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Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации

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PET-CT IN THE DIAGNOSIS OF OVARIAN CANCER

Trishina

Sofiya D.

Resident doctor of the 1st year of the Department of Instrumental Diagnostics in the direction of "Radiology"79202256757@yandex.ruhttps://orcid.org/0000-0002-6499-3326Andreeva

Anna A.

Resident doctor of the 1st year of the Department of Instrumental Diagnostics in the direction of "Radiology"ania.an-net@yandex.ruhttps://orcid.org/0000-0002-4895-794XChernicyn

Kirill I.

Postgraduate student of the Department of Instrumental Diagnostics, Head of the Diagnostic Department, radiologist of the Interregional Medical Center for Early Diagnosis and Treatment of Oncological DiseasesDockich@gmail.comhttps://orcid.org/0000-0001-5934-9504

Voronezh mtate medical university named after N. N. BurdenkoVoronezh state medical university named after N. N. Burdenko

20042023

12S2219221

13022023

16032023

2023

Relevance. Ovarian cancer is the fifth leading cause of death among women worldwide. Patients are known to have a very poor prognosis. In this regard, the diagnosis of ovarian carcinoma at the stage of cystitis is part of the difficult and demanding treatment. As a result, a decrease in the death rate and an increase in life expectancy. Objective: to study the possibilities and importance of PET-CT in the diagnosis of ovarian cancer in comparison with other methods of visualization of malignant neoplasms. Evaluate the advantages and disadvantages of this method. Methods: a literature search was conducted on the etiology, epidemiology, classification and clinical picture of ovariocarcinomas. The search was also conducted on the latest updates and advances in ovarian cancer imaging, including PET-CT. Results: Ovarian cancer is one of the types of gynecological cancer that is detected all over the world. In the structure of oncological diseases among the female population of Russia, he ranks 9th. The exact cause of ovariocarcinomas is unknown. Currently, the stage is determined based on the classification of FIGO (2014) and TNM. Diagnosis using PET-CT with 18-FDG has the greatest effectiveness and visualization of pathological processes in the ovaries with an increase in the level of protein-antigen CA-125 in the blood serum, as well as inaccurate and insufficient data as a result of CT or MRI studies. The maximum standardized absorption value using F-18 FDG PET-CT showed high diagnostic accuracy for differentiating epithelial ovarian cancer from benign pelvic tumors, including ovarian cancer at an early stage. But there is a need to refine the correct interpretation of the results of PET-CT with 18-FDG and integrate this method as a treatment planning aid. Conclusion: ovarian cancer is one of the most common malignant neoplasms in the world with significant morbidity and mortality. Advances in imaging are aimed at early detection, accurate stage determination, early relapse detection and lesion detection. PET-CT with 18-FDG is one of the most modern and high-quality methods in the diagnosis of ovariocarcinomas, allows to improve the process of early detection of the disease and establish the necessary treatment plan. However, this instrumental diagnostic method requires refinement and improvement of the interpretation of the results, since there are cases of inaccurate tracing and clarification of complex clinical cases, which can lead to an acceleration of the development of the pathological process due to incorrectly initiated or not initiated treatment.

