Imaging of ovarian cancer: Current concepts.

Rui Tiago Gil, Teresa Margarida Cunha, Mariana Horta

Abstract


Despite the advances in medicine over the past decades, ovarian cancer remains a major clinical and radiological challenge worldwide, with the highest mortality rate among gynaecologic malignancies. Modern histopathological and molecular genetic studies contributed to understand the pathogenesis of ovarian cancer, which now includes a heterogeneous group of malignant epithelial tumours that share the same origin as tubal cancer and peritoneal primary cancer. Based on this knowledge, the International Federation of Gynaecology and Obstetrics (FIGO) staging system was revised in 2014, providing better prognostic information and reinforcing personalised management of ovarian cancer. In accordance, there are now evidence-based imaging recommendations that provide accurate characterisation of adnexal masses that all radiologists should be aware of. Accurate mapping of tumour burden and distribution of disease by imaging plays a central role in treatment stratification and in predicting the success of cytoreductive surgery. The purpose of this article is to review the clinicopathological characteristics of ovarian cancer and their impact on radiological assessment, staging and therapeutic approach.


Keywords


ovarian cancer; gynaecologic diseases; cancer; imaging

Full Text:

PDF

References


Ledermann JA, Raja FA, Fotopoulou C, et al. Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 Suppl 6: vi 24-32.

Jayson GC, Kohn EC, Kitchener HC, et al. Ovarian cancer. Lancet 2014; 384: 1376-1388.

Spencer JA, Forstner R, Cunha TM, et al. ESUR guidelines for MR imaging of the sonographically indeterminate adnexal mass: an algorithmic approach. Eur Radiol 2010; 20(1): 25-35.

Kurman RJ, Carcangiu ML, Herrington CS, et al. Classification of tumours of the ovary. In: WHO classification of tumours, Vol. 6. 4th ed. Lyon: IARC Press 2014.

Cannistra SA, Gershenson DM, Recht A. Ovarian cancer, fallopian tube carcinoma, and peritoneal carcinoma. In: DeVita VT, Lawrence TS, Rosenberg SA (eds). DeVita, Hellman, and Rosenberg’s cancer: principles and practice of oncology. Lippincott, Williams & Wilkins, Philadelphia, PA 2011: pp 1368-1391.

Rendi MH. Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: histopathology. Available via www.uptodate.com. Published 2016. Updated June 26, 2017; Accessed January 19, 2018.

Prat J. FIGO Committee on Gynecologic Oncology. Staging classification for cancer of the ovary, fallopian tube, and peritoneum. Int J Gynaecol Obstet 2014; 124(1): 1-5.

Holschneider CH, Berek JS. Ovarian cancer: epidemiology, biology, and prognostic factors. Semin Surg Oncol 2000; 19: 3-10.

Hartge P, Whittemore A, Itnyre J, et al. Rates and risks of ovarian cancer in subgroups of white women in the United States. Obstet Gynecol 1994; 84: 760-764.

Weiderpass E, Tyczynscki JE. Epidemiology of patients with ovarian cancer with and without a BRCA1/2 Mutation. Mol Diagn Ther 2015; 19(6): 351-364.

Javadi S, Ganeshan DM, Qayyum A, et al. Ovarian cancer, the revised figo staging system, and the role of imaging. AJR Am J Roentgenol 2016; 206(6): 1351-1360.

Jayson GC, Kohn EC, Kitchener HC, et al. Ovarian cancer. Lancet 2014; 384(9951): 1376-1388.

Banerjee S, Kaye SB. New strategies in the treatment of ovarian cancer: current clinical perspectives and future potential. Clin Cancer Res 2013; 19(5): 961-968.

Lalwani N, Prassad SR, Vikram R, et al. Histologic, molecular, and cytogenetic features of ovarian cancers: implication for diagnosis and treatment. Radiographics 2011; 31(3): 625-646.

Kurman RJ, Shih IeM. The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory. Am J Surg Pathol 2010; 34: 433-443.

Colombo N, Peiretti M, Garbi A, et al. Non-epithelial ovarian cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012; Suppl 7: vii20–vii26.

Tewari K, Cappuccini F, Disaia PJ, et al. Malignant germ cell tumours of the ovary. Obstet Gynecol 2000; 95(1): 128-133.

Horta M, Cunha TM. Sex cord-stromal tumors of the ovary: a comprehensive review and update for radiologists. Diagn Interv Radiol 2015; 21: 277-286.

Chen VW, Ruiz B, Killeen JL, et al. Pathology and classification of ovarian tumours. Cancer 2003; 97(10): 2631-2642.

Vernooij F, Heintz P, Witteveen E, et al. The outcomes of ovarian cancer treatment are better when provided by gynecologic oncologists and in specialized hospitals: a systematic review. Gynecol Oncol 2007; 105: 801-812.

Levine D, Asch E, Mehta TS, et al. Assessment of factors that affect the quality of performance and interpretation of sonography of adnexal masses. J Ultrasound Med 2008; 27: 721-728.

Nunes N, Ambler G, Foo X, et al. Use of IOTA simple rules for diagnosis of ovarian cancer: meta-analysis. Ultrasound Obstet Gynecol 2014; 44: 503-514.

Brown DL, Doubilet PM, Miller FH, et al. Benign and malignant ovarian masses: selection of the most discriminating gray-scale and Doppler sonographic features. Radiology 1998; 208: 103-110.

Kinkel K, Lu Y, Mehdizade A, et al. Indeterminate ovarian mass at US: incremental value of second imaging test for characterization-meta-analysis and Bayesian analysis. Radiology 2005; 236(1): 85-94.

