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.
Similar content being viewed by others
References
Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P (2007) Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 18(3):581–592
Alsop K, Fereday S, Meldrum C, deFazio A, Emmanuel C, George J, Dobrovic A, Birrer MJ, Webb PM, Stewart C, Friedlander M, Fox S, Bowtell D, Mitchell G (2012) BRCA mutation frequency and patterns of treatment response in BRCA mutation-positive women with ovarian cancer: a report from the Australian ovarian cancer study group. J Clin Oncol 30(21):2654–2656
Earle CC, Schrag D, Neville BA, Yabroff KR, Topor M, Fahey A, Trimble EL, Bodurka DC, Bristow RE, Carney M, Warren JL (2006) Effect of surgeon specialty on processes of care and outcomes for ovarian cancer patients. J Natl Cancer Inst 98(3):172–180
Engelen MJ, van der Zee AG, de Vries EG, Willemse PH (2006) Debulking surgery for ovarian epithelial cancer performed by a gynaecological oncologist improved survival compared with less specialised surgeons. Cancer Treat Rev 32(4):320–323
Woo YL, Kyrgiou M, Bryant A, Everett T, Dickinson HO (2012) Centralisation of services for gynaecological cancers––a Cochrane systematic review. Gynecol Oncol 126(2):286–290
Valentin L, Ameye L, Testa A, Lécuru F, Bernard JP, Paladini D, Van Huffel S, Timmerman D (2006) Ultrasound characteristics of different types of adnexal malignancies. Gynecol Oncol 102(1):41–48
Sharma A, Apostolidou S, Burnell M, Campbell S, Habib M, Gentry-Maharaj A, Amso N, Seif MW et al (2012) Risk of epithelial ovarian cancer in asymptomatic women with ultrasound-detected ovarian masses: a prospective cohort study within the UK collaborative trial of ovarian cancer screening (UKCTOCS). Ultrasound Obstet Gynecol 40(3):338–344
Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I, International Ovarian Tumor Analysis (IOTA) Group (2000) Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the international ovarian tumor analysis (IOTA) group. Ultrasound Obstet Gynecol 16(5):500–505
Timmerman D, Testa AC, Bourne T, Ameye L, Jurkovic D, Van Holsbeke C, Paladini D, Van Calster B, Vergote I, Van Huffel S, Valentin L (2008) Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound Obstet Gynecol 31(6):681–690
Geomini P, Kruitwagen R, Bremer GL, Cnossen J, Mol BW (2009) The accuracy of risk scores in predicting ovarian malignancy: a systemic review. Obstet Gynecol 113(2 Pt 1):384–394
Jacobs I, Oram D, Fairbanks J, Turner J, Frost C, Grudzinskas JG (1990) A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynecol 97(10):922–929
Chia YN, Marsden DE, Robertson G, Hacker NF (2008) Triage of ovarian masses. Aust N Z J Obstet Gynaecol 48(3):322–328
Timmerman D, Testa AC, Bourne T, Ferrazzi E, Ameye L, Konstantinovic ML, Van Calster B, Collins WP, Vergote I, Van Huffel S, Valentin L (2005) Logistic regression model to distinguish between the benign and malignant adnexal mass before surgery: a multicenter study by the international ovarian tumor analysis group. J Clin Oncol 23(34):8794–8801
Valentin L, Hagen B, Tingulstad S, Eik-Nes S (2001) Comparison of ‘pattern recognition’ and logistic regression models for discrimination between benign and malignant pelvic masses: a prospective cross validation. Ultrasound Obstet Gynecol 18(4):357–365
Van Holsbeke C, Van Calster B, Bourne T, Ajossa S, Testa AC, Guerriero S, Fruscio R, Lissoni AA, Czerkierdowski A, Savelli L, Van Huffel S, Valentin L, Timmerman D (2012) External validation of diagnostic models to estimate the risk of malignancy in adnexal masses. Clin Cancer Res 18(3):815–825
Van Calster B, Timmerman D, Valentin L, McIndoe A, Ghaem-Maghami S, Testa AC, Vergote I, Bourne T (2012) Triaging women with ovarian masses for surgery: observational diagnostic study to compare RCOG guidelines with an international ovarian tumour analysis (IOTA) group protocol. BJOG 119(6):662–671
Moore RG, McMeekin DS, Brown AK, DiSilvestro P, Miller MC, Allard WJ, Gajewski W, Kurman R, Bast RC Jr, Skates SJ (2009) A novel multiple marker bioassay utilizing HE4 and CA125 for the prediction of ovarian cancer in patients with a pelvic mass. Gynecol Oncol 112(1):40–46
