Diagnostic Performance of F-18 FDG PET/CT Compared with CA125, HE4, and ROMA for Epithelial Ovarian Cancer

Abstract

Objective: This study aimed to examine the diagnostic performance of F-18 fluorodeoxyglucose positron emission tomography with computed tomography (F-18 FDG PET/CT) compared with cancer antigen 125 (CA125), human epididymis protein 4 (HE4), and risk of ovarian malignancy algorithm (ROMA) score to distinguish epithelial ovarian cancer from benign tumors.

Methods: A total of 46 patients with pelvic masses, who underwent F-18 FDG PET/CT, CA125, and HE4 before surgery between January 2015 and December 2018, were included in this retrospective study. The diagnostic performance of CA125, HE4, ROMA score, and maximum standardized uptake value (SUVmax) to differentiate epithelial ovarian cancer from benign pelvic tumors was examined by receiver operating characteristic curve analysis.

Results: Among the 46 patients, 28 were cases of ovarian cancers and 18 were of benign. The mean values of CA125, HE4, ROMA score, and SUVmax were significantly higher in the ovarian cancer group than the benign group. In early cancer stages (stages I and II), Area under the curve for SUVmax was significantly higher than CA125 and ROMA score (0.778 for CA125, 0.753 for HE4, 0.682 for ROMA score, and 0.922 for SUVmax).

Conclusion: SUVmax using F-18 FDG PET/CT showed a high diagnostic accuracy for differentiating epithelial ovarian cancer from benign pelvic tumors, including early stage ovarian cancer. F-18 FDG PET/CT can be a useful modality for the assessment of pelvic mass.<br />.

Keywords: Epithelial Ovarian Cancer; F-18 FDG PET/CT; ROMA score; SUVmax.

Figure 1

ROC Curves of CA125, HE4, ROMA Score, and SUVmax in Distinguishing Ovarian Cancers from benign Tumors. (a) ROC curves of all patients. (b) ROC curves of premenopausal patients. (c) ROC curves of postmenopausal patients. (d) ROC curves of early stage. (e) ROC curves of advanced stage. AUC, area under curve; CA125, Cancer antigen 125; HE4, human epididymis protein 4; ROMA, risk of ovarian malignancy algorithm; SUVmax, maximum standardized uptake value; ROC, receiver operating characteristic curve