al. Whole-body positron emission tomography and tumor marker CA125 for detection of recurrence in epithelial ovarian cancer. Int J Gynecol Cancer. 2006;16(Suppl 1):99–107.

    Article  PubMed  Google Scholar 

  50. Pan HS, et al. Combined positron emission tomography-computed tomography and tumor markers for detecting recurrent ovarian cancer. Arch Gynecol Obstet. 2011;283(2):335–41.

    Article  CAS  PubMed  Google Scholar 

  51. Antunovic L, et al. Revisiting the clinical value of 18F-FDG PET/CT in detection of recurrent epithelial ovarian carcinomas: correlation with histology, serum CA-125 U/mL assay, and conventional radiological modalities. Clin Nucl Med. 2012;37(8):e184–8.

    Article  PubMed  Google Scholar 

  52. Palomar A, et al. Value of FDG PET/CT in patients with treated ovarian cancer and raised CA125 serum levels. Mol Imaging Biol. 2012;14(1):123–9.

    Article  PubMed  Google Scholar 

  53. Chen YM, et al. Is there an impact of 18F-FDG PET/CT on the surveillance and clinical management of recurrent ovarian cancer? Research based on a large sample in a single PET/CT center. Nucl Med Commun. 2014;35(4):347–52.

    Article  PubMed  Google Scholar 

  54. Fagotti A, et al. A treatment selection protocol for recurrent ovarian cancer patients: the role of FDG-PET/CT and staging laparoscopy. Oncology. 2008;75(3–4):152–8.

    Article  CAS  PubMed  Google Scholar 

  55. Thrall MM, et al. Clinical use of combined positron emission tomography and computed tomography (FDG-PET/CT) in recurrent ovarian cancer. Gynecol Oncol. 2007;105(1):17–22.

    Article  PubMed  Google Scholar 

  56. Mangili G, et al. Integrated PET/CT as a first-line re-staging modality in patients with suspected recurrence of ovarian cancer. Eur J Nucl Med Mol Imaging. 2007;34(5):658–66.

    Article  CAS  PubMed  Google Scholar 

  57. Kitajima K, et al. Performance of integrated FDG-PET/contrast-enhanced CT in the diagnosis of recurrent ovarian cancer: comparison with integrated FDG-PET/non-contrast-enhanced CT and enhanced CT. Eur J Nucl Med Mol Imaging. 2008;35(8):1439–48.

    Article  PubMed  Google Scholar 

  58. Chung HH, et al. Role of [18F]FDG PET/CT in the assessment of suspected recurrent ovarian cancer: correlation with clinical or histological findings. Eur J Nucl Med Mol Imaging. 2007;34(4):480–6.

    Article  PubMed  Google Scholar 

  59. Simcock B, et al. The impact of PET/CT in the management of recurrent ovarian cancer. Gynecol Oncol. 2006;103(1):271–6.

    Article  PubMed  Google Scholar 

  60. Bilici A, et al. Clinical value of FDG PET/CT in the diagnosis of suspected recurrent ovarian cancer: is there an impact of FDG PET/CT on patient management? Eur J Nucl Med Mol Imaging. 2010;37(7):1259–69.

    Article  PubMed  Google Scholar 

  61. Soussan M, et al. Impact of FDG PET-CT imaging on the decision making in the biologic suspicion of ovarian carcinoma recurrence. Gynecol Oncol. 2008;108(1):160–5.

    Article  PubMed  Google Scholar 

  62. Fulham MJ, et al. The impact of PET-CT in suspected recurrent ovarian cancer: a prospective multi-centre study as part of the Australian PET Data Collection Project. Gynecol Oncol. 2009;112(3):462–8.

    Article  CAS  PubMed  Google Scholar 

  63. Lurain JR. Second-look laparotomy and other reoperations for ovarian cancer. In: Sciarra JJ, editor. Gynecology and obstetrics. Philadelphia: Lippincott Williams & Wilkins; 2004.

    Google Scholar 

  64. Rubin SC, et al. Ten-year follow-up of ovarian cancer patients after second-look laparotomy with negative findings. Obstet Gynecol. 1999;93(1):21–4.

    CAS  PubMed  Google Scholar 

  65. Rubinstein E, Knudsen JB. Clinical aspects of second-look laparotomy in ovarian cancer. Ann Chir Gynaecol. 1986;75(3):177–9.

    CAS  PubMed  Google Scholar 

  66. Obermair A, Sevelda P. Impact of second look laparotomy and secondary cytoreductive surgery at second-look laparotomy in ovarian cancer patients. Acta Obstet Gynecol Scand. 2001;80(5):432–6.