Urban N, Thorpe JD, Bergan LA, Forrest RM, Kampani AV, Scholler N, O’Briant KC, Anderson GL, Cramer DW, Berg CD, McIntosh MW, Hartge P, Drescher CW (2011) Potential role of HE4 in multimodal screening for epithelial ovarian cancer. J Natl Cancer Inst 103(21):1630–1634
Karlsen MA, Sandhu N, Høgdall C, Christensen IJ, Nedergaard L, Lundvall L, Engelholm SA, Pedersen AT, Hartwell D, Lydolph M, Laursen IA, Høgdall EV (2012) Evaluation of HE4, CA125, risk of ovarian malignancy algorithm (ROMA) and risk of malignancy index (RMI) as diagnostic tools of epithelial ovarian cancer in patients with a pelvic mass. Gynecol Oncol 127(2):379–383
Jacob F, Meier M, Caduff R, Goldstein D, Pochechueva T, Hacker N, Fink D, Heinzelmann-Schwarz V (2011) No benefit from combining HE4 and CA125 as ovarian tumor markers in a clinical setting. Gynecol Oncol 121(3):487–491
Campbell S (2012) Ovarian cancer: role of ultrasound in preoperative diagnosis and population screening. Ultrasound Obstet Gynecol 40(3):245–254
Reade CJ, Riva JJ, Busse JW, Goldsmith CH, Elit L (2013) Risks and benefits of screening asymptomatic women for ovarian cancer: a systematic review and meta-analysis. Gynecol Oncol 130(3):674–681
Long KC, Kauff ND (2013) Screening for familial ovarian cancer: a ray of hope and a light to steer by. J Clin Oncol 31(1):8–10
Mohaghegh P, Rockall AG (2012) Imaging strategy for early ovarian cancer: characterization of adnexal masses with conventional and advanced imaging techniques. Radiographics 32(6):1751–1773
Timmerman D, Schwärzler P, Collins WP, Claerhout F, Coenen M, Amant F, Vergote I, Bourne TH (1999) Subjective assessment of adnexal masses with the use of ultrasonography: an analysis of interobserver variability and experience. Ultrasound Obstet Gynecol 13:11–16
Dodge JE, Covens AL, Lacchetti C, Elit LM, Le T, Devries-Abound M, Fung-Kee-Fung M, Gynecology Cancer Disease Site Group (2012) Management of a suspicious adnexal mass: a clinical practice guideline. Curr Oncol 19(4):244–257
Kinkel K, Lu Y, Mehdizade A, Pelte MF, Hricak H (2005) Indeterminate ovarian mass at US: incremental value of second imaging test for characterization–meta-analysis and Bayesian analysis. Radiology 236(1):85–94
Bharwani N, Reznek RH, Rockall AG (2011) Ovarian cancer management: the role of imaging and diagnostic challenges. Eur J Radiol 78(1):41–51
Alt CD, Brockner KA, Eichbaum M, Sohn C, Arnegger FU, Kauczor HU, Hallscheidt P (2011) Imaging of female pelvic malignancies regarding MRI, CT, and PET/CT: part 2. Strahlenther Onkol 187(11):705–714
Basu S, Kwee TC, Surti S, Akin EA, Yoo D, Alavi A (2011) Fundamentals of PET and PET/CT imaging. Ann N Y Acad Sci 1228:1–18
Nishizawa S, Inubushi M, Ozawa F, Kido A, Okada H (2007) Physiological FDG uptake in the ovaries after hysterectomy. Ann Nucl Med 21(6):345–348
Zhu ZH, Cheng WY, Cheng X, Dang YH (2007) Characteristics of physiological uptake of uterus and ovaries on 18F-fluorodeoxyglucose positron emission tomography. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 29(1):124–129
Iyer RB, Balachandran A, Devine CE (2007) PET/CT and cross sectional imaging of gynecologic malignancy. Cancer Imaging 7 (Spec No A):S130–S138
Castellucci P, Perrone AM, Picchio M, Ghi T, Farsad M, Nanni C, Messa C, Meriggiola MC, Pelusi G, Al-Nahhas A, Rubello D, Fazio F, Fanti S (2007) Diagnostic accuracy of 18F-FDG PET/CT in characterizing ovarian lesions and staging ovarian cancer: correlation with transvaginal ultrasonography, computed tomography, and histology. Nucl Med Commun 28(8):589–595
Risum S, Høgdall C, Loft A, Berthelsen AK, Høgdall E, Nedergaard L, Lundvall L, Engelholm SA (2007) The diagnostic value of PET/CT for primary ovarian cancer––a prospective study. Gynecol Oncol 105(1):145–149
Yamamoto Y, Oguri H, Yamada R, Maeda N, Kohsaki S, Fukaya T (2008) Preoperative evaluation of pelvic masses with combined 18F-fluorodeoxyglucose positron emission tomography and computed tomography. Int J Gynaecol Obstet 102(2):124–127
Nam EJ, Yun MJ, Oh YT, Kim JW, Kim JH, Kim S, Jung YW, Kim SW, Kim YT (2010) Diagnosis and staging of primary ovarian cancer: correlation between PET/CT, Doppler US, and CT or MRI. Gynecol Oncol 116(3):389–394
