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18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) predictive score for complete resection in primary cytoreductive surgery
  1. Felix Boria1,
  2. Luis Chiva2,
  3. Maria Carbonell3,
  4. Monica Gutierrez4,
  5. Lidia Sancho5,
  6. Andres Alcazar6,
  7. Monica Coronado7,
  8. Alicia Hernández Gutiérrez8 and
  9. Ignacio Zapardiel3
  1. 1Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Madrid, Spain
  2. 2Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
  3. 3Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
  4. 4Clinica Universidad de Navarra, Madrid, Spain
  5. 5Nuclear Medicine, Clinica Universidad de Navarra, Madrid, Spain
  6. 6Radiology Department, Clinica Universidad de Navarra, Madrid, Spain
  7. 7Nuclear Medicine, La Paz University Hospital, Madrid, University, Spain
  8. 8Gynecology Oncology, Hospital Universitario La Paz, Madrid, Spain
  1. Correspondence to Dr Luis Chiva, Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, 28027, Spain; lchiva{at}


Objective To assess the value of preoperative 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan, combined with clinical variables, in predicting complete cytoreduction in selected patients with advanced ovarian cancer.

Methods We carried out a multicenter, observational, retrospective study evaluating patients who underwent primary cytoreductive surgery for advanced ovarian cancer in two Spanish centers between January 2017 and January 2022. Inclusion criteria were histological confirmation of invasive epithelial ovarian carcinoma; preoperative International Federation of Gynecology and Obstetrics (FIGO) stage III or IV; upfront cytoreductive surgery; and 18F-FDG PET/CT performed 1 month prior to surgery. A modified 18F-FDG PET/CT peritoneal cancer index score was calculated for all patients. Clinical variables and preoperative 18F-FDG PET/CT findings were analyzed and a multivariate model was constructed. A predictive score based on the odds ratio of the variables was calculated to determine patient selection.

Results A total of 45 patients underwent primary cytoreductive surgery. Complete resection was achieved in 36 (80%) patients. On multivariate analysis, two clinical variables (age ≥58 years and American Society of Anesthesiology score ≥3) and two preoperative 18F-FDG PET/CT scan findings (presence of extra-abdominal lymph node involvement and modified peritoneal cancer index value of 6 or more) were associated with gross residual disease. For this multivariate model predictive of non-complete cytoreduction, the area under the curve was 0.881. A predictive value of ≥5 was the most predictive cut-off for gross residual disease. Complete resection rate was 91.7% in patients with a score of ≤4 and 33.3% in patients with a score of ≥5 points on the predictive score.

Conclusions In selected patients, a predictive score value ≥5 may be consider as a cut-off point for triaging patients to diagnostic laparoscopy before the primary surgery or neoadjuvant chemotherapy.

  • ovarian cancer
  • surgical oncology
  • preoperative care

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors All author contributed equally to this work. FB had the original idea and organized all of the study. LC and IZ contributed equally in the coordination of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.