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Diagnostic Value of Preoperative SUVmax on FDG-PET/CT for the Detection of Ovarian Cancer

Tanizaki, Yuko MD*; Kobayashi, Aya MD*; Shiro, Michihisa MD*; Ota, Nami MD*; Takano, Rei MD*; Mabuchi, Yasushi MD, PhD*; Yagi, Shigetaka MD*; Minami, Sawako MD, PhD*; Terada, Masaki MD, PhD; Ino, Kazuhiko MD, PhD*

International Journal of Gynecological Cancer: March 2014 - Volume 24 - Issue 3 - p 454–460
doi: 10.1097/IGC.0000000000000074
Ovarian Cancer

Objective The objective of this study was to investigate the preoperative diagnostic value of 18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography and computed tomography (PET/CT) in patients with ovarian cancer.

Methods One hundred sixty patients suspected of having malignant ovarian tumors were included in this study. All patients underwent FDG-PET/CT scans before operation, and the maximum standardized uptake value (SUVmax) of the primary tumor was measured. We evaluated the diagnostic accuracy of SUVmax for detecting malignancy and its relationship with histological findings.

Results Postoperative pathological diagnoses showed that 67 were malignant, 14 were borderline malignant, and 79 were benign tumors. With the use of a cutoff SUVmax of 2.9 obtained from the receiver operating characteristic curve analysis, the sensitivity, specificity, positive predictive value, and negative predictive value for detecting malignancy were 80.6%, 94.6%, 91.5%, and 87.1%, respectively. Positive FDG accumulation (SUVmax ≥ 2.9) was shown in 89.5% of serous adenocarcinoma and in 92.3% of endometrioid adenocarcinoma. In contrast, lower frequencies of positive FDG accumulation were shown in clear cell adenocarcinoma (54.5%), mucinous adenocarcinoma (66.7%), and metastatic carcinoma (66.7%), and the median SUVmax of these 3 histological types were significantly lower than those of serous and endometrioid types. In addition, a positive FDG accumulation was shown in all patients with malignant transformation of mature cystic teratoma. Finally, of the 14 borderline malignant tumors, only 2 (14.3%) showed positive FDG accumulation.

Conclusions The SUVmax on FDG-PET/CT is useful for differentiating ovarian cancer from borderline or benign tumor with a high specificity and positive predictive value. However, our data also demonstrated a lower FDG uptake value in clear cell or mucinous histological finding, suggesting that SUVmax may vary depending on the tumor histological subtype.

*Department of Obstetrics and Gynecology, Wakayama Medical University; and †Wakayama-Minami Radiology Clinic, Wakayama, Japan.

Address correspondence and reprint requests to Yuko Tanizaki, MD, Department of Obstetrics and Gynecology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan. E-mail:

The authors declare no conflicts of interest.

Received June 5, 2013

Accepted November 25, 2013

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.