THIN-SECTION CT FOLLOW-UP OF METASTATIC OVARIAN-CARCINOMA CORRELATIONWITH LEVELS OF CA-125 MARKER AND CLINICAL HISTORY

Second-look laparotomy and CA-125 are the gold standard in follow-up o f ovarian carcinoma. Since no definite role seems established for cros s-sectional imaging in assessment of recurrence we employed thin-secti on computed tomography (CT), correlated with CA-125 levels and detaile d knowledge of the clinical history as a follow-up protocol. One hundr ed seventy-seven patients with ovarian carcinoma were selected because of: (a) pathologically proven remission after first-line chemotherapy , (b) follow-up by means of thin-section CT every 6 months for the fir st 3 years and every 10 months subsequently, (c) monitoring CA-125 ser um levels every 3 months for the first 3 years and every 6 months subs equently (d) pathologic confirmation or clinical and laboratory follow -up after 12 months or longer from the CT findings. Fifty percent of t he patients showed recurrence of disease. Our protocol yielded 93.2% t rue positive, dubious findings in 5.6%, 1.0% false negatives, 97.7% tr ue negatives, and 2.3% false positive. with a tailored technique, CT w as particularly sensitive in early diagnosis of peritoneal seeding, ev en in the absence of ascites or increases in the levels of CA-125. Rep eated administration of contrast medium, water enemas, and repeated sc anning of suspicious volumes with differing scanning parameters cr ere the factors managed by the radiologist. We conclude that thin-section CT, correlated with CA-125 levels and careful review of the clinical history could represent a valid alternative to repeated explorative la parotomies in the follow-up of ovarian carcinomas. (C) Elsevier Scienc e Inc., 1998.