What is the appropriate use of CT in combination with tumor marker and medical examination findings in the follow-up of postoperative patients with ovarian cancer?

Abstract Background The aim of this study was to establish the appropriate use of CT in combination with tumor marker and medical examination findings in the follow-up of postoperative patients with ovarian cancer based on the recurrence pattern in CT imaging and clinical findings. Methods The subjects were 194 consecutive patients with primary ovarian cancer treated at our hospital between 2014 and 2019. Recurrence patterns on chest and abdominopelvic CT images obtained for routine postoperative follow-up were evaluated retrospectively to optimize scan range. Medical records were reviewed to determine whether clinical signs and symptoms (patient-reported symptoms and transvaginal ultrasound findings) and tumor markers levels can be sufficiently reliable indicators of recurrence. Results A total of 890 CT examinations were performed for the 194 patients. Data from the 146 patients with no residual disease at the first CT after standard treatment were analyzed. Recurrence was detected by CT in 15 patients: abdominopelvic recurrence alone in 12 patients, and concurrent chest and abdominopelvic recurrence in 3 patients (2.1%). Abdominopelvic recurrence preceded chest recurrence in all cases. At the time of CT-based recurrence, 13 patients (87%) had medical examination findings and/or elevated tumor markers, while the remaining 2 patients had neither. Conclusions Regular medical examination and tumor markers were useful for detecting recurrence, but overlooked 13% of patients with recurrence. This indicates that routine abdominopelvic CT is essential for follow-up. However, routine chest CT may not be beneficial unless abdominopelvic recurrence is seen.