Imaging for Recurrent High-Grade Serous Carcinoma at 6 Months
Rationale for Comprehensive Restaging
- The European Society for Medical Oncology (ESMO) guidelines recommend full re-staging including bone imaging in patients with recurrence, given the high risk of concomitant distant metastases 1, 2
- The standard approach for recurrent disease involves thoracic and abdominal CT as the preferred modality over plain radiography 1
Bone Metastasis Screening Strategy
- Symptomatic patients should undergo bone scintigraphy or radiography if they have signs and symptoms of bone metastases, including localized bone pain 3, 1
- Elevated bone-specific alkaline phosphatase (B-ALP) suggests bone involvement and warrants consideration of bone imaging 3, 4
- Patients with aggressive tumor biology warrant consideration of bone imaging 1, 4
Optimal Imaging Approach for HGSC Recurrence
- Contrast-enhanced CT of chest, abdomen, and pelvis is the cornerstone for restaging 1, 2
- PET/CT with 18FDG may be used instead of CT and bone scintigraphy when conventional methods are inconclusive 1, 2
Clinical Algorithm
- For asymptomatic recurrence at 6 months, obtain contrast-enhanced CT chest/abdomen/pelvis as primary restaging tool 1, 2
- If symptomatic or biochemical evidence exists, add bone scintigraphy or consider PET/CT 3, 1
- For symptomatic recurrence, full restaging with contrast-enhanced CT chest/abdomen/pelvis and bone-specific imaging (bone scan, PET/CT, or MRI) is recommended 1, 2, 3, 1