Introduction/Background Epithelial ovarian cancer (EOC) is the most lethal gynecological malignancy, with relapse occurring in about 70% of advanced cases with poor prognosis. The aim of the study was to evaluate functional visceral fat activity (VAT) evaluated by 18F- fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) as a predictor of metastases in EOC.

Methodology We enrolled study protocols and PET/CT data of 398 CRC patients; 345 patients were subsequently excluded for various reasons. The remaining 53 patients with histologically confirmed adenocarcinoma, carcinoma and cystadenocarcinoma were then prospectively assessed and underwent ¹⁸F-FDG PET/CT after a surgical treatment and chemotherapy. Age, histology, stage, and tumor grade were recorded. Functional VAT activity was measured by maximum standardized uptake value (SUVmax) using 18F-FDG PET/CT and tested as a predictor of later metastases in eight abdominal locations (RE – Epigastric Region, RLH – Left Hypochondriac Region, RRL – Right Lumbar Region, RU – Umbilical Region, RLL – Left Lumbar Region, RRI – Right Inguinal Region, RP – Hypogastric (Pubic) Region, RLI – Left Inguinal Region) and pelvic cavity (P) in the adjusted regression models. We also identified the best areas under the curve (AUC) for SUVmax with the corresponding sensitivity (Se) and specificity (Sp).

Results In both adjusted for regression models and ROC analysis, 18F-FDG accumulation in RE (cut-off SUVmax 1.18; Se 64%; Sp 64%; AUC 0.669; p = 0.035) could predict later metastases in EOC patients, as opposed to age, sex, primary tumor location, tumor grade, and histology.

Conclusion Functional VAT SUVmax is significantly associated with later metastases in EOC patients and can be used as their predictor.