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Clinical Utility of Positron Emission Tomography/Computed Tomography in the Evaluation of Suspected Recurrent Ovarian Cancer in the Setting of Normal CA-125 Levels
  1. Priya Bhosale, MD*,
  2. Silanath Peungjesada, MD,
  3. Wei Wei, MD,
  4. Charles F. Levenback, MD§,
  5. Kathleen Schmeler, MD§,
  6. Eric Rohren, MD,
  7. Homer A. Macapinlac, MD and
  8. Revathy B. Iyer, MD*
  1. * Department of Diagnostic Radiology, The University of Texas M.D.Anderson Cancer Center, Houston;
  2. Department of Radiology Services, VA North Texas Health Care System, Dallas; Departments of
  3. Biostatistics,
  4. § Gynecology Oncology, and
  5. Nuclear Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX.
  1. Address correspondence and reprint requests to Priya Bhosale, MD, Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe, Box 368, Houston, TX 77030. E-mail: Priya.bhosale{at}


Objectives: This study was conducted to estimate the accuracy of [18F]-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) as compared with contrast-enhanced CT (CECT) in detecting cancer in patients who have normal cancer antigen (CA)-125 (<35 U/dL) but are suspected of having a recurrent disease based on clinical symptoms.

Methods: We retrospectively reviewed the records of patients who had undergone primary cytoreductive surgery and subsequently underwent CECT and FDG-PET/CT for suspected recurrence. [18F]-fluorodeoxyglucose positron emission tomography/computed tomography and CECT interpretation to evaluate a recurrent disease was carried out independently by 2 experienced radiologists who were blinded to the final diagnosis for the suspected recurrence. Long-term follow-up imaging (12 months) and biopsy reports were used to assess the true status of the suspected recurrence seen on FDG-PET/CT or CECT. Sensitivity and specificity of all modalities were estimated. McNemar test was used to compare pairs of modalities. All tests were 2-sided, and P ≤ 0.05 was considered statistically significant.

Results: Sixty-six patients met the eligibility criteria for inclusion in our analysis. Fifty-eight percent (18/31) and 54% (17/31) of the patients with normal CA-125 levels had evidence of a recurrent disease on FDG-PET/CT and CECT, respectively. Thirty-one percent (6/19) of the patients with no indication of cancer on CECT had evidence of disease on FDG-PET/CT images, which was supported by pathological proof.

Conclusion: [18F]-Fluorodeoxyglucose positron emission tomography/computed tomography is capable of detecting ovarian cancer recurrence in symptomatic patients with normal CA-125 levels and, in this setting, has slightly better sensitivity than CECT and can be considered as the frontline modality for all such patients.

  • CA-125
  • Ovarian cancer
  • Recurrence
  • Accuracy
  • CECT

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