The Value of PET-CT in Ovarian Epithelial Carcinoma: A Population-Based Study in British Columbia, Canada

In epithelial ovarian cancer (EOC), consensus regarding optimal use of PET/CT is lacking. Limited evidence suggests its accuracy in preoperative staging, investigating recurrence and predicting optimal secondary debulking. This study evaluated indications for PET/CT, impact of PET/CT results on EOC management, and its added value over conventional imaging.

Patients with EOC aged 19 years and older who underwent PET/CT at BC Cancer Vancouver between January 2007 and September 2017 were eligible. Medical records were retrospectively reviewed with the following data abstracted: patient demographics, PET/CT indications and results, recent conventional imaging results, and application of PET/CT findings. Basic descriptive analysis was performed to determine most common use of PET/CT and its management impact.

257 PET/CTs in 216 patients were eligible. Most PET/CTs (135/257, 52.6%) were performed for suspected disease recurrence/progression. Management after PET/CT changed in 1/3 of cases with the greatest impact seen when assessing suitability in recurrent disease for focal radiotherapy or secondary surgical debulking. For 106/257 cases with recent conventional imaging available, although differences in disease extent were found in ~50%, clinical conclusions drawn were the same in ~75%.

Although PET/CT is most commonly used to investigate suspected recurrence/progression, its impact on management here is low. Greater impact is seen when considering localized therapy in EOC recurrence. When compared with recent conventional imaging, although PET/CT may detect differences in disease extent, clinical conclusions are frequently the same.

Impact of PET/CT on management is greatest in EOC recurrence when considering local therapies, beyond which clinical presentation and conventional imaging may suffice.