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Wilson MP, Sorour S, Bao B, Murad MH, Man V, Krill M, Low G. Diagnostic accuracy of contrast-enhanced CT versus PET/CT for advanced ovarian cancer staging: a comparative systematic review and meta-analysis. Abdom Radiol (NY) 2024:10.1007/s00261-024-04195-x. [PMID: 38523146 DOI: 10.1007/s00261-024-04195-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/07/2024] [Accepted: 01/12/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Accurate staging of ovarian cancer is critical to guide optimal management pathways. North American guidelines recommend contrast-enhanced CT as the primary work-up for staging ovarian cancer. This meta-analysis aims to compare the diagnostic accuracy of contrast-enhanced CT alone to PET/CT for detecting abdominal metastases in patients with a new or suspected diagnosis of ovarian cancer. MATERIALS AND METHODS A systematic review of MEDLINE, EMBASE, Scopus, the Cochrane Library, and the gray literature from inception to October 2022 was performed. Studies with a minimum of 5 patients evaluating the diagnostic accuracy of contrast-enhanced CT and/or PET/CT for detecting stage 3 ovarian cancer as defined by a surgical/histopathological reference standard ± clinical follow-up were included. Study, clinical, imaging, and accuracy data for eligible studies were independently acquired by two reviewers. Primary meta-analysis was performed in studies reporting accuracy on a per-patient basis using a bivariate mixed-effects regression model. Risk of bias was evaluated using QUADAS-2. RESULTS From 3701 citations, 15 studies (918 patients with mean age ranging from 51 to 65 years) were included in the systematic review. Twelve studies evaluated contrast-enhanced CT (6 using a per-patient assessment and 6 using a per-region assessment) and 11 studies evaluated PET/CT (7 using a per-patient assessment and 4 using a per-region assessment). All but one reporting study used consensus reading. Respective sensitivity and specificity values on a per-patient basis were 82% (67-91%, 95% CI) and 72% (59-82%) for contrast-enhanced CT and 87% (75-94%) and 90% (82-95%) for PET/CT. There was no significant difference in sensitivities between modalities (p = 0.29), but PET/CT was significantly more specific than CT (p < 0.01). Presumed variability could not be assessed in any single category due to limited studies using per-patient assessment. Studies were almost entirely low risk for bias and applicability concerns using QUADAS-2. CONCLUSION Contrast-enhanced CT demonstrates non-inferior sensitivity compared to PET/CT, although PET/CT may still serve as an alternative and/or supplement to CT alone prior to and/or in lieu of diagnostic laparoscopy in patients with ovarian cancer. Future revisions to existing guidelines should consider these results to further refine the individualized pretherapeutic diagnostic pathway.
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Affiliation(s)
- Mitchell P Wilson
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, Edmonton, Alberta, T6G 2B7, Canada.
| | - Sara Sorour
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Bo Bao
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Mohammad Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Room 2-54, 205 3rd Ave SW, Rochester, MN, 55905, USA
| | - Vincent Man
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Matthew Krill
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, Edmonton, Alberta, T6G 2B7, Canada
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Buehner TM, Liotta M, Potkul RK, Wagner RH, Savir-Baruch B. Initial Experience with the Radiotracer 18F-Fluciclovine PET/CT in Ovarian Cancer. Mol Imaging Biol 2024; 26:45-52. [PMID: 36754935 DOI: 10.1007/s11307-023-01807-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE Early and accurate staging of ovarian cancer is paramount to disease survival. Conventional imaging including FDG PET/CT are limited in the evaluation of small metastatic lesions. 18F-Fluciclovine has minimal urine and bowel excretion allowing optimal visualization of the abdomen and pelvis. This study examines 18F-fluciclovine uptake in known primary and recurrent ovarian cancer. METHODS Seven patients with a confirmed diagnosis of epithelial ovarian cancer underwent 18F-fluciclovine PET/CT imaging. Forty-one (41) lesions were identified with 18F-fluciclovine and confirmed to be true positive (n = 41). We aim to explore if 18F-fluciclovine uptake in ovarian lesions were greater than background uptake of bone marrow, blood pool, and bladder. Quantification analysis was performed to determine max and mean standard uptake values (SUVmax and SUVmean) of known and suspected lesions compared to SUVmean uptake of background structures. RESULTS 18F-Fluciclovine demonstrated 100% sensitivity (41/41) for uptake in known ovarian lesions. The average SUVmax (±SD) uptake of known ovarian lesions was 5.9 (±2.6) and 5.1 (±2.0) on early and delayed images, respectively. The average tumor SUVmax to SUVmean of background (±SD) (T:B) ratios on early and delay were 1.9 (±0.8), 2.1 (±0.9) for marrow; 3.8 (±1.8), 3.4 (±1.5) for aorta; and 8.4 (±4.3), 1.5 (±1.7) for bladder, respectively. CONCLUSION 18F-Fluciclovine uptake in malignant ovarian lesions was above background levels suggesting its feasibility in the imaging of ovarian cancer. Due to increasing tracer washout via the urinary bladder over time, early imaging at 4 min post injection is favorable.
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Affiliation(s)
- Tina M Buehner
- Rush University Medical Center, Chicago, IL, USA.
- Loyola University Chicago, Maywood, IL, USA.
| | | | | | | | - Bital Savir-Baruch
- Loyola University Chicago, Maywood, IL, USA
- University of Arizona, Tucson, AZ, USA
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Miceli V, Gennarini M, Tomao F, Cupertino A, Lombardo D, Palaia I, Curti F, Riccardi S, Ninkova R, Maccioni F, Ricci P, Catalano C, Rizzo SMR, Manganaro L. Imaging of Peritoneal Carcinomatosis in Advanced Ovarian Cancer: CT, MRI, Radiomic Features and Resectability Criteria. Cancers (Basel) 2023; 15:5827. [PMID: 38136373 PMCID: PMC10741537 DOI: 10.3390/cancers15245827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
PC represents the most striking picture of the loco-regional spread of ovarian cancer, configuring stage III. In the last few years, many papers have evaluated the role of imaging and therapeutic management in patients with ovarian cancer and PC. This paper summed up the literature on traditional approaches to the imaging of peritoneal carcinomatosis in advanced ovarian cancer, presenting classification systems, most frequent patterns, routes of spread and sites that are difficult to identify. The role of imaging in diagnosis was investigated, with particular attention to the reported sensitivity and specificity data-computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-CT (PET-CT)-and to the peritoneal cancer index (PCI). In addition, we explored the therapeutic possibilities and radiomics applications that can impact management of patients with ovarian cancer. Careful staging is mandatory, and patient selection is one of the most important factors influencing complete cytoreduction (CCR) outcome: an accurate pre-operative imaging may allow selection of patients that may benefit most from primary cytoreductive surgery.
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Affiliation(s)
- Valentina Miceli
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Marco Gennarini
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Federica Tomao
- Department of Gynecological, Obstetrical and Urological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (F.T.); (I.P.)
| | - Angelica Cupertino
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Dario Lombardo
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Innocenza Palaia
- Department of Gynecological, Obstetrical and Urological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (F.T.); (I.P.)
| | - Federica Curti
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Sandrine Riccardi
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Roberta Ninkova
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Francesca Maccioni
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Paolo Ricci
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Carlo Catalano
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
| | - Stefania Maria Rita Rizzo
- Clinica di Radiologia EOC, Istituto Imaging della Svizzera Italiana (IIMSI), 6900 Lugano, Switzerland;
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Lucia Manganaro
- Department of Radiological, Oncology and Patological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy; (V.M.); (M.G.); (A.C.); (D.L.); (F.C.); (S.R.); (R.N.); (F.M.); (P.R.); (C.C.)
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Li X, Wang L, Guo P, Sun Q, Zhang Y, Chen C, Zhang Y. Diagnostic performance of noninvasive imaging using computed tomography, magnetic resonance imaging, and positron emission tomography for the detection of ovarian cancer: a meta-analysis. Ann Nucl Med 2023; 37:541-550. [PMID: 37422857 DOI: 10.1007/s12149-023-01856-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE The aim of this meta-analysis was to compare the diagnostic value of noninvasive imaging methods computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) in the detection of ovarian cancer (OC). METHODS PubMed, Embase, and Ovid were comprehensively searched from the date of inception to 31st, March, 2022. Pooled sensitivity, specificity, positive likelihood ratio (+ LR), negative likelihood ratio (- LR), diagnostic odds ratio (DOR), and area under the curve (AUC) of summary receiver operating characteristic (SROC) with their respective 95% confidence intervals (CIs) were calculated. RESULTS Sixty-one articles including 4284 patients met the inclusion criteria of this study. Pooled estimates of sensitivity, specificity, and AUC of SROC with respective 95% CIs of CT on patient level were 0.83 (0.73, 0.90), 0.69 (0.54, 0.81), and 0.84 (0.80, 0.87). The overall sensitivity, specificity, SROC value with respective 95% CIs of MRI were 0.95 (0.91, 0.97),0.81 (0.76, 0.85), and 0.90 (0.87, 0.92) on patient level. Pooled estimates of sensitivity, specificity, SROC value of PET/CT on patient level were 0.92 (0.88, 0.94), 0.88 (0.83, 0.92), and 0.96 (0.94, 0.97). CONCLUSION Noninvasive imaging modalities including CT, MRI, PET (PET/CT, PET/MRI) yielded favorable diagnostic performance in the detection of OC. Hybrid implement of different tools (PET/MRI) is more accurate for identifying metastatic OC.
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Affiliation(s)
- Xiaoxiao Li
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Luqin Wang
- Anhui Precision Medicine Technology Engineering Laboratory, Hefei, China
- Department of Bioinformatics, Precedo Pharmaceuticals Co. Ltd, Hefei, China
| | - Pengfei Guo
- Department of Bioinformatics, Precedo Pharmaceuticals Co. Ltd, Hefei, China
| | - Qiangkun Sun
- Department of Bioinformatics, Precedo Pharmaceuticals Co. Ltd, Hefei, China
| | - Yating Zhang
- Department of Bioinformatics, Precedo Pharmaceuticals Co. Ltd, Hefei, China
| | - Cheng Chen
- Department of Bioinformatics, Precedo Pharmaceuticals Co. Ltd, Hefei, China.
- Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China.
| | - Yulong Zhang
- Anhui Precision Medicine Technology Engineering Laboratory, Hefei, China.
- Department of Bioinformatics, Precedo Pharmaceuticals Co. Ltd, Hefei, China.
