The diagnostic value of <sup>18</sup>F-FDG PET/CT in epithelial ovarian cancer recurrence: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

HU Shasha ^1,2 , WANG Xiaoyan ³ ,  LIU Chang ^1,2 , YANG Lifeng ³

1. The First Ward of the Department of Gynecology, the First Hospital of Lanzhou University, Lanzhou 730000, P. R. China;
2. Key Laboratory of Gynecological Oncology of Gansu Province, Lanzhou 730000, P. R. China;
3. School of Nursing, Hexi University, Zhangye 734000, P. R. China;

Corresponding author：

LIU Chang, Email: 814060052@qq.com

Keywords：

Epithelial ovarian cancer; Recurrence; ¹⁸F-FDG PET/CT; Diagnosis; Meta-analysis

DOI：

10.7507/1672-2531.202206069

Video：

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Objective To systematically review the diagnostic value of ¹⁸F-FDG PET/CT in recurrent epithelial ovarian cancer after treatment. Methods The PubMed, EMbase, Cochrane Library, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect diagnostic tests of ¹⁸F-FDG PET/CT for epithelial ovarian cancer from inception to February 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using Meta-Disc 1.4 and Stata 15.0 software. Results A total of 15 studies involving 792 patients were included in this study. The results of meta-analysis showed that the sensitivity, specificity, and area under the curve of ¹⁸F-FDG PET/CT in the diagnosis of recurrent epithelial ovarian cancer were 0.88 (95%CI 0.85 to 0.90), 0.80 (95%CI 0.75 to 0.85) and 0.91, respectively. The results of the subgroup analysis showed that the sensitivity of the prospective studies was the same as that of the retrospective studies, but the specificity of the prospective studies was higher than that of the retrospective studies. The diagnostic sensitivity and specificity of ¹⁸F-FDG PET/CT in recurrent epithelial ovarian cancer were higher in Asian studies than in European/North American studies. Conclusion ¹⁸F-FDG PET/CT has high diagnostic value in recurrent epithelial ovarian cancer. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： HU Shasha, WANG Xiaoyan, LIU Chang, YANG Lifeng. The diagnostic value of ¹⁸F-FDG PET/CT in epithelial ovarian cancer recurrence: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2023, 23(5): 528-533. doi: 10.7507/1672-2531.202206069 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	徐杰茹, 陈磊, 张敏, 等. 1990—2019年中国卵巢癌发病与死亡趋势及其年龄-时期-队列模型分析. 中国肿瘤, 2022, 31(4): 276-283.
3.	Perrone AM, Girolimetti G, Procaccini M, et al. Potential for mitochondrial DNA sequencing in the differential diagnosis of gynaecological malignancies. Int J Mol Sci, 2018, 19(7): 2048.
4.	The Cancer Genome Atlas Research Network. Integrated genomic analysis of ovarian carcinoma. Nature, 2011, 474: 609-615.
5.	Colombo N, Lorusso D, Scollo P. Impact of recurrence of ovarian cancer on quality of life and outlook for the future. Int J Gynecol Cancer, 2017, 27(6): 1134-1140.
6.	du Bois A, Reuss A, Pujade-Lauraine E, et al. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d'Investigateurs Nationaux Pour les Etudes des Cancers de l'Ovaire (GINECO). Cancer, 2009, 115(6): 1234-1244.
7.	Vahidfar N, Farzanefar S, Ahmadzadehfar H, et al. A review of nuclear medicine approaches in the diagnosis and the treatment of gynecological malignancies. Cancers (Basel), 2022, 14(7): 1779.
8.	Slart RHJA, Writing group, Reviewer group, et al. FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. Eur J Nucl Med Mol Imaging, 2018, 45(7): 1250-1269.
