Is Multidetector-Computed Tomography Scanning more accurate than 18F-fluorodeoxyglucose Positron Emission Tomography for diagnosing Ovarian Cancer in adolescent and adult patients? A structured literature review

Abstract

Aim: This review aims to verify of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18FDG-PET/CT), and Multidetector computed tomography (MDCT) in the differentiating between malignant and benign ovarian tumors and further in the detection recurrent ovarian cancer. Background & Rationale: Cancer is considered the most cause of mortality worldwide, and cancer of the ovary is the main reason for death among gynecologic malignancies in developed regions. The late presence of ovarian cancer's symptoms and late diagnosis lead to the increasing death-rate of women due to ovarian cancer becoming widespread throughout the peritoneal cavity. Ovarian cancer is considered an immense burden not only to patients and, but also for social economies and healthcare organizations. The history of the patient's family with ovarian cancer is the main certain risk factor for ovarian cancer. The mortality rate of ovarian cancer is expected to be increased significantly by the year 2040. The International Federation of Gynecology and Obstetrics (FIGO) classifies ovarian cancer into four main stages. The neoplasms of the ovary are malignant or benign, which divided into cystic or solid tumors. The malignant ovarian tumors are divided into epithelial ovarian cancer, sex cord-stromal tumors, and germ cell tumors. Methods: A structured literature review (SLR) was performed. PICO framework was conducted to frame the review's research question. Quantitative studies that were relevant to the question of this review and met the inclusion and exclusion criteria were searched based on the number of electronic databases. QUADAS-2 checklist to evaluate the risk of bias and quality of included studies. Results: All included researches that met the inclusion criteria evaluated the accuracy of 18FDG-PET/CT and MDCT scan by identifying the specificity and sensitivity of findings. Across all included studies, the sensitivity rate of 18FDG-PET/CT in the detection of recurrent ovarian cancer varied between 91% and 100%, and the specificity rate was 76%, and diagnostic accuracy ranged between 87% and 97.8%.The sensitivity rate and diagnostic accuracy of CT scans were 90.6% and 85.3%. On the other hand, the sensitivity and specificity rate of 18FDG-PET/CT and MDCT in the recognition of malignant and benign ovarian cancer were (91% versus 76%) and (67% versus 70%) respectively. 4 Conclusions: Descriptive data synthesis of included studies was conducted. Therefore, the result of this review indicates that 18FDG-PET/CT has higher diagnostic accuracy and sensitivity in the detection of recurrent ovarian cancer compared with CT scan. Furthermore, 18FDG-PET/CT has a higher sensitivity, but lower specificity than CT scan in the prediction of malignant and benign ovarian cancer in adolescent and adult patients. Further research is needed to evaluate the accuracy of MDCT and 18FDG-PET/CT in the diagnosis the recurrent ovarian cancer and differentiating between malignant and benign ovarian tumors because all included studies have heterogeneous characteristics, and they used different reference standards, which may underestimate the accuracy of these modalities.