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Development and Validation of 18F-FDG PET/CT-Based Models for Predicting Successful Complete Cytoreduction During Primary Cytoreductive Surgery for Advanced Ovarian cancer. Clin Nucl Med 2023; 48:e51-e59. [PMID: 36607373 DOI: 10.1097/rlu.0000000000004417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of this study was to develop an 18F-FDG PET/CT-based model to predict complete cytoreduction during primary cytoreductive surgery (CRS) for ovarian cancer (OC). PATIENTS AND METHODS We retrospectively identified patients with stage III-IV OC who underwent primary CRS between June 2013 and February 2020 at 2 tertiary centers. Patients from each hospital were assigned to training and test sets. The abdominal cavity was divided into 3 sections, and data for the PET/CT-derived parameters were collected through image analysis. Various prediction models were constructed by combining clinicopathologic characteristics and PET/CT-derived parameters. The performance of the model with the highest area under the receiver operating characteristic curve (AUC) was externally validated. RESULTS The training and test sets included 159 and 166 patients, respectively. The median age of patients in the test set was 55 years; 72.3% of them had stage III tumors, and 65.4% underwent complete cytoreduction. Metabolic tumor volume, total lesion glycolysis, and the number of metastatic lesions above the upper margin of the renal vein (area A) were selected among the PET/CT parameters. The best predictive multivariable model consisted of CA-125 (<750 or ≥750 IU/mL), number of metastatic lesions (<2 or ≥2), and metabolic tumor volume of area A, predicting complete cytoreduction with an AUC of 0.768. The model was validated using a test set. Its predictive performance yielded an AUC of 0.771. CONCLUSIONS We successfully developed and validated a preoperative model to predict complete cytoreduction in advanced OC. This model can facilitate patient selection for primary CRS in clinical practice.
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Rupa R, Prema R, Popat PB, Manchanda S, Venkatesh K, Chandramohan A, Subbian A, Rangarajan B. Imaging Recommendations for Diagnosis, Staging, and Management of Ovarian and Fallopian Tube Cancers. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
AbstractOvarian malignancy the third most common gynecological malignancy and is the leading cause of death in women. Non-specific clinical presentation delays the diagnosis, and they often present in the advanced stage of disease. No imaging modality is recommended for screening as there is no significant mortality reduction. Ultrasound (USG) is usually the initial modality in suspected ovarian mass. MRI is recommended for the characterization of indeterminate ovarian or adnexal mass on USG. CT abdomen and pelvis with oral and IV contrast is the recommended imaging modality in staging the disease, predicting the resectability and in selecting the patients who would benefit from neoadjuvant chemotherapy. Early ovarian cancers are staged by post-surgical histology and undergo upfront surgery. Advanced disease benefit by neoadjuvant chemotherapy and less morbidity by interval cytoreduction where image-guided biopsy is performed for histological diagnosis. Follow-up recommendations are based on tumor histology. CT/PET CT is recommended for diagnosing recurrence.
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Affiliation(s)
- Renganathan Rupa
- Department of Diagnostic and Interventional Radiology, Division of Breast and Women's Imaging and Interventions, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India
| | - Renganathan Prema
- Department of Diagnostic and Interventional Radiology, Division of Breast and Women's Imaging and Interventions, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India
| | | | - Smita Manchanda
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kasi Venkatesh
- Department of Diagnostic and Interventional Radiology, Division of Abdominal Imaging and ablative therapies, Kovai Medical Center and Hospitals, Coimbatore, India
| | - Anuradha Chandramohan
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Anbukkani Subbian
- Department of Gynecological Oncology, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India
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Onuma T, Asare-Werehene M, Yoshida Y, Tsang BK. Exosomal Plasma Gelsolin Is an Immunosuppressive Mediator in the Ovarian Tumor Microenvironment and a Determinant of Chemoresistance. Cells 2022; 11:cells11203305. [PMID: 36291171 PMCID: PMC9600545 DOI: 10.3390/cells11203305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/15/2022] [Accepted: 10/18/2022] [Indexed: 12/03/2022] Open
Abstract
Ovarian Cancer (OVCA) is the most fatal gynecologic cancer and has a 5-year survival rate less than 45%. This is mainly due to late diagnosis and drug resistance. Overexpression of plasma gelsolin (pGSN) is key contributing factor to OVCA chemoresistance and immunosuppression. Gelsolin (GSN) is a multifunctional protein that regulates the activity of actin filaments by cleavage, capping, and nucleation. Generally, it plays an important role in cytoskeletal remodeling. GSN has three isoforms: cytosolic GSN, plasma GSN (pGSN), and gelsolin-3. Exosomes containing pGSN are released and contribute to the progression of OVCA. This review describes how pGSN overexpression inhibits chemotherapy-induced apoptosis and triggers positive feedback loops of pGSN expression. It also describes the mechanisms by which exosomal pGSN promotes apoptosis and dysfunction in tumor-killing immune cells. A discussion on the potential of pGSN as a prognostic, diagnostic, and therapeutic marker is also presented herein.
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Affiliation(s)
- Toshimichi Onuma
- Department of Obstetrics & Gynecology, Faculty of Medicine & Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1H 8L1, Canada
- Department of Cellular and Molecular Medicine & the Centre for Infection, Immunity and Inflammation (CI3), Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
- Department of Obstetrics and Gynecology, University of Fukui, Fukui 910-8507, Japan
| | - Meshach Asare-Werehene
- Department of Obstetrics & Gynecology, Faculty of Medicine & Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1H 8L1, Canada
- Department of Cellular and Molecular Medicine & the Centre for Infection, Immunity and Inflammation (CI3), Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, University of Fukui, Fukui 910-8507, Japan
- Correspondence: (Y.Y.); (B.K.T.)
| | - Benjamin K. Tsang
- Department of Obstetrics & Gynecology, Faculty of Medicine & Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1H 8L1, Canada
- Department of Cellular and Molecular Medicine & the Centre for Infection, Immunity and Inflammation (CI3), Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
- Correspondence: (Y.Y.); (B.K.T.)
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Nougaret S, Sadowski E, Lakhman Y, Rousset P, Lahaye M, Worley M, Sgarbura O, Shinagare AB. The BUMPy road of peritoneal metastases in ovarian cancer. Diagn Interv Imaging 2022; 103:448-459. [PMID: 36155744 DOI: 10.1016/j.diii.2022.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022]
Abstract
Ovarian cancer is the most common cause of death due to gynecologic malignancies, with more than 70% of patients presenting with advanced stage disease at the time of diagnosis. The extent and distribution of tumor guide primary treatment selection and clinical management. While primary cytoreductive surgery with complete tumor resection improves survival, patients with extensive peritoneal disease may benefit from neoadjuvant chemotherapy first to reduce tumor burden followed by interval cytoreductive surgery. Imaging plays an essential role in triaging patients including selecting patients who may benefit from neoadjuvant chemotherapy before cytoreductive surgery. Interestingly, there are no universally established criteria to predict resectability and local practices depend on local guidelines and surgeon preferences. Nevertheless, certain anatomical tumor locations are known to be difficult to resect and are associated with suboptimal cytoreduction or require special surgical considerations. This review discusses the recent advances in the initial management of patients with ovarian cancer, a practical approach to the assessment and communication of peritoneal metastases locations on CT and MRI. It also explores recent advances in genomics profiling and radiomics that may influence the initial management of these patients.
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Affiliation(s)
- Stephanie Nougaret
- Department of Radiology, IRCM, Montpellier Cancer Research Institute, 34090 Montpellier, France; INSERM, U1194, University of Montpellier, 34295 Montpellier, France.
| | - Elizabeth Sadowski
- Departments of Radiology, Obstetrics and Gynecology, University of Wisconsin, WI 53726, United States
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Pascal Rousset
- Department of Radiology, Centre Hospitalier Lyon-Sud, Pierre-Benite 69495, France
| | - Max Lahaye
- Department of Radiology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, 1066 CX, Amsterdam, the Netherlands
| | - Michael Worley
- Department of Surgery, Dana-Farber Cancer Institute, Boston, MA 02115, United States
| | - Olivia Sgarbura
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier, F-34298, France; Department of Surgical Oncology, Cancer Institute Montpellier (ICM), University of Montpellier, Montpellier, France
| | - Atul B Shinagare
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA 02215, United States; Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, United States
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Gagliardi T, Adejolu M, deSouza NM. Diffusion-Weighted Magnetic Resonance Imaging in Ovarian Cancer: Exploiting Strengths and Understanding Limitations. J Clin Med 2022; 11:1524. [PMID: 35329850 PMCID: PMC8949455 DOI: 10.3390/jcm11061524] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 02/06/2023] Open
Abstract
Detection, characterization, staging, and response assessment are key steps in the imaging pathway of ovarian cancer. The most common type, high grade serous ovarian cancer, often presents late, so that accurate disease staging and response assessment are required through imaging in order to improve patient management. Currently, computerized tomography (CT) is the most common method for these tasks, but due to its poor soft-tissue contrast, it is unable to quantify early response within lesions before shrinkage is observed by size criteria. Therefore, quantifiable techniques, such as diffusion-weighted magnetic resonance imaging (DW-MRI), which generates high contrast between tumor and healthy tissue, are increasingly being explored. This article discusses the basis of diffusion-weighted contrast and the technical issues that must be addressed in order to achieve optimal implementation and robust quantifiable diffusion-weighted metrics in the abdomen and pelvis. The role of DW-MRI in characterizing adnexal masses in order to distinguish benign from malignant disease, and to differentiate borderline from frankly invasive malignancy is discussed, emphasizing the importance of morphological imaging over diffusion-weighted metrics in this regard. Its key role in disease staging and predicting resectability in comparison to CT is addressed, including its valuable use as a biomarker for following response within individual lesions, where early changes in the apparent diffusion coefficient in peritoneal metastases may be detected. Finally, the task of implementing DW-MRI into clinical trials in order to validate this biomarker for clinical use are discussed, along with the trials that include it within their protocols.
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Affiliation(s)
- Tanja Gagliardi
- Department of Imaging, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (T.G.); (M.A.)
| | - Margaret Adejolu
- Department of Imaging, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (T.G.); (M.A.)
| | - Nandita M. deSouza
- Department of Imaging, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (T.G.); (M.A.)