9.	Liu S, Feng Z, Wen H, et al. 18F-FDG PET/CT can predict chemosensitivity and proliferation of epithelial ovarian cancer via SUVmax value. Jpn J Radiol, 2018, 36(9): 544-550.
10.	Nawi NM, Mohamad I, Khader M, et al. Diagnostic accuracy of 18F-FDG PET/CT in the evaluation of recurrent ovarian cancer. Bangladesh J Medical Sci, 2021, 20(2): 302-312.
11.	西尔艾力·吾门尔, 赵艳萍. (18)F-FDGPET/CT显像联合CA125及HE4在上皮性卵巢癌患者术后复发/转移诊断中的价值. 分子影像学杂志, 2020, 43(1): 70-75.
12.	Vallius T, Hynninen J, Kemppainen J, et al. 18F-FDG-PET/CT based total metabolic tumor volume change during neoadjuvant chemotherapy predicts outcome in advanced epithelial ovarian cancer. Eur J Nucl Med Mol Imaging, 2018, 45(7): 1224-1232.
13.	Lee YJ, Kim YM, Jung PS, et al. Diagnostic value of integrated ¹⁸F-fluoro-2-deoxyglucose positron emission tomography/computed tomography in recurrent epithelial ovarian cancer: accuracy of patient selection for secondary cytoreduction in 134 patients. J Gynecol Oncol, 2018, 29(3): e36.
14.	李敏, 李绪清, 颜士杰, 等. (18)F-脱氧葡萄糖PET/CT联合CA125在诊断卵巢癌复发转移中的应用价值. 重庆医科大学学报, 2017, 42(12): 1635-1638.
15.	Kim TH, Kim J, Kang YK, et al. Identification of metabolic biomarkers using serial 18F-FDG PET/CT for prediction of recurrence in advanced epithelial ovarian cancer. Transl Oncol, 2017, 10(3): 297-303.
16.	Ghosh J, Thulkar S, Kumar R, et al. Role of FDG PET-CT in asymptomatic epithelial ovarian cancer with rising serum CA-125: a pilot study. Natl Med J India, 2013, 26(6): 327-331.
17.	Antunovic L, Cimitan M, Borsatti E, et al. Revisiting the clinical value of 18F-FDG PET/CT in detection of recurrent epithelial ovarian carcinomas: correlation with histology, serum CA-125 assay, and conventional radiological modalities. Clin Nucl Med, 2012, 37(8): e184-e188.
18.	Chung HH, Kwon HW, Kang KW, et al. PreoperativeFDG PET/CT predicts recurrence in patients with epithelial ovarian cancer. J Gynecol Oncol, 2012, 23(1): 28-34.
19.	奚嘉婧, 兰晓莉, 曹国祥, 等. ¹⁸F-FDG PET/CT显像在上皮性卵巢癌术后随访中的应用价值及对临床决策的影响. 中国医学影像技术, 2011, 27(7): 1451-1454.
20.	Nasu K, Abe W, Takai N, et al. Impact of positron emission tomography/computed tomography in the management of patients with epithelial ovarian carcinoma after treatment. Arch Gynecol Obstet, 2011, 283(5): 1121-1126.
21.	García-Velloso MJ, Jurado M, Ceamanos C, 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): 1396-1405.
22.	Murakami M, Miyamoto T, Iida T, 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.
23.	万卫星, 尤徐阳, 陆燕君, 等. ~(18)F-FDG符合线路显像在卵巢上皮性癌术后监测中的价值. 中华核医学杂志, 2005, (5): 22-25.
24.	Cho SM, Ha HK, Byun JY, et al. Usefulness of FDG PET for assessment of early recurrent epithelial ovarian cancer. AJR Am J Roentgenol, 2002, 179(2): 391-395.
25.	Lerman H, Metser U, Grisaru D, 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): 266-271.
26.	Anjos DA, Etchebehere EC, Ramos CD, et al. 18F-FDG PET/CT delayed images after diuretic for restaging invasive bladder cancer. J Nucl Med, 2007, 48(5): 764-770.
27.	Nakamoto Y, Saga T, Fujii S. Positron emission tomography application for gynecologic tumors. Int J Gynecol Cancer, 2005, 15(5): 701-709.
28.	Sun J, Cui XW, Li YS, et al. The value of 18F-FDG PET/CT imaging combined with detection of CA125 and HE4 in the diagnosis of recurrence and metastasis of ovarian cancer. Eur Rev Med Pharmacol Sci, 2020, 24(13): 7276-7283.
