FDG PET/CT case reportearly detection of ovarian cancer

NM case conference, 2008-01-18chairman: Nan-Jing Peng, MD

• 46 y/o female• SLE under regular medication• uterine myoma S/P hysterectomy 7-8 years ago• family history of lung cancer (father)

• Patient’s sister is a GYN doctor• Tumor marker checked every year: normal • Elevating CA-199 level in 2 months, CA-19-9: 209.6 U/ml on 2007-12-24

• Contrast-enhanced abdominal CT: negative• GYN echo: negative• Colonscopy: negative• FDG PET/CT on 2007-12-24

“Small” focal FDG uptake at left adnexa(SUVmax: early 3.7 and delayed 5.2)

Highly suspicious malignany

FDG PET/CT on 2007-12-24

left adnexa adjacent bowel adhesion

Debulking surgery on 2008-01-14

Pathology: mucinous adenocarcinoma of left ovary, stage Ia

• DDx: benign v.s. malignant ovarian lesion:DDx: benign v.s. malignant ovarian lesion:

• Increased ovarian 18F-FDG uptake: (1) postmenopausal patients: indicated malignancy

(2) premenopausal patients: could be either malignant or functional

• SUV 7.9 separated benign from malignant ovarian uptake

• Many malignant and functional ovarian lesions had overlapping SUVs

• Detecting a dominant functional ovarian cyst on CT and discussing the menstrual cycle phase with the patient may assist in differentiating physiologic from malignant 18F-FDG ovarian uptake.

J Nucl Med 2004; 45:266–271

sensitivity specificity accuracy PPV NPV

57% 95% 85% 80% 86%

• Physiologic Ovarian UptakePhysiologic Ovarian Uptake

• long diameters: 2.0±0.3 cm

• early SUVmax: 4.4±1.5 g/ml

• delayed SUVmax: 5.0±1.62 g/ml

• FDG can accumulate in the normal ovarian follicle or corpus luteum.

• The typical spherical or discoid FDG accumulation in the ovary during the early luteal

phase or ovulatory phase represents normal physiological uptake.

• In premenopausal women it is preferable to schedule pelvic FDG PET scans within a

few days after the start of menstruation.

Eur J Nucl Med Mol Imaging (2005) 32:757–763