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW7 3RP, UK
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10
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Accuracy of Pretreatment Ultrasonography Assessment of Intra-Abdominal Spread in Epithelial Ovarian Cancer: A Prospective Study. Diagnostics (Basel) 2021; 11:diagnostics11091600. [PMID: 34573942 PMCID: PMC8519008 DOI: 10.3390/diagnostics11091600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/19/2021] [Accepted: 08/26/2021] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to test the accuracy of ultrasonography performed by gynecological oncologists for the preoperative assessment of epithelial ovarian cancer (EOC) spread in the pelvis and abdominal cavity. A prospective, observational cohort study was performed at a single tertiary cancer care unit. Patients with suspected EOC were recruited and underwent comprehensive transvaginal and abdominal ultrasonography performed by a gynecological oncologist. Sixteen intra-abdominal localizations and parameters were assessed using ultrasonography and compared with surgical-pathological status (reference standard). Sensitivity, specificity, positive and negative predictive values, and overall accuracy were calculated. Differences were analyzed using Fisher’s exact and chi-square tests. Ultimately, we included 132 patients (median age 62 years), of whom 67% were in stage IIIC–IVB and 72% had serous cancer. Overall prediction accuracies for the involvement of the omentum, small bowel mesentery root, and frozen pelvis, and detecting ascites were >90%. Detecting the involvement of the pelvis peritoneum, liver and spleen hilum, and rectosigmoid colon, and predictions of disease stage and residual disease had overall accuracies of 80–90%. The lowest accuracy was for involvement of the abdominal peritoneum (69%) and diaphragm peritoneum (right 71%; left 75%) and surgical complexity prediction (77%). Stratification of results by presence or absence of ascites revealed significantly higher specificity of ultrasonography (clinically meaningful) for assessments of the abdominal/pelvic peritoneum, spleen hilum, and rectum wall, if there were ascites. A gynecological oncologist, experienced in surgery and sonology, performing comprehensive ultrasonography on patients with EOC can accurately detect intraperitoneal lesions and recognize critical disease manifestations and predict stage, surgical complexity, and residual disease, which allow accurate qualification of patients for primary debulking surgery or neoadjuvant chemotherapy.
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11
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Nougaret S, McCague C, Tibermacine H, Vargas HA, Rizzo S, Sala E. Radiomics and radiogenomics in ovarian cancer: a literature review. Abdom Radiol (NY) 2021; 46:2308-2322. [PMID: 33174120 DOI: 10.1007/s00261-020-02820-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/01/2020] [Accepted: 10/10/2020] [Indexed: 01/25/2023]
Abstract
Ovarian cancer remains one of the most lethal gynecological cancers in the world despite extensive progress in the areas of chemotherapy and surgery. Many studies have postulated that this is because of the profound heterogeneity that underpins response to therapy and prognosis. Standard imaging evaluation using CT or MRI does not take into account this tumoral heterogeneity especially in advanced stages with peritoneal carcinomatosis. As such, newly emergent fields in the assessment of tumor heterogeneity have been proposed using radiomics to evaluate the whole tumor burden heterogeneity as opposed to single biopsy sampling. This review provides an overview of radiomics, radiogenomics, and proteomics and examines the use of these newly emergent fields in assessing tumor heterogeneity and its implications in ovarian cancer.
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Affiliation(s)
- S Nougaret
- IRCM, Montpellier Cancer Research Institute, INSERM, U1194, University of Montpellier, 208 Ave des Apothicaires, 34295, Montpellier, France. .,Department of Radiology, Montpellier Cancer institute, 208 Ave des Apothicaires, 34295, Montpellier, France.
| | - Cathal McCague
- Department of Radiology, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
| | - Hichem Tibermacine
- IRCM, Montpellier Cancer Research Institute, INSERM, U1194, University of Montpellier, 208 Ave des Apothicaires, 34295, Montpellier, France.,Department of Radiology, Montpellier Cancer institute, 208 Ave des Apothicaires, 34295, Montpellier, France
| | - Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Stefania Rizzo
- Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, CH, Switzerland.,Facoltà di Scienze Biomediche, Università della Svizzera Italiana, Lugano, CH, Switzerland
| | - E Sala
- Department of Radiology, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
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12
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Diagnostic performance of PET/CT and PET/MR in the management of ovarian carcinoma-a literature review. Abdom Radiol (NY) 2021; 46:2323-2349. [PMID: 33175199 DOI: 10.1007/s00261-020-02847-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/25/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022]
Abstract
Ovarian cancer is a challenging disease. It often presents at an advanced stage with frequent recurrence despite optimal management. Accurate staging and restaging are critical for improving treatment outcomes and determining the prognosis. Imaging is an indispensable component of ovarian cancer management. Hybrid imaging modalities, including positron emission tomography/computed tomography (PET/CT) and PET/magnetic resonance imaging (MRI), are emerging as potential non-invasive imaging tools for improved management of ovarian cancer. This review article discusses the role of PET/CT and PET/MRI in ovarian cancer.
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13
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Abstract
The mainstay management of advanced ovarian cancer is maximal cytoreductive surgery followed by chemotherapy. Neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) are alternative treatments for patients with comorbidity, poor performance status, and predicted for suboptimal debulking surgery. It is the invariable principle in any situation that no residual disease after the completion of surgery is useful for patients with ovarian cancer. Therefore, the prediction of optimal debulking before the treatment of ovarian cancer is of utmost importance. Many studies have reported on the use of serum biomarkers, such as cancer antigen 125 (CA125) or human epididymis 4 (HE4), and imaging studies, such as computed tomography (CT), diffusion-weighted magnetic resonance imaging (DW-MRI), and positron emission tomography (PET)/CT, to identify adequate surgical candidates for primary debulking surgery (PDS). Laparoscopy has also been studied as a reliable tool for the prediction of optimal debulking. Here, we summarize a review of the related literature.
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Affiliation(s)
- Yong Jung Song
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
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14
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Liu P, Deng L, Yang L, Yuan X, Xia W, Su Y. Magnetic resonance imaging for evaluating tumor resectability in advanced ovarian cancer: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23419. [PMID: 33327269 PMCID: PMC7738068 DOI: 10.1097/md.0000000000023419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This study will evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) to investigate tumor resectability at primary debulking surgery among women experiencing advanced-stage ovarian cancer. METHODS We will systematically search the randomized controlled trials (RCTs) for potentially eligible studies from electronic databases, including 4 English databases (PubMed, EMBASE, Web of Science, and Cochrane Library) and 3 Chinese databases (China National Knowledge Infrastructure, WanFang, and China Biomedical Database). The study language will be restricted to English and Chinese. Also, 2 independent authors will collect and carry out data extraction as well as quality assessment. Data will be synthesized using appropriate statistical methods. RESULTS We will summarize present study's evidence to assess the diagnostic accuracy of MRI for evaluating tumor resectability at primary debulking surgery in women experiencing advanced-stage ovarian cancer. CONCLUSION The present study will put forward the latest high-quality evidence for MRI's clinical application for evaluating tumor resectability in women experiencing advanced ovarian cancer. ETHICS AND DISSEMINATION Since the present study is a systematic review and meta-analysis based on the published literature, ethical approval will not be necessary. PROTOCOL REGISTRATION NUMBER DOI 10.17605/OSF.IO/UWDRF (https://osf.io/uwdrf/).
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Affiliation(s)
| | | | - Lijun Yang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province
| | | | - Wei Xia
- Department of Radiology
- Department of Imaging Center, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
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15
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Vieira AC, Antunes N, Damasceno E, Ramalho M, Esteves S, Vaz F, Félix A, Cunha TM. Ovarian carcinoma in patients with BRCA mutation - a correlation between the growing pattern of peritoneal implants evaluated by CT/MRI and the genotype BRCA1 and BRCA2. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00183-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Ovarian cancer is the leading cause of death from gynecologic cancer. The risk of developing ovarian cancer is significantly increased in patients that carry a genetic mutation of tumor suppressor gene BRCA1 or BRCA2. The majority of BRCA-associated ovarian/fallopian tube cancers are high-grade serous carcinomas (HGSC). The recognition of patterns of disease is crucial to identify distinctive imaging features that could be useful for predicting prognosis and therapeutic response.
Results
An institutional review board-approved retrospective study was performed and included 34patients (23 BRCA-mutated and 11 BRCA wild-type) with HGSC FIGO III/IV who underwent pre-operative or pre-chemotherapy contrast-enhanced CT/MRI of the abdomen and pelvis between January 2003 and December 2017. Three radiologists independently reviewed the imaging studies and looked for qualitative features of the primary tumor and peritoneal metastases (nodular versus infiltrative pattern). Two pathologists also assessed the histopathologic characteristics of the surgical specimens, with emphasis on the growth pattern of metastatic deposits (expansive/nodular and infiltrative) and inflammatory infiltrate (intra- and/or peritumoral).
No significant associations were found between the different groups of patients (BRCA1-mutant HGSC, BRCA2-mutant HGSC. and BRCA wild-type) and CT/MRI features of ovarian tumors, morphology of peritoneal metastasis, and pathologic characteristics.
Conclusion
Identification of specific imaging and pathologic features is important to pursue an optimal personalized cancer treatment strategy and to develop precision medicine in the future.
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Abstract
Mesenteries are extensions of the visceral and parietal peritoneum consisting of fat, vessels, nerves, and lymphatics. Mesenteric masses have a wide differential diagnosis with neoplastic, infectious, or inflammatory etiologies and can either be solid or cystic. Imaging features are critical for the diagnosis. We review the epidemiology, imaging spectrum, and differentiating features and treatment of mesenteric masses.
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17
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Diagnostic value of [ 18F]FDG PET/MRI for staging in patients with ovarian cancer. EJNMMI Res 2020; 10:117. [PMID: 33006685 PMCID: PMC7532239 DOI: 10.1186/s13550-020-00712-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/24/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose To evaluate the diagnostic potential of PET/MRI with 2-[18F]fluoro-2-deoxy-d-glucose ([18F]FDG) in ovarian cancer. Materials and methods Participants comprised 103 patients with suspected ovarian cancer underwent pretreatment [18F]FDG PET/MRI, contrast-enhanced CT (ceCT) and pelvic dynamic contrast-enhanced MRI (ceMRI). Diagnostic performance of [18F]FDG PET/MRI and ceMRI for assessing the characterization and the extent of the primary tumor (T stage) and [18F]FDG PET/MRI and ceCT for assessing nodal (N stage) and distant (M stage) metastases was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. The McNemar test was employed for statistical analysis. Results Accuracy for the characterization of suspected ovarian cancer was significantly better for [18F]FDG PET/MRI (92.5%) [95% confidence interval (CI) 0.84–0.95] than for ceMRI (80.6%) (95% CI 0.72–0.83) (p < 0.05). Accuracy for T status was 96.4% (95% CI 0.96–0.96) and 92.9% (95% CI 0.93–0.93) for [18F]FDG PET/MRI and ceMRI/ceCT, respectively. Patient-based accuracies for N and M status were 100% (95% CI 0.88–1.00) and 100% (95% CI 0.88–1.00) for [18F]FDG PET/MRI and 85.2% (95% CI 0.76–0.85) and 30.8% (95% CI 0.19–0.31) for ceCT and M staging representing significant differences (p < 0.01). Lesion-based sensitivity, specificity and accuracy for N status were 78.6% (95% CI 0.57–0.91), 95.7% (95% CI 0.93–0.97) and 93.9% (95% CI 0.89–0.97) for [18F]FDG PET/MRI and 42.9% (95% CI 0.24–0.58), 96.6% (95% CI 0.94–0.98) and 90.8% (95% CI 0.87–0.94) for ceCT. Conclusions [18F]FDG PET/MRI offers better sensitivity and specificity for the characterization and M staging than ceMRI and ceCT, and diagnostic value for T and N staging equivalent to ceMRI and ceCT, suggesting that [18F]FDG PET/MRI might represent a useful diagnostic alternative to conventional imaging modalities in ovarian cancer.