29.	Castellucci P, Perrone AM, Picchio M, 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): 589-595.
30.	Yuan Y, Gu ZX, Tao XF, 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): 1002-1006.
31.	郭佳, 陈跃. 18F-FDGPET/CT显像监测卵巢癌患者术后复发/转移的临床价值分析. 山东医药, 2011, 51(3): 55-56.
32.	Vargas HA, Burger IA, Goldman DA, et al. Volume-based quantitative FDG PET/CT metrics and their association with optimal debulking and progression-free survival in patients with recurrent ovarian cancer undergoing secondary cytoreductive surgery. Eur Radiol, 2015, 25(11): 3348-3353.
33.	Yamamoto M, Tsujikawa T, Fujita Y, et al. Metabolic tumor burden predicts prognosis of ovarian cancer patients who receive platinum-based adjuvant chemotherapy. Cancer Sci, 2016, 107(4): 478-485.
34.	Bono Y, Mizumoto Y, Nakamura M, et al. FDG-PET-positive ovarian thecoma with GLUT5 expression: five cases. J Obstet Gynaecol Res, 2017, 43(3): 599-603.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 徐杰茹, 陈磊, 张敏, 等. 1990—2019年中国卵巢癌发病与死亡趋势及其年龄-时期-队列模型分析. 中国肿瘤, 2022, 31(4): 276-283.
3. Perrone AM, Girolimetti G, Procaccini M, et al. Potential for mitochondrial DNA sequencing in the differential diagnosis of gynaecological malignancies. Int J Mol Sci, 2018, 19(7): 2048.
4. The Cancer Genome Atlas Research Network. Integrated genomic analysis of ovarian carcinoma. Nature, 2011, 474: 609-615.
5. Colombo N, Lorusso D, Scollo P. Impact of recurrence of ovarian cancer on quality of life and outlook for the future. Int J Gynecol Cancer, 2017, 27(6): 1134-1140.
6. du Bois A, Reuss A, Pujade-Lauraine E, et al. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d'Investigateurs Nationaux Pour les Etudes des Cancers de l'Ovaire (GINECO). Cancer, 2009, 115(6): 1234-1244.
7. Vahidfar N, Farzanefar S, Ahmadzadehfar H, et al. A review of nuclear medicine approaches in the diagnosis and the treatment of gynecological malignancies. Cancers (Basel), 2022, 14(7): 1779.
8. Slart RHJA, Writing group, Reviewer group, et al. FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. Eur J Nucl Med Mol Imaging, 2018, 45(7): 1250-1269.
9. Liu S, Feng Z, Wen H, et al. 18F-FDG PET/CT can predict chemosensitivity and proliferation of epithelial ovarian cancer via SUVmax value. Jpn J Radiol, 2018, 36(9): 544-550.
10. Nawi NM, Mohamad I, Khader M, et al. Diagnostic accuracy of 18F-FDG PET/CT in the evaluation of recurrent ovarian cancer. Bangladesh J Medical Sci, 2021, 20(2): 302-312.
11. 西尔艾力·吾门尔, 赵艳萍. (18)F-FDGPET/CT显像联合CA125及HE4在上皮性卵巢癌患者术后复发/转移诊断中的价值. 分子影像学杂志, 2020, 43(1): 70-75.
12. Vallius T, Hynninen J, Kemppainen J, et al. 18F-FDG-PET/CT based total metabolic tumor volume change during neoadjuvant chemotherapy predicts outcome in advanced epithelial ovarian cancer. Eur J Nucl Med Mol Imaging, 2018, 45(7): 1224-1232.
13. Lee YJ, Kim YM, Jung PS, et al. Diagnostic value of integrated ¹⁸F-fluoro-2-deoxyglucose positron emission tomography/computed tomography in recurrent epithelial ovarian cancer: accuracy of patient selection for secondary cytoreduction in 134 patients. J Gynecol Oncol, 2018, 29(3): e36.
14. 李敏, 李绪清, 颜士杰, 等. (18)F-脱氧葡萄糖PET/CT联合CA125在诊断卵巢癌复发转移中的应用价值. 重庆医科大学学报, 2017, 42(12): 1635-1638.
15. Kim TH, Kim J, Kang YK, et al. Identification of metabolic biomarkers using serial 18F-FDG PET/CT for prediction of recurrence in advanced epithelial ovarian cancer. Transl Oncol, 2017, 10(3): 297-303.