    Article  CAS  PubMed  Google Scholar 

  67. Sijmons EA, Heintz AP. Second-look and second surgery: second chance or second best? Semin Surg Oncol. 2000;19(1):54–61.

    Article  CAS  PubMed  Google Scholar 

  68. Cohn DE, et al. Novel perioperative imaging with 18F-FDG PET/CT and intraoperative 18F-FDG detection using a handheld gamma probe in recurrent ovarian cancer. Gynecol Oncol. 2008;110(2):152–7.

    Article  CAS  PubMed  Google Scholar 

  69. Ebina Y, et al. Impact of FDG PET in optimizing patient selection for cytoreductive surgery in recurrent ovarian cancer. Eur J Nucl Med Mol Imaging. 2014;41(3):446–51.

    Article  CAS  PubMed  Google Scholar 

  70. Mansueto M, et al. Positron emission tomography/computed tomography introduction in the clinical management of patients with suspected recurrence of ovarian cancer: a cost-effectiveness analysis. Eur J Cancer Care (Engl). 2009;18(6):612–9.

    Article  CAS  Google Scholar 

  71. Smith GT, et al. Cost analysis of FDG PET for managing patients with ovarian cancer. Clin Positron Imaging. 1999;2(2):63–70.

    Article  PubMed  Google Scholar 

  72. Risum S, et al. Influence of 2-(18F) fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography on recurrent ovarian cancer diagnosis and on selection of patients for secondary cytoreductive surgery. Int J Gynecol Cancer. 2009;19(4):600–4.

    Article  PubMed  Google Scholar 

  73. Pfannenberg C, et al. 18F-FDG-PET/CT to select patients with peritoneal carcinomatosis for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2009;16(5):1295–303.

    Article  PubMed  Google Scholar 

  74. Peng P, et al. Benefits of fluorine-18 fludeoxyglucose positron emission tomography in secondary cytoreductive surgery for patients with recurrent epithelial ovarian cancer. Br J Radiol. 2015;88(1052):20150109.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  75. Lenhard SM, et al. Predictive value of PET-CT imaging versus AGO-scoring in patients planned for cytoreductive surgery in recurrent ovarian cancer. Eur J Obstet Gynecol Reprod Biol. 2008;140(2):263–8.

    Article  CAS  PubMed  Google Scholar 

  76. Nishiyama Y, et al. Monitoring the neoadjuvant therapy response in gynecological cancer patients using FDG PET. Eur J Nucl Med Mol Imaging. 2008;35(2):287–95.

    Article  PubMed  Google Scholar 

  77. Lee JW, et al. The role of metabolic tumor volume and total lesion glycolysis on 18F-FDG PET/CT in the prognosis of epithelial ovarian cancer. Eur J Nucl Med Mol Imaging. 2014;41(10):1898–906.

    Article  PubMed  Google Scholar 

  78. Chung HH, et al. Prognostic value of preoperative metabolic tumor volume and total lesion glycolysis in patients with epithelial ovarian cancer. Ann Surg Oncol. 2012;19(6):1966–72.

    Article  PubMed  Google Scholar 

  79. Kim CY, et al. Quantitative metabolic parameters measured on F-18 FDG PET/CT predict survival after relapse in patients with relapsed epithelial ovarian cancer. Gynecol Oncol. 2015;136(3):498–504.

    Article  PubMed  Google Scholar 

  80. Mayoral M, et al. Prognostic value of 18F-FDG PET/CT volumetric parameters in recurrent epithelial ovarian cancer. Rev Esp Med Nucl Imagen Mol. 2016;35(2):88–95.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Neeta Pandit-Taskar, Sonia Mahajan & Weining Ma

  2. Department of Radiology, Weill Cornell Medical College, New York, NY, USA

    Neeta Pandit-Taskar

Authors
  1. Neeta Pandit-Taskar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sonia Mahajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Weining Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Neeta Pandit-Taskar .

Editor information

Editors and Affiliations

  1. Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA

    H. William Strauss

  2. University of Pisa, Regional Center of Nuclear Medicine, Pisa, Italy

    Giuliano Mariani

  3. University of Pisa, Regional Center of Nuclear Medicine, Pisa, Italy

    Duccio Volterrani

  4. Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA

    Steven M. Larson

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Pandit-Taskar, N., Mahajan, S., Ma, W. (2017). Diagnostic Applications of Nuclear Medicine: Ovarian Cancer. In: Strauss, H., Mariani, G., Volterrani, D., Larson, S. (eds) Nuclear Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-26236-9_46

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-26236-9_46

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-26234-5

  • Online ISBN: 978-3-319-26236-9

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation