The Diagnostic Value of FDG PET/CT in Detecting Ovarian Cancer Recurrence in Patients with Elevated CA-125 Levels: A Systematic Review and Meta-Analysis

Background levated levels of cancer antigen-125 (CA-125) are strongly associated with the likelihood of ovarian cancer recurrence, making it a significant concern in clinical practice. [18F]FDG PET/CT has emerged as a valuable tool for detecting recurrent ovarian cancer. This study aims to evaluate the diagnostic performance of [18F]FDG PET/CT in identifying ovarian cancer relapse among patients exhibiting rising CA-125 levels, through a systematic review and meta-analysis. Methods A comprehensive search was carried out across PubMed, Embase, and the Cochrane Library, encompassing all records up to July 2024. Studies were eligible for inclusion if they provided data on true positives (TP), false positives (FP), true negatives (TN), and false negatives (FN) regarding the detection of ovarian cancer recurrence in patients with elevated CA-125 levels. Studies were excluded if they were duplicates, lacked full-text availability, contained incomplete information or were unable to be included in data extraction, involved animal studies, or were reviews or systematic reviews. The data were analyzed using STATA version 15.1. Results Across all included studies, the pooled sensitivity and specificity were 0.94 (95% confidence interval (CI): 0.89–0.97) and 0.89 (95% CI: 0.71–0.96), respectively. The positive likelihood ratio (LR+) was 7.11 (95% CI: 2.75–18.38), while the negative likelihood ratio (LR–) was 0.07 (95% CI: 0.03–0.15). The overall diagnostic odds ratio (DOR) amounted to 99.20 (95% CI: 26.66–369.14). Additionally, the area under the receiver operating characteristic curve (AUC) reached 0.97 (95% CI: 0.95–0.98). Conclusion With its high sensitivity and specificity, [18F]FDG PET/CT serves as an effective tool for detecting ovarian cancer recurrence in patients exhibiting elevated CA-125 levels. These results endorse its effectiveness as a dependable diagnostic method in clinical settings. Advances in Knowledge This meta-analysis provides updated pooled evidence that [18F]FDG PET/CT demonstrates excellent diagnostic accuracy (AUC 0.97) in detecting ovarian cancer recurrence in patients with elevated CA-125. Compared with earlier meta-analyses limited to PET alone, our findings highlight the added value of integrated PET/CT systems in improving specificity and reducing false positives, thereby supporting its recommendation in international guidelines and strengthening its role in clinical decision-making for recurrent ovarian cancer.