16. Ghosh J, Thulkar S, Kumar R, et al. Role of FDG PET-CT in asymptomatic epithelial ovarian cancer with rising serum CA-125: a pilot study. Natl Med J India, 2013, 26(6): 327-331.
17. Antunovic L, Cimitan M, Borsatti E, et al. Revisiting the clinical value of 18F-FDG PET/CT in detection of recurrent epithelial ovarian carcinomas: correlation with histology, serum CA-125 assay, and conventional radiological modalities. Clin Nucl Med, 2012, 37(8): e184-e188.
18. Chung HH, Kwon HW, Kang KW, et al. PreoperativeFDG PET/CT predicts recurrence in patients with epithelial ovarian cancer. J Gynecol Oncol, 2012, 23(1): 28-34.
19. 奚嘉婧, 兰晓莉, 曹国祥, 等. ¹⁸F-FDG PET/CT显像在上皮性卵巢癌术后随访中的应用价值及对临床决策的影响. 中国医学影像技术, 2011, 27(7): 1451-1454.
20. Nasu K, Abe W, Takai N, et al. Impact of positron emission tomography/computed tomography in the management of patients with epithelial ovarian carcinoma after treatment. Arch Gynecol Obstet, 2011, 283(5): 1121-1126.
21. García-Velloso MJ, Jurado M, Ceamanos C, 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): 1396-1405.
22. Murakami M, Miyamoto T, Iida T, 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.
23. 万卫星, 尤徐阳, 陆燕君, 等. ~(18)F-FDG符合线路显像在卵巢上皮性癌术后监测中的价值. 中华核医学杂志, 2005, (5): 22-25.
24. Cho SM, Ha HK, Byun JY, et al. Usefulness of FDG PET for assessment of early recurrent epithelial ovarian cancer. AJR Am J Roentgenol, 2002, 179(2): 391-395.
25. Lerman H, Metser U, Grisaru D, 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): 266-271.
26. Anjos DA, Etchebehere EC, Ramos CD, et al. 18F-FDG PET/CT delayed images after diuretic for restaging invasive bladder cancer. J Nucl Med, 2007, 48(5): 764-770.
27. Nakamoto Y, Saga T, Fujii S. Positron emission tomography application for gynecologic tumors. Int J Gynecol Cancer, 2005, 15(5): 701-709.
28. Sun J, Cui XW, Li YS, et al. The value of 18F-FDG PET/CT imaging combined with detection of CA125 and HE4 in the diagnosis of recurrence and metastasis of ovarian cancer. Eur Rev Med Pharmacol Sci, 2020, 24(13): 7276-7283.
29. Castellucci P, Perrone AM, Picchio M, 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): 589-595.
30. Yuan Y, Gu ZX, Tao XF, 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): 1002-1006.
31. 郭佳, 陈跃. 18F-FDGPET/CT显像监测卵巢癌患者术后复发/转移的临床价值分析. 山东医药, 2011, 51(3): 55-56.
32. Vargas HA, Burger IA, Goldman DA, et al. Volume-based quantitative FDG PET/CT metrics and their association with optimal debulking and progression-free survival in patients with recurrent ovarian cancer undergoing secondary cytoreductive surgery. Eur Radiol, 2015, 25(11): 3348-3353.
33. Yamamoto M, Tsujikawa T, Fujita Y, et al. Metabolic tumor burden predicts prognosis of ovarian cancer patients who receive platinum-based adjuvant chemotherapy. Cancer Sci, 2016, 107(4): 478-485.
34. Bono Y, Mizumoto Y, Nakamura M, et al. FDG-PET-positive ovarian thecoma with GLUT5 expression: five cases. J Obstet Gynaecol Res, 2017, 43(3): 599-603.

Chinese Journal of Evidence-Based Medicine

The diagnostic value of ¹⁸F-FDG PET/CT in epithelial ovarian cancer recurrence: a meta-analysis

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Chinese Journal of Evidence-Based Medicine

The diagnostic value of 18F-FDG PET/CT in epithelial ovarian cancer recurrence: a meta-analysis

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The diagnostic value of ¹⁸F-FDG PET/CT in epithelial ovarian cancer recurrence: a meta-analysis