Vergote I, Tropé CG, Amant F, Kristensen GB, Ehlen T, Johnson N, Verheijen RH, van der Burg ME, Lacave AJ, Panici PB, Kenter GG, Casado A, Mendiola C, Coens C, Verleye L, Stuart GC, Pecorelli S, Reed NS, European Organization for Research and Treatment of Cancer-Gynaecological Cancer Group; NCIC Clinical Trials Group (2010) Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 363(10):943–953
Forstner R (2007) Radiological staging of ovarian cancer: imaging findings and contribution of CT and MRI. Eur Radiol 17(12):3223–3235
Fischerova D (2011) Ultrasound scanning of the pelvis and abdomen for staging of gynecological tumors: a review. Ultrasound Obstet Gynecol 38(3):246–266
Testa AC, Bourne TH (2009) Characterising pelvic masses using ultrasound. Best Pract Res Clin Obstet Gynaecol 23(5):725–738
Fischerova D, Cibula D, Dundr P, Zikan M, Freitag P, Slama J, Calda P (2008) The role of ultrasound in prediction of optimal versus suboptimal cytoreductive surgery in advanced ovarian cancers OC 132: 18th World congress on ultrasound in obstetrics and gynecology. Ultrasound Obstet Gynecol 32:243–307
Uzan C, Kane A, Rey A, Gouy S, Pautier P, Lhomme C, Duvillard P, Morice P (2011) How to follow up advanced-stage borderline tumours? Mode of diagnosis of recurrence in a large series stage II–III serious borderline tumours of the ovary. Ann Oncol 22(3):631–635
Zanetta G, Rota S, Lissoni A, Meni A, Brancatelli G, Buda A (2001) Ultrasound, physical examination, and CA 125 measurement for the detection of recurrence after conservative surgery for early borderline ovarian tumors. Gynecol Oncol 81(1):63–66
Mitchell D, Javitt M, Glanc P, Bennett G, Brown D, Dubinsky T, Harisinghani M, Harris R, Horowitz N, Pandharipande P, Pannu H, Podrasky A, Royal H, Shipp T, Siegel C, Simpson L, Wong-You-Cheong J, Zelop C (2012) Staging and follow-up of ovarian cancer ACR appropriateness criteria®
Woodward PJ, Hosseinzadeh K, Saenger JS (2004) From the archives of the AFIP: radiologic staging of ovarian carcinoma with pathologic correlation. Radiographics 24(1):225–246
Forstner R, Hricak H, Occhipinti KA, Powell CB, Frankel SD, Stern JL (1995) Ovarian cancer: staging with CT and MR imaging. Radiology 197(3):619–626
Tempany CM, Zou KH, Silverman SG, Brown DL, Kurtz AB, McNeil BJ (2000) Staging of advanced ovarian cancer: comparison of imaging modalities––report from the radiological diagnostic oncology group. Radiology 215(3):761–767
Coakley FV, Choi PH, Gougoutas CA, Pothuri B, Venkatraman E, Chi D, Bergman A, Hricak H (2002) Peritoneal metastases: detection with spiral CT in patients with ovarian cancer. Radiology 223(2):495–499
Sebastian S, Lee SI, Horowitz NS, Scott JA, Fischman AJ, Simeone JF, Fulle AF, Hahn PF (2008) PET-CT versus CT alone in ovarian cancer recurrence. Source Abdomen Imaging 33(1):112–118
Markman M (2009) Optimal management of recurrent ovarian cancer. Int J Gynecol Cancer 19(Suppl 2):S40–S43
Murakami M, Miyamoto T, Iida T, Tsukada H, Watanabe M, Shida M, Maeda H, Nasu S, Yasuda S, Yasuda M, Ide M (2006) Whole-body positron emission tomography and tumor marker CA125 for detection of recurrence in epithelial ovarian cancer. Int J Gynecol Cancer 16(1):99–107
Thrall MM, DeLoia JA, Gallion H, Avril N (2007) Clinical use of combined positron emission tomography and computed tomography (FDG-PET/CT) in recurrent ovarian cancer. Gynecol Oncol 105(1):17–22
Acknowledgments
The authors thank Dr. Dorothy Huang, Dr. André Fedier and Dr. Hans Ulrich Brauer for their critical review in the preparation of the manuscript.
Conflict of interest
The authors declare that they had no financial support and that there is no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Manegold-Brauer, G., Bellin, A.K., Tercanli, S. et al. The special role of ultrasound for screening, staging and surveillance of malignant ovarian tumors: distinction from other methods of diagnostic imaging. Arch Gynecol Obstet 289, 491–498 (2014). https://doi.org/10.1007/s00404-013-3081-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-013-3081-8