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Marko J, Marko KI, Pachigolla SL, Crothers BA, Mattu R, Wolfman DJ. Mucinous Neoplasms of the Ovary: Radiologic-Pathologic Correlation. Radiographics 2020; 39:982-997. [PMID: 31283462 DOI: 10.1148/rg.2019180221] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Mucinous neoplasms of the ovary account for 10%-15% of ovarian neoplasms. They may be benign, borderline, or malignant. The large majority are benign or borderline, accounting for 80% and 16%-17%, respectively. Mucinous neoplasms of the ovary most commonly affect women in their 20s to 40s. The clinical manifestation is nonspecific, but most mucinous ovarian neoplasms manifest as large unilateral pelvic masses. At gross pathologic analysis, mucinous ovarian neoplasms appear as large multiloculated cystic masses. The contents of the cyst loculi vary on the basis of differences in internal mucin content. At histologic analysis, mucinous ovarian neoplasms are composed of multiple cysts lined by mucinous epithelium, often resembling gastrointestinal-type epithelium. Imaging evaluation most commonly includes US and/or MRI. The imaging findings parallel the gross pathologic features and include a large, unilateral, multiloculated cystic mass. The cyst loculi vary in echogenicity, attenuation, and signal intensity depending on the mucin content. Mucinous neoplasms of the ovary are staged surgically using the FIGO (International Federation of Gynecology and Obstetrics) staging system. Primary treatment is surgical, with adjuvant chemotherapy considered in the uncommon case of mucinous carcinoma with extraovarian disease. Since most mucinous ovarian neoplasms are benign or borderline, the overall prognosis is excellent.
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Affiliation(s)
- Jamie Marko
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.M.); Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC (K.I.M.); University of Illinois College of Medicine, Peoria, Ill (S.L.P.); Department of Pathology, the Joint Pathology Center, Washington, DC (B.A.C., R.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Department of Radiology, Johns Hopkins Hospital and Health System, Washington, DC (D.J.W.)
| | - Kathryn I Marko
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.M.); Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC (K.I.M.); University of Illinois College of Medicine, Peoria, Ill (S.L.P.); Department of Pathology, the Joint Pathology Center, Washington, DC (B.A.C., R.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Department of Radiology, Johns Hopkins Hospital and Health System, Washington, DC (D.J.W.)
| | - Suvidya L Pachigolla
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.M.); Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC (K.I.M.); University of Illinois College of Medicine, Peoria, Ill (S.L.P.); Department of Pathology, the Joint Pathology Center, Washington, DC (B.A.C., R.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Department of Radiology, Johns Hopkins Hospital and Health System, Washington, DC (D.J.W.)
| | - Barbara A Crothers
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.M.); Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC (K.I.M.); University of Illinois College of Medicine, Peoria, Ill (S.L.P.); Department of Pathology, the Joint Pathology Center, Washington, DC (B.A.C., R.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Department of Radiology, Johns Hopkins Hospital and Health System, Washington, DC (D.J.W.)
| | - Rubina Mattu
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.M.); Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC (K.I.M.); University of Illinois College of Medicine, Peoria, Ill (S.L.P.); Department of Pathology, the Joint Pathology Center, Washington, DC (B.A.C., R.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Department of Radiology, Johns Hopkins Hospital and Health System, Washington, DC (D.J.W.)
| | - Darcy J Wolfman
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.M.); Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC (K.I.M.); University of Illinois College of Medicine, Peoria, Ill (S.L.P.); Department of Pathology, the Joint Pathology Center, Washington, DC (B.A.C., R.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Department of Radiology, Johns Hopkins Hospital and Health System, Washington, DC (D.J.W.)
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Kemppainen J, Hynninen J, Virtanen J, Seppänen M. PET/CT for Evaluation of Ovarian Cancer. Semin Nucl Med 2019; 49:484-492. [DOI: 10.1053/j.semnuclmed.2019.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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20
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Rema P, John ER, Samabasivan S, Prahladan A, George P, Ranjith JS, Thomas S. Evaluation of Computed Tomography Scan and CA 125 Response in Predicting Operability in Advanced Ovarian Cancer and Assessing Survival Outcome in Interval Cytoreductive Surgery. Indian J Surg Oncol 2019; 10:426-434. [PMID: 31496584 DOI: 10.1007/s13193-018-0868-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/06/2018] [Accepted: 12/18/2018] [Indexed: 11/26/2022] Open
Abstract
The study aims at the prediction of optimal cytoreduction (OCR) in patients undergoing interval cytoreduction (ICR) in advanced epithelial ovarian cancer (AEOC) based on CT imaging and CA 125 values and assessing the survival pattern of these patients after ICR. This is a prospective observational study of patients with stage III C ovarian cancer who underwent ICR in our institution after neoadjuvant chemotherapy (NACT). All consecutive patients operated from April 2016 to October 2017 were included in the study. From their medical records, their demographic details and clinical variables were recorded. The CA 125 value and CT scan findings before and after chemotherapy were documented. A Bristow's predictive score (BS) was calculated based on the radiological parameters. After ICR, the outcome of the surgery was documented. Optimal cytoreduction (OCR) was defined as no gross residual disease after surgery. The surgical outcome was correlated with the CA 125 difference pre and post chemotherapy and Bristow's predictive score pre and post chemotherapy. The patients were followed up and their survival at 6 and 12 months was assessed. Univariate and multivariate analysis was done to identify factors predicting OCR. 51 patients were included in the study. Age group of the women ranged from 31 to 74 years with a mean of 52 years. Majority of the patients (70.6%) were postmenopausal. Of the 51 women, OCR could be achieved in 31 patients (60.8%). Post-chemotherapy, 36 patients had elevated CA125 above baseline of which 50% attained OCR. Forty six patients had CA 125 response post chemotherapy of which 67.4% attained OCR. Forty five patients had reduction in Bristow Score compared to the pre chemo values of which 64.4% attained OCR which was not found to be statistically significant. Overall survival was 100% survival at 6 months and 92.8% at 12 months in those who achieved OCR. Those with residual disease 0.1-1 cm had survival of 74.1% at 6 and 12 months. Those with residual disease > 1 cm had a survival of 50% at 6 and 12 months. CA125 response has a significant role in predicting OCR while CT evaluation using the BS was not useful in predicting OCR during ICR for AEOC.
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Affiliation(s)
- P Rema
- 1Department of Surgical Oncology, Regional Cancer Centre, Thiruvanathapuram, Kerala India
| | - Elizabeth Reshmi John
- Department of Obstetrics and Gynecology, Azeezia Medical College Hospital, Meeyannoor, Kollam 37, Kerala, India
- Thiruvananthapuram, India
| | - Suchetha Samabasivan
- 1Department of Surgical Oncology, Regional Cancer Centre, Thiruvanathapuram, Kerala India
| | - Anil Prahladan
- 3Department of Radiodiagnosis, Regional Cancer Centre, Thiruvanathapuram, Kerala India
| | - Preethi George
- 4Department of Biostatistics, Regional Cancer Centre, Thiruvanathapuram, Kerala India
| | - J Siva Ranjith
- 1Department of Surgical Oncology, Regional Cancer Centre, Thiruvanathapuram, Kerala India
| | - Shaji Thomas
- 1Department of Surgical Oncology, Regional Cancer Centre, Thiruvanathapuram, Kerala India
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Zhang S, Han F, Liang Z, Tan J, Cao W, Gao Y, Pomeroy M, Ng K, Hou W. An investigation of CNN models for differentiating malignant from benign lesions using small pathologically proven datasets. Comput Med Imaging Graph 2019; 77:101645. [PMID: 31454710 DOI: 10.1016/j.compmedimag.2019.101645] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/02/2019] [Accepted: 08/01/2019] [Indexed: 12/14/2022]
Abstract
Cancer has been one of the most threatening diseases to human health. There have been many efforts devoted to the advancement of radiology and transformative tools (e.g. non-invasive computed tomographic or CT imaging) to detect cancer in early stages. One of the major goals is to identify malignant from benign lesions. In recent years, machine deep learning (DL), e.g. convolutional neural network (CNN), has shown encouraging classification performance on medical images. However, DL algorithms always need large datasets with ground truth. Yet in the medical imaging field, especially for cancer imaging, it is difficult to collect such large volume of images with pathological information. Therefore, strategies are needed to learn effectively from small datasets via CNN models. To forward that goal, this paper explores two CNN models by focusing extensively on expansion of training samples from two small pathologically proven datasets (colorectal polyp dataset and lung nodule dataset) and then differentiating malignant from benign lesions. Experimental outcomes indicate that even in very small datasets of less than 70 subjects, malignance can be successfully differentiated from benign via the proposed CNN models, the average AUCs (area under the receiver operating curve) of differentiating colorectal polyps and pulmonary nodules are 0.86 and 0.71, respectively. Our experiments further demonstrate that for these two small datasets, instead of only studying the original raw CT images, feeding additional image features, such as the local binary pattern of the lesions, into the CNN models can significantly improve classification performance. In addition, we find that our explored voxel level CNN model has better performance when facing the small and unbalanced datasets.
