CA 125, PET alone, PET–CT, CT and MRI in diagnosing recurrent ovarian carcinoma: A systematic review and meta-analysis
Introduction
It is widely known that carcinoma of the ovary is the third commonest tumor of the female genital tract after carcinomas of the cervix and endometrium; however, its prognosis is relatively poor since it accounts for approximately half of all deaths caused by those tumors [1], [2]. It is initially sensitive to platinum-based cytotoxic chemotherapy after the primary cytoreductive surgery. The overall response rate with primary therapy is about 80%. However, 60–70% of patients will eventually relapse [3] and the median survival time of patients with recurrent ovarian cancer ranges from 12 to 24 months [4]. The value of early detection of recurrent disease continues to be debated, and there is no evidence to support which early treatment for its recurrence can produce more prolonged survival [5]. However, with the development of new target drugs, the accurate diagnosis of its recurrent will probably afford a better chance that its prolonged remission and sustained quality of life could be attained due to its appropriate salvage treatment [6].
Diagnostic second-look laparotomy (SLL) is, conventionally, considered to be the gold standard of the detection of recurrent ovarian carcinoma [7], [8], [9], however, since SLL is still an invasive modality which may have the potential surgical complications and high anesthesia risk, there is the need for a noninvasive diagnostic tool. Although extensive researches have been performed with regard to the diagnostic performance of noninvasive methods for the detection of recurrent ovarian carcinoma, such as CA 125, PET alone, PET–CT, CT and MRI, the optimal diagnostic tool has yet not been identified.
Havrilesky [10] performed a meta-analysis to assess the diagnostic performance of FDG-PET in comparison with that of CT and MRI in the patients with ovarian cancer; however, it did not assess another important noninvasive method—CA 125, which is widely used both in surveillance and follow up. Furthermore a relatively small population of recurrent ovarian cancer patients was conducted in only 5 studies included. Thus, the aim of our study was to perform a comprehensive systematic review to obtain the overall diagnostic performance of CA 125, PET alone, PET–CT, CT and MRI for the detection of recurrent ovarian cancer on a per-patient and a per-lesion basis, which to our knowledge, had not previously been studied.
Section snippets
Literature search
A comprehensive computer literature search [11] of abstracts about studies in human subjects was performed to identify articles about the diagnostic performance of CA 125, PET (interpreted with or without the use of CT), CT and MRI for the detection of recurrent ovarian cancer. The MEDLINE and EMBASE databases, from January 1995 to November 2007, were used with the following key words (“PET” OR “positron emission tomography” OR “FDG” OR “fluorodeoxyglucose” OR “CT” OR “computed tomography” OR
Literature search and study design characteristics
Our research yielded 272 primary studies, of which 238 (87.5%) were excluded (Fig. 1). The reasons for exclusion were (a) researchers in the articles did not use histopathologic analysis or close clinical and imaging follow-up for at least 6 months (n = 195). (b) Researchers in the articles did not use report data that could be used to construct or calculate true-positive, false-positive, true-negative and false-negative (n = 34). (c) Researchers used sequential test combinations (n = 3). (d) Data
Discussion
It is widely known that recurrence is often a major clinical problem for patients who have undergone surgery due to malignant tumors, in particular ovarian cancer has a propensity for recurrence even after primary chemotherapy in early-stage tumor [55], so clinical follow-up is crucial for patients with ovarian cancer. This meta-analysis focused on evaluating the diagnostic ability of CA 125, PET (interpreted with or without the use of CT), CT and MRI, which are the widely used noninvasive
Conclusion
This meta-analysis was the first report that assessed and compared summary estimates of overall diagnostic ability for those noninvasive methods that were currently used for detecting recurrent ovarian cancer. If CA 125, PET alone, PET–CT, CT and MRI were compared with each other, the results of our meta-analysis demonstrated that PET–CT might be a useful supplement to current surveillance techniques, particularly for those patients with an increasing CA 125 level and negative CT or MR imaging,
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They contributed equally to this work as first author.