overviewovarian cancerepithelial ovarian cancerinstrumental diagnosisPET-CT

обзоррак яичниковэпителиальный рак яичниковинструментальная диагностикаПЭТ-КТ

Relevance. Ovarian cancer is the fifth most common cause of death among the female population worldwide. It is known that the prognosis of these patients is extremely unfavorable. In this regard, the diagnosis of ovarian carcinoma in the early stages is an integral part of proper and timely treatment. As a result, a decrease in the mortality rate and an increase in life expectancy. Objective: to study the possibilities and importance of PET-CT in the diagnosis of ovarian cancer in comparison with other methods of visualization of malignant neoplasms. Evaluate the advantages and disadvantages of this method. Materials and methods: a literature search was conducted on the etiology, epidemiology, classification and clinical picture of ovariocarcinomas. The search was also conducted on the latest updates and advances in ovarian cancer imaging, including PET-CT. Results: Ovarian cancer ranks 9th in the structure of oncological diseases among the female population of Russia. Approximately 13.7% of ovarian cancer cases are detected at the local stage, and about 52% of cases are detected at the metastasis stage, at which the five-year survival rate reaches 29.7% instead of 91.8% if the diagnosis was made earlier, before local spread. The exact cause of ovariocarcinomas is unknown. Currently, the stage is determined based on the classification of FIGO (2014) and TNM. In the early stages, the disease may be asymptomatic or with minor symptoms of discomfort, which significantly complicates the early detection of the disease. George Rusu, Patricio Achimas-Kadariu, Andra Pichiu, etc. in their study "Comparative study between 18F-deoxyglucose (hereinafter 18F-FDG) PET-CT and conventional imaging in the assessment of progressive disease and recurrence of ovarian carcinoma" they write that positron emission tomography is a more effective and effective method in detecting newly identified epithelial tumors of the ovaries in comparison with various traditional methods visualizations. Also, timely diagnosis using PET-CT with 18F-FDG led to a change in therapeutic and surgical tactics in 55.17% of patients in their group, compared with only 17.24% after diagnosis using conventional imaging. The authors draw our attention to the fact that PET-CT with 18F-FDG still remains the only tool that helps to determine not only the morphological features of the tumor, but also its metabolic changes. In the scientific work "Diagnostic value of integrated PET-CT with 18F-fluoro-2-deoxyglucose in recurrent epithelial ovarian cancer", Yang Jae Lee, Yun Man Kim, Phil Seung Jung et al. conclude that the diagnosis using positron emission computed tomography with 18F-FDG has a high informative value and visualization of pathological processes in the ovaries with an increase in the level of the protein-antigen CA-125 in the blood serum, as well as with inaccurate or insufficient data as a result of CT or MRI studies. The scientists selected 134 patients who underwent total cytoreductive surgery after imaging the neoplasm using PET-CT with 18F-FDG, and made sure that 124 of them (92.5%) had a positive result of recurrence of epithelial ovarian cancer. Among them, 72 patients were suspected of an undisseminated relapse according to PET-CT with 18F-FDG, as a result, 65 (89.0%) patients were confirmed to have relapse. These data suggest that PET-CT with 18F-FDG has 98.5% sensitivity, 87.7% accuracy and 88.9% positive prognostic value. The average preoperative level of cancer antigen 125 (CA-125) in patients with a false positive result was 28.8 units/ml. In his article "Diagnostic indicators of PET/CT with 18F-FDG compared to CA125, HE4 and ROMA in epithelial ovarian cancer", the authors of which are Song Song Lee, Ji Sun Park, Ken Bok Lee and others. An analysis was conducted to study the diagnostic value of positron emission tomography based on 18F-FDG with computed tomography compared with cancer antigen 125 (CA125), human testicular appendage protein 4 (HE4) and risk assessment of ovarian malignancies (ROMA) for the detection of epithelial ovarian cancer from benign tumors. For the study, the authors selected 46 patients with pelvic tumors who underwent PET-CT with 18F-FDG, CA125 and HE4 before surgery in the period from January 2015 to December 2018. According to the results of the analysis, the authors revealed that among 46 patients, 28 had ovarian cancer, and 18 were benign. The mean values of CA125, HE4, ROMA and the maximum standardized absorption value (SUVmax) were significantly higher in the group with ovarian cancer than in the group with benign tumors. In the early stages of cancer (stages I and II), the area under the curve for the maximum standardized absorption value was significantly higher than that of CA125 and ROMA (0.778 for CA125, 0.753 for HE4, 0.682 for ROMA and 0.922 for SUVmax).). Discussion: PET-CT with F18-FDG is one of the most important imaging methods used in the diagnosis and treatment of ovariocarcinomas. Diagnosis using PET-CT with F18-FDG has the greatest informativeness and visualization of pathological processes in the ovaries with an increase in the level of protein-antigen CA-125 in the blood serum, as well as with inaccurate or insufficient data as a result of CT or MRI studies. The maximum standardized absorption value using F18-FDG in PET-CT showed high diagnostic accuracy for differentiating epithelial ovarian cancer from benign pelvic tumors, including ovarian cancer at an early stage. But there is a need to refine the correct interpretation of PET-CT results with F18-FDG and integrate this method as a treatment planning aid. Conclusions: ovarian cancer is one of the most common malignant neoplasms in the world with significant morbidity and mortality. Advances in imaging are aimed at early detection, accurate stage determination, early relapse detection and lesion detection. PET-CT with F18-FDG is one of the most modern and high-quality methods in the diagnosis of ovariocarcinomas, allows to improve the process of early detection of the disease and establish the necessary treatment plan. However, this instrumental diagnostic method requires refinement and improvement of the interpretation of the results, since there are cases of inaccurate tracing and clarification of complex clinical cases, which can lead to an acceleration of the development of the pathological process due to incorrectly initiated or not initiated treatment.

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Клинические рекомендации: Рак яичников/рак маточной трубы/первичный рак брюшины(фельдшеров) / ред. совет: Ашрафян Л.А., [и др.]. – Москва: ГЭОТАР-Медиа, 2020. – 73 с.

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Zamwar UM, Anjankar AP. Aetiology, Epidemiology, Histopathology, Classification, Detailed Evaluation, and Treatment of Ovarian Cancer. Cureus. 2022 Oct 21;14(10):e30561. doi: 10.7759/cureus.30561. PMID: 36415372; PMCID: PMC9676071. Available ftom: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9676071/

George R., Patriciu A., Andra P., …, et al. Comparative Study between 18F-FDG PET/CT and Conventional Imaging in the Evaluation of Progressive Disease and Recurrence in Ovarian Carcinoma [Internet]. 2021 Jun [cited 2022 Feb5]; 3;9(6):666. doi: 10.3390/healthcare9060666. Available ftom: https://pubmed.ncbi.nlm.nih.gov/34205173/

Young J. L., Yong M. K., Phill S. J., …, et al. Diagnostic value of integrated ¹⁸F-fluoro-2-deoxyglucose positron emission tomography/computed tomography in recurrent epithelial ovarian cancer[Internet].2018 May[cited 2022 Feb5];29(3):e36. doi: 10.3802/jgo.2018.29.e36. Available ftom: https://pubmed.ncbi.nlm.nih.gov/29400023/

Sun Seong Lee, Ji Sun Park, Kyung Bok Lee, Dae Hoon Jeong, Jung Mi Byun, Seok Mo Lee. Diagnostic Performance of F-18 FDG PET/CT Compared with CA125, HE4, and ROMA for Epithelial Ovarian Cancer., 2021 Apr 1;22(4):1123-1127. doi:10.31557/APJCP.2021.22.4.1123. Available ftom: https://pubmed.ncbi.nlm.nih.gov/33906304/