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Affiliation(s)
- Shu Zhang
- Department of Radiology, Stony Brook University, Stony Brook, NY, 11794 USA
| | - Fangfang Han
- Northeastern University, Shenyang, Liaoning, 110819 PR China
| | - Zhengrong Liang
- Department of Radiology, Stony Brook University, Stony Brook, NY, 11794 USA; Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794 USA; Department of Electrical & Computer Engineering, Stony Brook University, Stony Brook, NY, 11794 USA.
| | - Jiaxing Tan
- Department of Computer Science, City University of New York, the Graduate Center, NY, 10016 USA
| | - Weiguo Cao
- Department of Radiology, Stony Brook University, Stony Brook, NY, 11794 USA
| | - Yongfeng Gao
- Department of Radiology, Stony Brook University, Stony Brook, NY, 11794 USA
| | - Marc Pomeroy
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794 USA
| | - Kenneth Ng
- Department of Electrical & Computer Engineering, Stony Brook University, Stony Brook, NY, 11794 USA
| | - Wei Hou
- Department of Preventive Medicine, Stony Brook University, Stony Brook, NY, 11794 USA
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22
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Kang SK, Reinhold C, Atri M, Benson CB, Bhosale PR, Jhingran A, Lakhman Y, Maturen KE, Nicola R, Pandharipande PV, Salazar GM, Shipp TD, Simpson L, Small W, Sussman BL, Uyeda JW, Wall DJ, Whitcomb BP, Zelop CM, Glanc P. ACR Appropriateness Criteria ® Staging and Follow-Up of Ovarian Cancer. J Am Coll Radiol 2019; 15:S198-S207. [PMID: 29724422 DOI: 10.1016/j.jacr.2018.03.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/12/2022]
Abstract
In the management of epithelial ovarian cancers, imaging is used for cancer detection and staging, both before and after initial treatment. The decision of whether to pursue initial cytoreductive surgery for ovarian cancer depends in part on accurate staging. Contrast-enhanced CT of the abdomen and pelvis (and chest where indicated) is the current imaging modality of choice for the initial staging evaluation of ovarian cancer. Fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT and MRI may be appropriate for problem-solving purposes, particularly when lesions are present on CT but considered indeterminate. In patients who achieve remission, clinical suspicion for relapse after treatment prompts imaging evaluation for recurrence. Contrast-enhanced CT is the modality of choice to assess the extent of recurrent disease, and fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT is also usually appropriate, as small metastatic foci may be identified. If imaging or clinical examination confirms a recurrence, the extent of disease and timing of disease recurrence then determines the choice of treatments, including surgery, chemotherapy, and radiation therapy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Stella K Kang
- Principal Author, New York University Medical Center, New York, New York.
| | | | - Mostafa Atri
- Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | - Anuja Jhingran
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yulia Lakhman
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Refky Nicola
- State University of New York Upstate Medical University, Syracuse, New York
| | | | | | - Thomas D Shipp
- Brigham & Women's Hospital, Boston, Massachusetts; American Congress of Obstetricians and Gynecologists
| | - Lynn Simpson
- Columbia University, New York, New York; American Congress of Obstetricians and Gynecologists
| | - William Small
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois
| | - Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont
| | | | | | - Bradford P Whitcomb
- Tripler Army Medical Center, Honolulu, Hawaii; Society of Gynecologic Oncology
| | - Carolyn M Zelop
- Valley Hospital, Ridgewood, New Jersey, and NYU School of Medicine, New York, New York; American Congress of Obstetricians and Gynecologists
| | - Phyllis Glanc
- Specialty Chair, Sunnybrook Health Sciences Centre Bayview Campus, Toronto, Ontario, Canada
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Fuso L, Ferrero A, Vietti E, Petracchini M, Mineccia M, Villa M, Menato G. Development of a preoperative computed tomography score for the management of advanced epithelial ovarian cancer. Int J Gynecol Cancer 2018; 29:599-604. [PMID: 30829578 DOI: 10.1136/ijgc-2018-000054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/19/2018] [Accepted: 10/28/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The main objective is to develop a model based on computed tomographic features to predict surgical outcome and establish cut-offs to rationalize clinical management in advanced epithelial ovarian carcinoma. The secondary purpose is to identify parameters that should be reported by radiologists to allow a correct pre-operative evaluation. METHODS This study evaluated the association between 17 radiologic parameters and surgical outcome through the review of 61 computed tomographic scans. Each parameter received a score according to the strength of statistical association and points were added to obtain a predictive index value. The absence of residual tumor was considered an optimal result. Receiver operating characteristic curves were applied to assess the ability to predict surgical outcome. The score was applied to the study population to verify if the therapeutic approach had been congruent with the predicted results and to define adequate cut-offs. RESULTS Analysis with a receiver operating characteristic curve demonstrated a statistical association with surgical outcome (area under curve=0.949). The clinical approach agreed with the predicted outcome. Patients with lower scores received primary debulking surgery (mean predictive index value 2.4) whereas those with higher scores (mean 14.1) were given neoadjuvant chemotherapy. Further surgical investigation (laparoscopy) was performed in patients with higher predictive index value variability (0-17.5). Different cut-offs were analysed to define the model applicability. The results show that surgery is appropriate for patients with a predictive index value <6 (failure rate 11.5%) while a predictive index value >8 should address to neoadjuvant chemotherapy (0% of inappropriately unexplored patients). In addition, patients with a predictive index value between 6 and 8 could benefit from diagnostic exploration with a good success rate (71.4%). CONCLUSIONS The model correctly discerns patients who can benefit from surgery (predictive index value <6) from those who should undergo neoadjuvant chemotherapy (>8) and establishes a range (6-8) where surgical investigations may be helpful. This score is a flexible tool where cut-offs can be changed according to the desire to be surgically more aggressive or more conservative.
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Affiliation(s)
- Luca Fuso
- Gynaecology and Obstetrics Academic Department, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | - Annamaria Ferrero
- Gynaecology and Obstetrics Academic Department, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | - Elena Vietti
- Gynaecology and Obstetrics Academic Department, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | | | - Michela Mineccia
- Surgical Oncology Department, A.O. Ordine Mauriziano, Turin, Italy
| | - Michela Villa
- Gynaecology and Obstetrics Academic Department, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | - Guido Menato
- Gynaecology and Obstetrics Academic Department, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
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Roze JF, Hoogendam JP, van de Wetering FT, Spijker R, Verleye L, Vlayen J, Veldhuis WB, Scholten RJPM, Zweemer RP. Positron emission tomography (PET) and magnetic resonance imaging (MRI) for assessing tumour resectability in advanced epithelial ovarian/fallopian tube/primary peritoneal cancer. Cochrane Database Syst Rev 2018; 10:CD012567. [PMID: 30298516 PMCID: PMC6517226 DOI: 10.1002/14651858.cd012567.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Ovarian cancer is the leading cause of death from gynaecological cancer in developed countries. Surgery and chemotherapy are considered its mainstay of treatment and the completeness of surgery is a major prognostic factor for survival in these women. Currently, computed tomography (CT) is used to preoperatively assess tumour resectability. If considered feasible, women will be scheduled for primary debulking surgery (i.e. surgical efforts to remove the bulk of tumour with the aim of leaving no visible (macroscopic) tumour). If primary debulking is not considered feasible (i.e. the tumour load is too extensive), women will receive neoadjuvant chemotherapy to reduce tumour load and subsequently undergo (interval) surgery. However, CT is imperfect in assessing tumour resectability, so additional imaging modalities can be considered to optimise treatment selection. OBJECTIVES To assess the diagnostic accuracy of fluorodeoxyglucose-18 (FDG) PET/CT, conventional and diffusion-weighted (DW) MRI as replacement or add-on to abdominal CT, for assessing tumour resectability at primary debulking surgery in women with stage III to IV epithelial ovarian/fallopian tube/primary peritoneal cancer. SEARCH METHODS We searched MEDLINE and Embase (OVID) for potential eligible studies (1946 to 23 February 2017). Additionally, ClinicalTrials.gov, WHO-ICTRP and the reference list of all relevant studies were searched. SELECTION CRITERIA Diagnostic accuracy studies addressing the accuracy of preoperative FDG-PET/CT, conventional or DW-MRI on assessing tumour resectability in women with advanced stage (III to IV) epithelial ovarian/fallopian tube/primary peritoneal cancer who are scheduled to undergo primary debulking surgery. DATA COLLECTION AND ANALYSIS Two authors independently screened titles and abstracts for relevance and inclusion, extracted data and performed methodological quality assessment using QUADAS-2. The limited number of studies did not permit meta-analyses. MAIN RESULTS Five studies (544 participants) were included in the analysis. All studies performed the index test as replacement of abdominal CT. Two studies (366 participants) addressed the accuracy of FDG-PET/CT for assessing incomplete debulking with residual disease of any size (> 0 cm) with sensitivities of 1.0 (95% CI 0.54 to 1.0) and 0.66 (95% CI 0.60 to 0.73) and specificities of 1.0 (95% CI 0.80 to 1.0) and 0.88 (95% CI 0.80 to 0.93), respectively (low- and moderate-certainty evidence). Three studies (178 participants) investigated MRI for different target conditions, of which two investigated DW-MRI and one conventional MRI. The first study showed that DW-MRI determines incomplete debulking with residual disease of any size with a sensitivity of 0.94 (95% CI 0.83 to 0.99) and a specificity of 0.98 (95% CI 0.88 to 1.00) (low- and moderate-certainty evidence). For abdominal CT, the sensitivity for assessing incomplete debulking was 0.66 (95% CI 0.52 to 0.78) and the specificity 0.77 (95% CI 0.63 to 0.87) (low- and low-certainty evidence). The second study reported a sensitivity of DW-MRI of 0.75 (95% CI 0.35 to 0.97) and a specificity of 0.96 (95% CI 0.80 to 1.00) (very low-certainty evidence) for assessing incomplete debulking with residual disease > 1 cm. In the last study, the sensitivity for assessing incomplete debulking with residual disease of > 2 cm on conventional MRI was 0.91 (95% CI 0.59 to 1.00) and the specificity 0.97 (95% CI 0.87 to 1.00) (very low-certainty evidence). Overall, the certainty of evidence was very low to moderate (according to GRADE), mainly due to small sample sizes and imprecision. AUTHORS' CONCLUSIONS Studies suggested a high specificity and moderate sensitivity for FDG-PET/CT and MRI to assess macroscopic incomplete debulking. However, the certainty of the evidence was insufficient to advise routine addition of FDG-PET/CT or MRI to clinical practice..In a research setting, adding an alternative imaging method could be considered for women identified as suitable for primary debulking by abdominal CT, in an attempt to filter out false-negatives (i.e. debulking, feasible based on abdominal CT, unfeasible at actual surgery).
