Staging Ovarian Cancer Using FDG PET/CT

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.00
Procedures: 1.00
Abdomen and Pelvis: 1.00

Magnetic Resonance Imaging: 1.00
Procedures: 1.00
Body: 1.00

Nuclear Medicine Technology: 2.00
Procedures: 2.00
Endocrine and Oncology Procedures: 2.00

Registered Radiologist Assistant: 2.50
Patient Care: 0.50
Patient Management: 0.50
Procedures: 2.00
Abdominal Section: 2.00

Sonography: 1.00
Procedures: 1.00
Gynecology: 1.00

Radiation Therapy: 2.00
Patient Care: 1.00
Patient and Medical Record Management: 1.00
Procedures: 1.00
Treatment Sites and Tumors: 1.00

Outline

1. Introduction
2. Ovarian Cancer
3. Patterns of Spread of Ovarian Cancer
4. Imaging of Recurrent Ovarian Cancer
5. PET/CT Findings of Ovarian Cancer Metastases
   1. Peritoneal Metastases
   2. Lymph Node Metastases
   3. Distant Organ Metastases
6. Evaluation of Response to Therapy
7. Pitfalls of PET/CT
8. Conclusions

Objectives

Upon completion of this course, students will:

1. be familiar with the most common causes of mortality in women with gynecological cancers
2. be familiar with initial treatments for ovarian cancer
3. be familiar with recurrence rate in women in ovarian cancer (post-surgical)
4. understand why PET/CT may be a useful diagnostic techniques for detection of ovarian cancer recurrence
5. understand which diagnostic techniques may have limited predictive value in the identification of ovarian cancer recurrence
6. understand the advantages of FDG PET/CT for the detection of ovarian cancer recurrences
7. understand that ovarian cancer is a malignancy that is frequently diagnosed at an advanced stage, that is, in three-quarters of women with ovarian cancer
8. be familiar with the five-year survival rates for patients with early stage and advanced stage disease
9. understand that the cornerstone of management for women with ovarian cancer is surgery
10. be familiar with the guidelines of the National Comprehensive Cancer Network for the diagnosis of ovarian cancer
11. be familiar with the treatment modalities that can prolong survival in women with recurrent ovarian cancer
12. be familiar with the path of tumor metastasis via lymph nodes
13. be familiar with the proportion of patients with Stages I, II, III-IV ovarian cancer malignancies with lymph node involvement
14. be familiar with difficulties in identifying small ovarian cancer metastasis
15. be familiar with sensitivity of FDG PET/CT for detection of recurrent cancer
16. be familiar with the specificity of FDG PET/CT for detection of recurrent cancer
17. be familiar with the sensitivity of MRI for the detection of recurrent cancer
18. be familiar with the specificity of MRI for the detection of recurrent cancer
19. understand how metabolic activity with FDG PET/CT imaging allows visualization of peritoneal metastases
20. be familiar with the type of fluid vessel or vasculature or circulation that carries metastatic ovarian tumor cells
21. be familiar with at least three of the structures to which peritoneal fluid carries metastatic tumor cells
22. be familiar with the percentage of patients in whom gravity facilitates spread of malignancy
23. be familiar with how ovarian cancer tumor cells seed the sigmoid mesocolon
24. understand the definition of Sister Mary Joseph nodules
25. be familiar with how retained embryofetal structures with residual patency may provide routes of metastasis
26. be familiar with how often lymphatic dissemination occurs in women with early stage ovarian cancer
27. understand which types of lymph node ovarian cancer metastases are not well detected with FDG PET/CT
28. be familiar with common findings on FDG PET/CT in stage IV (advanced) ovarian cancer
29. be familiar with the sensitivity of FDG PET/CT for detecting distant metastasis
30. be familiar with which diagnostic techniques work for assessing response to therapy
31. be familiar with how FDG PET/CT findings can predict overall survival of women with ovarian cancer
32. be familiar with the characteristics which may complicate FDG PET/CT response assessment in ovarian cancer patients who have been administered chemotherapy
33. understand which characteristics may complicate FDG PET/CT response assessment independent of treatment modality
34. understand that caution in interpreting FDG PET/CT findings needs to be exercised for at least 6 months post-surgery
35. understand the role of FDG PET/CT when other studies such as MRI are negative