Van Calster B, Timmerman D, Valentin L, et al. Triaging women with ovarian masses for surgery: observational diagnostic study to compare RCOG guidelines with an International Ovarian Tumour Analysis (IOTA) group protocol. BJOG 2012; 119: 662-671.

Forstner R, Meissnitzer M, Cunha TM. Update on imaging of ovarian Cancer. Curr Radiol Rep 2016; 4: 31.

Anthoulakis C, Nikoloudis N. Pelvic MRI as the ‘‘gold standard’’ in the subsequent evaluation of US-indeterminate adnexal lesions: a systematic review. Gynecol Oncol 2014; 132(3): 661-668.

Forstner R, Thomassin-Naggara I, Cunha TM, et al. ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an update. Eur Radiol 2017; 27(6): 2248-2257.

Namimoto T, Awai K, Nakaura T, et al. Role of diffusion-weighted imaging in the diagnosis of gynecological diseases. Eur Radiol 2009; 19(3): 745-760.

Thomassin-Naggara I, Daraï E, Cuenod CA, et al. Contribution of diffusion-weighted MR imaging for predicting benignity of complex adnexal masses. Eur Radiol 2009; 19(6): 1544-1552.

Thomassin-Naggara I, Toussaint I, Perrot N, et al. Characterization of complex adnexal masses: value of adding perfusion- and diffusion-weighted MR imaging to conventional MR imaging. Radiology 2011; 258(3): 793-803.

Johnson W, Taylor MB, Carrington BM, et al. The value of hyoscine butyl-bromide in pelvic MRI. Clin Radiol 2007; 62: 1087-1093.

Li HM, Qiang JW, Ma FH, et al. The value of dynamic contrast-enhanced MRI in characterizing complex ovarian tumours. J Ovarian Res 2017; 10(1): 4.

Dias JL, Gomes FV, Lucas R, et al. The shading sign: is it exclusive of endometriomas? Abdom Imaging 2015; 40(7): 2566-2572.

Corwin MT, Gersovich EO, Lamb R, et al. Differentiation of Ovarian endometriomas from haemorrhagic cysts at MR imaging: Utility of the T2 dark spot sign. Radiology 2014; 271(1): 126-132.

Oh SN, Rha SE, Byun JY, et al. MRI features of ovarian fibromas: emphasis on their relationship to the ovary. Clin Radiol 2008; 63(5): 529-535.

Thomassin-Naggara I, Daraï E, Nassar-Slaba J, et al. Value of dynamic enhanced magnetic resonance imaging for distinguishing between ovarian fibroma and subserous uterine leiomyoma. J Comput Assist Tomogr 2007; 31: 236-242.

Foti PV, Attina G, Spadola S, et al. MR imaging of ovarian masses: classification and differential diagnosis. Insights Imaging 2016; 7(1): 21-41.

Hricak H, Chen M, Coakley FV, et al. Complex adnexal masses: detection and characterization with MR imaging-multivariate analysis. Radiology 2000; 214(1): 39-46.

Ghattamaneni S, Bhuskute N, Weston MJ, et al. Discriminative MRI features of fallopian tube masses. Clin Radiol 2009; 64(8): 815-831.

Mitchell DG, Javitt MC, Glanc P, et al. ACR Appropriateness criteria staging and follow-up of ovarian cancer. J Am Coll Radiol 2013; 10(11): 822-827.

Tognon G, Carnazza M, Ragnoli M, et al. Prognostic factors in early-stage ovarian cancer. Ecancermedicalscience 2013; 7: 325.

Kandukuri SR, Rao J. FIGO 2013 staging system for ovarian cancer: what is new in comparison to the 1988 staging system? Curr Opin Obstet Gynecol 2015; 27(1): 48-52.

Zeppernick F, Meinhold-Heerlein I. The new FIGO staging system for ovarian, fallopian tube, and primary peritoneal cancer. Arch Gynecol Obstet 2014; 290(5): 839-842.

Suidan RS, Ramirez PT, Sarasohn DM, et al. A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer. Gynecol Oncol 2014; 134(3): 455-461.

Borley J, Wilhelm-Benartzi C, Williamson R, et al. Radiological predictors of cytoreductive outcomes in patients with advanced ovarian cancer. BJOG 2015; 122(6): 843-849.

Spencer JA, Weston MJ, Saidi SA, et al. Clinical utility of image-guided peritoneal and omental biopsy. Nat Rev Clin Oncol 2010; 7(11): 623-631.

Rockall A. Diffusion weighted MRI in ovarian cancer. Curr Opin Oncol 2014; 26: 529-535.

Suidan RS, Ramirez PT, Sarasohn DM, et al. A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer. Gynecol Oncol 2014; 34: 455-461.

Borley J, Wilhelm-Benartzi C, Williamson R, et al. Radiological predictors of cytoreductive outcomes in patients with advanced ovarian cancer. BJOG 2015; 122(6): 843-849.

Gomez-Hildago NR, Martinez-Cannon BA, et al. Predictors of optimal cytoreduction in patients with newly diagnosed advanced-stage epithelial ovarian cancer: time to incorporate laparoscopic assessment into the standard of care. Gynecol Oncol 2015; 137: 553-558.

Low RN, Barone RM, Lucero J. Comparison of MRI and CT for predicting the peritoneal cancer index (PCI) preoperatively in patients being considered for cytoreductive surgical procedures. Ann Surg Oncol 2015; 22: 1708-1715.

Kang SK, Reinhold C, Atri M, et al. ACR appropriateness criteria staging and follow-up of ovarian cancer. J Am Coll Radiol 2018; S198-S207.


Refbacks

  • There are currently no refbacks.