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Affiliation(s)
- Joline F Roze
- UMC Utrecht Cancer CenterDepartment of Gynaecological OncologyUtrechtNetherlands3508 GA
| | - Jacob P Hoogendam
- UMC Utrecht Cancer CenterDepartment of Gynaecological OncologyUtrechtNetherlands3508 GA
| | - Fleur T van de Wetering
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityCochrane NetherlandsPO Box 85500UtrechtNetherlands3508 GA
| | - René Spijker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityCochrane NetherlandsPO Box 85500UtrechtNetherlands3508 GA
| | - Leen Verleye
- Belgian Health Care Knowledge CentreKruidtuinlaan 55BrusselsBelgium1000
| | - Joan Vlayen
- Belgian Health Care Knowledge CentreKruidtuinlaan 55BrusselsBelgium1000
| | - Wouter B Veldhuis
- University Medical Center UtrechtDepartment of RadiologyRoom E01.132PO Box 85500UtrechtNetherlands3508 GA
| | - Rob JPM Scholten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityCochrane NetherlandsPO Box 85500UtrechtNetherlands3508 GA
| | - Ronald P Zweemer
- UMC Utrecht Cancer CenterDepartment of Gynaecological OncologyUtrechtNetherlands3508 GA
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Value of 18F-FDG PET/CT Combined With Tumor Markers in the Evaluation of Ascites. AJR Am J Roentgenol 2018; 210:1155-1163. [PMID: 29629798 DOI: 10.2214/ajr.17.18733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The purpose of this study is to investigate the value of 18F-FDG PET/CT combined with assessment of tumor markers in serum or ascites for the diagnosing and determining the prognosis of benign and malignant ascites. MATERIALS AND METHODS Patients with ascites of unknown cause who underwent evaluation with FDG PET/CT were included in this retrospective study. The maximum standardized uptake value (SUVmax) and levels of the tumor markers carbohydrate antigen-125 (CA-125) and carcinoembryonic antigen (CEA) in serum and ascites were recorded. The diagnostic values of FDG PET/CT, CEA and CA-125 levels in serum or ascites, and the combination of imaging plus tumor marker assessment were evaluated. Factors that were predictive of survival were also analyzed. RESULTS A total of 177 patients were included. Malignant ascites was eventually diagnosed in 104 patients, and benign ascites was diagnosed in the remaining 73 patients. With the use of FDG PET/CT, 44 patients (42.3%) were found to have primary tumors. The sensitivity, specificity, and accuracy of FDG PET/CT were 92.3%, 83.6%, and 88.7%, respectively. CA-125 levels in serum and ascites showed much better sensitivity than did CEA levels, but they showed significantly lower specificity. If the combination of tumor markers and FDG PET/CT was analyzed, the sensitivity, specificity, and accuracy of tumor markers in serum were 96.6%, 78.1%, and 88.7%, and those of tumor markers in ascites were 97.7%, 80.0%, and 90.4%, respectively. Sex may be an important factor affecting survival time (hazard ratio, 0.471; p = 0.004), but age, CEA level, and FDG PET/CT findings could not predict survival. CONCLUSION FDG PET/CT combined with assessment of tumor markers, especially CEA, increased the efficacy of diagnosis of ascites of unknown causes. Male sex conferred a poorer prognosis, whereas age, CEA level, and FDG uptake had no predictive significance in patients with malignant ascites.
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Nasser S, Lazaridis A, Evangelou M, Jones B, Nixon K, Kyrgiou M, Gabra H, Rockall A, Fotopoulou C. Correlation of pre-operative CT findings with surgical & histological tumor dissemination patterns at cytoreduction for primary advanced and relapsed epithelial ovarian cancer: A retrospective evaluation. Gynecol Oncol 2016; 143:264-269. [PMID: 27586894 DOI: 10.1016/j.ygyno.2016.08.322] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Computed tomography (CT) is an essential part of preoperative planning prior to cytoreductive surgery for primary and relapsed epithelial ovarian cancer (EOC). Our aim is to correlate pre-operative CT results with intraoperative surgical and histopathological findings at debulking surgery. METHODS We performed a systematic comparison of intraoperative tumor dissemination patterns and surgical resections with preoperative CT assessments of infiltrative disease at key resection sites, in women who underwent multivisceral debulking surgery due to EOC between January 2013 and December 2014 at a tertiary referral center. The key sites were defined as follows: diaphragmatic involvement(DI), splenic disease (SI), large (LBI) and small (SBI) bowel involvement, rectal involvement (RI), porta hepatis involvement (PHI), mesenteric disease (MI) and lymph node involvement (LNI). RESULTS A total of 155 patients, mostly with FIGO stage IIIC disease (65%) were evaluated (primary=105, relapsed=50). Total macroscopic cytoreduction rates were: 89%. Pre-operative CT findings displayed high specificity across all tumor sites apart from the retroperitoneal lymph node status, with a specificity of 65%. The ability however of the CT to accurately identify sites affected by invasive disease was relatively low with the following sensitivities as relating to final histology: 32% (DI), 26% (SI), 46% (LBI), 44% (SBI), 39% (RI), 57% (PHI), 31% (MI), 63% (LNI). CONCLUSION Pre-operative CT imaging shows high specificity but low sensitivity in detecting tumor involvement at key sites in ovarian cancer surgery. CT findings alone should not be used for surgical decision making.
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Affiliation(s)
- S Nasser
- West London Gynecological Cancer Center, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - A Lazaridis
- West London Gynecological Cancer Center, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - M Evangelou
- Department of Mathematics and Statistics, Huxley Building, Imperial College, Queen's Gate South Kensington Campus, London SW7 2AZ, UK
| | - B Jones
- West London Gynecological Cancer Center, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - K Nixon
- West London Gynecological Cancer Center, Imperial College London, Du Cane Road, London W12 0HS, UK; Department of Surgery and Cancer, Ovarian Cancer Action Research Center, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - M Kyrgiou
- West London Gynecological Cancer Center, Imperial College London, Du Cane Road, London W12 0HS, UK; Department of Surgery and Cancer, Ovarian Cancer Action Research Center, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - H Gabra
- West London Gynecological Cancer Center, Imperial College London, Du Cane Road, London W12 0HS, UK; Department of Surgery and Cancer, Ovarian Cancer Action Research Center, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - A Rockall
- Department of Radiology, Imperial College Cancer Imaging Centre, Du Cane Road, London W12 0HS, UK
| | - C Fotopoulou
- West London Gynecological Cancer Center, Imperial College London, Du Cane Road, London W12 0HS, UK; Department of Surgery and Cancer, Ovarian Cancer Action Research Center, Imperial College London, Du Cane Road, London W12 0HS, UK.
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Grueneisen J, Umutlu L. Lokal- und Ganzkörperdiagnostik weiblicher Beckentumore. Radiologe 2016; 56:605-11. [DOI: 10.1007/s00117-016-0127-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE It is now recognized that ovarian cancer includes a heterogeneous group of malignant epithelial tumors originating from the ovaries, fallopian tubes, or peritoneum. This development has prompted the International Federation of Gynecology and Obstetrics (FIGO) to issue a revised staging system that can provide prognostic information and guidance on personalized management of ovarian cancer. CONCLUSION We review the epidemiology of ovarian cancer, the new FIGO staging system, and the role of imaging in the assessment, staging, and follow-up of ovarian cancer.
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Abstract
Dynamic-contrast enhanced (DCE) and diffusion-weighted (DW) MR imaging are invaluable in the detection, staging, and characterization of uterine and ovarian malignancies, for monitoring treatment response, and for identifying disease recurrence. When used as adjuncts to morphologic T2-weighted (T2-W) MR imaging, these techniques improve accuracy of disease detection and staging. DW-MR imaging is preferred because of its ease of implementation and lack of need for an extrinsic contrast agent. MR spectroscopy is difficult to implement in the clinical workflow and lacks both sensitivity and specificity. If used quantitatively in multicenter clinical trials, standardization of DCE- and DW-MR imaging techniques and rigorous quality assurance is mandatory.
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Affiliation(s)
- Nandita M deSouza
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
| | - Andrea Rockall
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, DuCane Road, London W12 0HS, UK; Department of Radiology, Imperial College, South Kensington, London SW7 2AZ, UK
| | - Susan Freeman
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
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Surgical outcome prediction in patients with advanced ovarian cancer using computed tomography scans and intraoperative findings. Taiwan J Obstet Gynecol 2015; 53:343-7. [PMID: 25286788 DOI: 10.1016/j.tjog.2013.10.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aimed to identify features on preoperative computed tomography (CT) scans that are predictive of suboptimal primary cytoreduction and to evaluate the correlation between CT findings and intraoperative findings in advanced ovarian cancer. MATERIALS AND METHODS We retrospectively reviewed preoperative CT scans and operative findings from patients with stage III/IV epithelial ovarian cancer who underwent primary cytoreduction between 2003 and 2006. Fourteen criteria were assessed. Clinical data were extracted from medical records. Residual tumors measuring ≥1 cm were considered suboptimal. RESULTS We retrospectively identified 118 patients who met the study inclusion criteria. The rate of optimal cytoreduction (≤1 cm residual disease) was 40%. On preoperative CT scans, omental extension to the stomach or spleen and inguinal or pelvic lymph nodes >2 cm were predictors of suboptimal cytoreduction on univariate (p = 0.016 and p = 0.028, respectively) and multivariate analysis (p = 0.042 and p = 0.029, respectively). Involvement of both omental extension and inguinal or pelvic lymph nodes had a positive predictive value (PPV) of 100%, a specificity of 100%, and an accuracy of 45.8% in predicting suboptimal cytoreduction. We correlated the preoperative CT findings with the intraoperative findings. There were significant correlations between CT and intraoperative findings of omental extension (p = 0.007), inguinal or pelvic lymph nodes >2 cm (p < 0.001), and large bowel mesentery implants >2 cm (p = 0.001). CONCLUSION The combination of omental extension to the stomach or spleen and involvement of inguinal or pelvic lymph nodes in preoperative CT scans is considered predictive of suboptimal cytoreduction. These patients may be more appropriately treated with neoadjuvant chemotherapy followed by surgical cytoreduction.
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Miccò M, Sala E, Lakhman Y, Hricak H, Vargas HA. Role of imaging in the pretreatment evaluation of common gynecological cancers. ACTA ACUST UNITED AC 2015; 10:299-321. [PMID: 24956296 DOI: 10.2217/whe.14.19] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Different treatment options are available for patients with gynecological cancers. Imaging plays an important role in assessment of patients with common cancers involving uterine body, cervix and ovaries, from detection to evaluation of the extent of disease. The purpose of this review is to highlight the role of cross-sectional imaging techniques in treatment stratification and overall management of patients with endometrial, cervical and ovarian cancers. Several imaging techniques used are described, including ultrasound, computed tomography (CT), MRI and PET/CT. Specific imaging appearances of the most common uterine, cervical and ovarian cancers are discussed. Imaging findings corresponding to the 2009 revised International Federation of Gynecology and Obstetrics (FIGO) staging of gynecologic malignancies are also described. In the multidisciplinary evaluation of patients with gynecologic malignancies, the role of the radiologist has become central for accurate diagnosis and evaluation of extent of disease to achieve better treatment selection and planning.
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Affiliation(s)
- Maura Miccò
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Value of (18)F-FDG PET/CT in the Detection of Ovarian Malignancy. Nucl Med Mol Imaging 2014; 49:42-51. [PMID: 25774237 DOI: 10.1007/s13139-014-0303-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Ovarian cancer is a leading cause of gynecologic malignancy. As symptoms of ovarian cancer are nonspecific, only 20 % of ovarian cancers are diagnosed while they are still limited to the ovaries. Thus, early and accurate detection of disease is important for an improved prognosis. For the accurate and effective diagnosis of ovarian malignancy on (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT), we analyzed several parameters, including visual assessment. METHOD A total of 51 peritoneal lesions in 19 patients who showed ovarian masses with diffuse peritoneal infiltration were enrolled. Twelve patients were confirmed to have ovarian malignancy and seven patients with benign disease by pathologic examination. All patients were examined by (18)F-FDG PET/CT, and an additional 2-h delayed (18)F-FDG PET/CT was also performed for 15 patients with 42 peritoneal lesions. We measured semiquantitative parameters including maximum and mean standardized uptake values (SUVmax, SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on a 1-h initial (18)F-FDG PET/CT image (Parameter1) and on a 2-h delayed image (Parameter2). Additionally, retention indices of each parameter were calculated, and each parameter among the malignant and benign lesions was compared by Mann-Whitney U test. We also assessed the visual characteristics of each peritoneal lesion, including metabolic extent, intensity, shape, heterogeneity, and total visual score. Associations between visual grades and malignancy were analyzed using linear by linear association methods. Moreover, a receiver operating characteristic (ROC) curve was analyzed to compare the effectiveness of significant parameters. RESULT In a comparison between the malignant and benign groups in the analysis of 51 total peritoneal lesions, SUVmax1, SUVmean1, and TLG1 showed significant differences. Also, in the analysis of 42 peritoneal lesions that underwent an additional 2-h (18)F-FDG PET/CT examination, SUVmax1,2, SUVmean1,2, TLG2, and the RI of TLG showed significant differences between the malignant and benign groups. MTV did not show significant differences in either the analysis of 51 peritoneal lesions or of 42 lesions. Regarding visual assessments, metabolic intensity, shape, heterogeneity, and total visual score showed an association with malignancy. In the ROC analysis, the AUC of the visual score was larger than the AUC of other parameters in both the analyses of 51 peritoneal lesions and of 42 lesions. CONCLUSION Although further study with a larger patient population is needed, the visual assessment of (18)F-FDG PET/CT imaging has a primary role in the detection of malignancy in ovarian cancer patients with assistance from other semi-quantitative parameters.
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Fischerova D, Burgetova A. Imaging techniques for the evaluation of ovarian cancer. Best Pract Res Clin Obstet Gynaecol 2014; 28:697-720. [DOI: 10.1016/j.bpobgyn.2014.04.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/13/2014] [Accepted: 04/18/2014] [Indexed: 12/15/2022]
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Lee JK, Min KJ, So KA, Kim S, Hong JH. The effectiveness of dual-phase 18F-FDG PET/CT in the detection of epithelial ovarian carcinoma: a pilot study. J Ovarian Res 2014; 7:15. [PMID: 24499648 PMCID: PMC3922340 DOI: 10.1186/1757-2215-7-15] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 02/03/2014] [Indexed: 11/27/2022] Open
Abstract
Background The aim of our study is to establish the potential role of dual-phase 18F-fluorodeoxyglucose positron emission tomography / computed tomography (FDG-PET/CT) in patients presenting ovarian masses with diffuse peritoneal infiltration for differentiating benign from malignant lesions. Methods Twenty patients (13 with ovarian cancers and 7 with benign lesions) were evaluated preoperatively by dual-phase 18F-FDG-PET/CT performed 1 h and 2 h after injection of 18F-FDG. The maximum standardized uptake value (SUVmax) for both time points SUVmax1 and SUVmax2 were determined, respectively, and the retention index (RI) was calculated by subtracting the SUVmax1 from the SUVmax2 and dividing by SUVmax1. Results The areas under the receiver operating characteristic curves (AUCs) of SUVmax1 and SUVmax2 were 0.753 (P = 0.062, 95% confidence interval [CI] = 0.512–0.915) and 0.835 (P = 0.001, 95% CI = 0.604–0.961), respectively. The AUC of the RI was 0.901 (P < 0.001, 95% CI = 0.684–0.988). Using pairwise comparisons, the AUC of SUVmax2 was significantly higher than that of SUVmax1 (P = 0.032). The AUC of the RI was higher than those of SUVmax1 and SUVmax2, but the difference was not statistically significant. Conclusion Dual-phase 18F-FDG PET/CT might be considered when preoperative imaging is indeterminate. A larger-scaled, prospective study is needed to verify these results.
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Affiliation(s)
| | | | | | - Sungeun Kim
- Department of Obstetrics and Gynecology, Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.
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Xu G, Wang J, Liu T, Wang M, Zhou S, Wu B, Jiang M. Synthesis and crystal structure of a novel copper(ii) complex of curcumin-type and its application in in vitro and in vivo imaging. J Mater Chem B 2014; 2:3659-3666. [DOI: 10.1039/c4tb00133h] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The results of TPEF imaging in a tumor-bearing mouse model demonstrated the potential of the obtained complex for in vivo tumor diagnosis.
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Affiliation(s)
- Guoyong Xu
- Center of Modern Experimental Technology
- Anhui University
- Hefei 230039, P.R. China
| | - Jiafeng Wang
- Department of Pharmacy
- Anhui University of Chinese Medicine
- Hefei 230038, P.R. China
| | - Tao Liu
- Department of Pharmacy
- Anhui University of Chinese Medicine
- Hefei 230038, P.R. China
| | - Mahong Wang
- Center of Modern Experimental Technology
- Anhui University
- Hefei 230039, P.R. China
| | - Shuangsheng Zhou
- Center of Modern Experimental Technology
- Anhui University
- Hefei 230039, P.R. China
- Department of Pharmacy
- Anhui University of Chinese Medicine
| | - Baoxing Wu
- Department of Pharmacy
- Anhui University of Chinese Medicine
- Hefei 230038, P.R. China
- State Key Laboratory of Crystal Materials
- Shandong University
| | - Minghua Jiang
- State Key Laboratory of Crystal Materials
- Shandong University
- Jinan 502100, P.R. China
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Manegold-Brauer G, Bellin AK, Tercanli S, Lapaire O, Heinzelmann-Schwarz V. The special role of ultrasound for screening, staging and surveillance of malignant ovarian tumors: distinction from other methods of diagnostic imaging. Arch Gynecol Obstet 2013; 289:491-8. [PMID: 24253338 DOI: 10.1007/s00404-013-3081-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 10/29/2013] [Indexed: 12/13/2022]
Abstract
Ovarian cancer is the most aggressive gynecologic malignancy, with a 5-year survival rate ranging around 40%. A crucial factor influencing the prognosis is early detection of a suspicious mass and referral to a gynecologic oncology center for further diagnosis, staging and debulking surgery. Here, we present the different imaging methods ultrasound (US), magnetic resonance imaging, computer tomography (CT) and 18F-fluoro-deoxyglucose positron emission tomography (PET)/CT that are used for the characterization, diagnosis, staging and surveillance of ovarian cancer. In this review, we focus on US and discuss in detail the advantages and the limitations, as well as the appropriate indications for each of the individual imaging techniques.
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Affiliation(s)
- Gwendolin Manegold-Brauer
- Ultrasound Unit, Department of Gynecology and Obstetrics, University Hospital of Basel, Basel, Switzerland,
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Mitchell DG, Javitt MC, Glanc P, Bennett GL, Brown DL, Dubinsky T, Harisinghani MG, Harris RD, Horowitz NS, Pandharipande PV, Pannu HK, Podrasky AE, Royal HD, Shipp TD, Siegel CL, Simpson L, Wong-You-Cheong JJ, Zelop CM. ACR Appropriateness Criteria Staging and Follow-up of Ovarian Cancer. J Am Coll Radiol 2013; 10:822-7. [DOI: 10.1016/j.jacr.2013.07.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 07/22/2013] [Indexed: 01/22/2023]
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Anthoulakis C, Nikoloudis N. Pelvic MRI as the "gold standard" in the subsequent evaluation of ultrasound-indeterminate adnexal lesions: a systematic review. Gynecol Oncol 2013; 132:661-8. [PMID: 24183731 DOI: 10.1016/j.ygyno.2013.10.022] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/08/2013] [Accepted: 10/22/2013] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Incidentally discovered adnexal masses are common, posing a challenging diagnostic problem because imaging features of benign and malignant overlap. Thus, once an adnexal lesion has been detected, the primary goal of further imaging is accurate tissue characterization resulting in surgery only for lesions that are indeterminate or frankly malignant. This study aims to conduct a systematic review, following the PRISMA guidelines, and critically appraise pelvic MR Imaging as the preferred advanced second imaging test, as regards detection of ovarian cancer and assessment of indeterminate adnexal masses, with respect to pre-operatively improving the assignment of these patients to the appropriate level of care. METHODS A comprehensive computerized systematic literature search of English language studies was performed (from 2002 to 2012) of PubMed, EMBASE, Scopus, Evidence Based Medicine Reviews (Cochrane Database and Cochrane Central Register of Controlled Trials), and Google Scholar. Relevant article reference lists were hand searched. RESULTS Computerized database search revealed 37 citations of relevance, 10 of which fulfilled the inclusion/exclusion criteria. From the aforementioned, 8 articles were acquired (2 authors were contacted but did not respond) as well as assessed with AHRQ, QUADAS, and STARD evaluation tools. Finally, 6 papers (5 prospective and 1 retrospective) were included in the systematic review. CONCLUSIONS MRI with intravenous (IV) contrast administration provides the highest post-test probability of ovarian cancer detection. However, the preponderant contribution of MRI in adnexal mass evaluation is its specificity because it provides confident diagnosis of many benign adnexal lesions.
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Affiliation(s)
- C Anthoulakis
- 3(rd) Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, "Ippokrateio" General Hospital of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece.
| | - N Nikoloudis
- 2(nd) Department of Surgery, General Hospital of Serres, 2(nd) Km Serres-Drama, 62100 Serres, Greece.
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Diagnostic accuracy of hand-assisted laparoscopy in predicting resectability of peritoneal carcinomatosis from gynecological malignancies. Eur J Surg Oncol 2013; 39:774-9. [PMID: 23597496 DOI: 10.1016/j.ejso.2013.03.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 10/06/2012] [Accepted: 03/25/2013] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Residual disease after excision surgery is the main prognostic factor in advanced ovarian cancer. Open surgery can delay neoadjuvant chemotherapy initiation. Therefore, a minimally invasive method for evaluating resectability would be of great interest. Aim of our study is to evaluate a new technique for assessing the extent of peritoneal carcinomatosis, combining manual palpation and standard laparoscopy. METHODS Prospective single-center study from October 2008 to January 2010. Patients with peritoneal carcinomatosis from gynecological malignancies were investigated by standard laparoscopy followed by laparoscopy plus manual palpation using Lapdisc(®) (Ethicon Inc.), at 43 abdominopelvic sites. When both techniques indicated resectability, standard cytoreduction surgery was performed via a midline laparotomy. The Fagotti, modified Fagotti, and Sugarbaker scores were computed. The diagnostic performance of each evaluation criterion was assessed by computing sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver-operating characteristic curves (ROC-AUCs). RESULTS Of the 29 included patients, 18 (62.1%) were considered to have resectable disease. Fourteen (14/18, 77.8%) had macroscopically complete cytoreduction. With Lapdisc(®), sensitivity was 100%, specificity 73.3%, PPV 77.8%, NPV 100%, and ROC-AUC 0.87. Corresponding values were as follows: laparoscopy, 100%, 40%, 60.9%, 100%, and 0.70; Fagotti and modified Fagotti scores, 100%, 46.7%, 63.6%, 100%, and 0.73; Sugarbaker score, 64.3%, 93.3%, 90%, 73.7%, and 0.79. The ROC-AUCs showed significantly better performance of Lapdisc(®) than of standard laparoscopy (P = 0.008). CONCLUSION Hand-assisted laparoscopy may perform better than laparoscopy alone for predicting the resectability of peritoneal carcinomatosis by increasing the number of sites evaluated.
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Nougaret S, Addley HC, Colombo PE, Fujii S, Al Sharif SS, Tirumani SH, Jardon K, Sala E, Reinhold C. Ovarian carcinomatosis: how the radiologist can help plan the surgical approach. Radiographics 2013; 32:1775-800; discussion 1800-3. [PMID: 23065169 DOI: 10.1148/rg.326125511] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Ovarian carcinoma is the most common cause of death due to gynecologic malignancy. Peritoneal involvement is present in approximately 70% of patients at the time of initial diagnosis. The disease spreads abdominally by direct extension, exfoliation of tumor cells into the peritoneal space, and dissemination of tumor cells along lymphatic pathways. Carcinomatosis characterizes an advanced stage of disease in which peritoneal disease has spread throughout the upper abdomen (stage IIIC) or in which diffuse peritoneal disease is accompanied by malignant pleural infiltration or visceral metastases (stage IV). Common sites of intraperitoneal seeding of ovarian carcinoma include the pelvis, omentum, paracolic gutters, liver capsule, and diaphragm. Soft-tissue thickening, nodularity, and enhancement are all signs of peritoneal involvement. Advanced-stage disease is treated either with initial cytoreductive surgery (debulking) followed by adjuvant chemotherapy, or with initial neoadjuvant chemotherapy followed by debulking. Radiologic imaging plays an important role in the selection of patients who may benefit from neoadjuvant chemotherapy before debulking. However, accurate interpretation of the imaging findings is challenging and requires a detailed knowledge of the complex peritoneal anatomy, directionality of flow of peritoneal fluid, and specific disease sites that are likely to present particular difficulties with regard to surgical access and technique. Although there is as yet no clear consensus on the criteria for resectability of peritoneal lesions, extensive involvement of the small bowel or mesenteric root, involved lymph nodes superior to the celiac axis, pleural infiltration, pelvic sidewall invasion, bladder trigone involvement, and hepatic parenchymal metastases or implants near the right hepatic vein are considered indicative of potential nonresectability. Implants larger than 2 cm in diameter in the diaphragm, lesser sac, porta hepatis, intersegmental fissure, gallbladder fossa, or gastrosplenic or gastrohepatic ligament also may represent nonresectable disease.
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Affiliation(s)
- Stephanie Nougaret
- Department of Diagnostic Radiology, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada.
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Wasnik AP, Menias CO, Platt JF, Lalchandani UR, Bedi DG, Elsayes KM. Multimodality imaging of ovarian cystic lesions: Review with an imaging based algorithmic approach. World J Radiol 2013; 5:113-25. [PMID: 23671748 PMCID: PMC3650202 DOI: 10.4329/wjr.v5.i3.113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/16/2012] [Accepted: 01/31/2013] [Indexed: 02/06/2023] Open
Abstract
Ovarian cystic masses include a spectrum of benign, borderline and high grade malignant neoplasms. Imaging plays a crucial role in characterization and pretreatment planning of incidentally detected or suspected adnexal masses, as diagnosis of ovarian malignancy at an early stage is correlated with a better prognosis. Knowledge of differential diagnosis, imaging features, management trends and an algorithmic approach of such lesions is important for optimal clinical management. This article illustrates a multi-modality approach in the diagnosis of a spectrum of ovarian cystic masses and also proposes an algorithmic approach for the diagnosis of these lesions.
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Jokerst JV, Cole AJ, Van de Sompel D, Gambhir SS. Gold nanorods for ovarian cancer detection with photoacoustic imaging and resection guidance via Raman imaging in living mice. ACS NANO 2012; 6:10366-77. [PMID: 23101432 PMCID: PMC3572720 DOI: 10.1021/nn304347g] [Citation(s) in RCA: 263] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Improved imaging approaches are needed for ovarian cancer screening, diagnosis, staging, and resection guidance. Here, we propose a combined photoacoustic (PA)/Raman approach using gold nanorods (GNRs) as a passively targeted molecular imaging agent. GNRs with three different aspect ratios were studied. Those with an aspect ratio of 3.5 were selected for their highest ex vivo and in vivo PA signal and used to image subcutaneous xenografts of the 2008, HEY, and SKOV3 ovarian cancer cell lines in living mice. Maximum PA signal was observed within 3 h for all three lines tested and increased signal persisted for at least two days postadministration. There was a linear relationship (R(2) = 0.95) between the PA signal and the concentration of injected molecular imaging agent with a calculated limit of detection of 0.40 nM GNRs in the 2008 cell line. The same molecular imaging agent could be used for clear visualization of the margin between tumor and normal tissue and tumor debulking via surface-enhanced Raman spectroscopy (SERS) imaging. Finally, we validated the imaging findings with biodistribution data and elemental analysis. To the best of our knowledge, this is the first report of in vivo imaging of ovarian cancer tumors with a photoacoustic and Raman imaging agent.
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Affiliation(s)
- Jesse V. Jokerst
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, 318 Campus Drive, Stanford, California 94305-5427, United States
| | - Adam J. Cole
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, 318 Campus Drive, Stanford, California 94305-5427, United States
| | - Dominique Van de Sompel
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, 318 Campus Drive, Stanford, California 94305-5427, United States
| | - Sanjiv S. Gambhir
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, 318 Campus Drive, Stanford, California 94305-5427, United States
- Bioengineering, Materials Science & Engineering, Bio-X, Stanford University, Stanford, California 94305, United States
- Address correspondence to
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Yuan Y, Gu ZX, Tao XF, Liu SY. Computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with ovarian cancer: A meta-analysis. Eur J Radiol 2012; 81:1002-6. [DOI: 10.1016/j.ejrad.2011.01.112] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 01/28/2011] [Indexed: 12/22/2022]
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Diagnostic value of PET/CT is similar to that of conventional MRI and even better for detecting small peritoneal implants in patients with recurrent ovarian cancer. Nucl Med Commun 2012; 33:509-15. [DOI: 10.1097/mnm.0b013e32834fc5bf] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Ovarian cancer is the second most common gynecologic malignancy. It is the deadliest, largely owing to late stage at the time of diagnosis. Ultrasound is modality of choice in the evaluation of suspected adnexal masses. Magnetic resonance imaging is an excellent problem solver when an adnexal mass is indeterminate on ultrasound. Staging of ovarian cancer remains surgical, though preoperative imaging can identify inoperable patients and identify suspicious sites for intraoperative biopsy. This article reviews the use of different imaging modalities in the detection and staging of ovarian carcinoma, and discusses imaging indications, radiologic features, and the shortcomings of imaging.
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Vogl TJ, Naguib NNN, Lehnert T, Nour-Eldin NEA, Eichler K, Zangos S, Gruber-Rouh T. Initial experience with repetitive transarterial chemoembolization (TACE) as a third line treatment of ovarian cancer metastasis to the liver: indications, outcomes and role in patient's management. Gynecol Oncol 2011; 124:225-9. [PMID: 22079359 DOI: 10.1016/j.ygyno.2011.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 10/31/2011] [Accepted: 11/01/2011] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate local tumor control and survival data after transarterial chemoembolization (TACE) with different drug combinations in the palliative third-line treatment of patients with ovarian cancer liver metastases. METHODS Sixty-five patients (mean age: 51.5 year) with unresectable hematogenous hepatic metastases of ovarian cancer who did not respond to systemic chemotherapy were repeatedly treated with TACE in 4-week intervals. The local chemotherapy protocol consisted of Mitomycin (group 1) (n=14; 21.5%), Mitomycin with Gemcitabine (group 2) (n=26; 40%), or Mitomycin with Gemcitabine and Cisplatin (group 3) (n=25; 38.5%). Embolization was performed with Lipiodol and starch microspheres. Local tumor response was evaluated by MRI according to RECIST criteria. Survival data were calculated according to the Kaplan-Meier method. RESULTS The local tumor control was: partial response (PR) in 16.9% (n=11), stable disease (SD) in 58.5% (n=38) and progressive disease (PD) in 24.6% (n=16) of patients. In group 1, we observed SD in 78.6% (11/14), and PD in 21.4% (3/14) of patients. In group 2, PR in 7.7% (2/26), SD in 57.7% (15/26), and PD in 34.6% (9/26) of patients. In group 3, PR in 36% (9/25), SD in 48% (12/25), and PD in 16% (4/25) of patients. Survival rate from the start of TACE was 58% after 1-year, 19% after 2-years, and 13% after 3-years. The median and mean survival times were 14 and 18.5 months without statistically significant difference for the 3 groups of patients (p=0.502). CONCLUSION Transarterial chemoembolization is effective palliative treatment in achieving local control in selected patients with liver metastases from ovarian cancer.
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Affiliation(s)
- Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany.
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