CC BY 4.0 · Indian J Med Paediatr Oncol 2023; 44(01): 100-109
DOI: 10.1055/s-0042-1759518
Review Article

Imaging Recommendations for Diagnosis, Staging, and Management of Ovarian and Fallopian Tube Cancers

Renganathan Rupa
1   Department of Diagnostic and Interventional Radiology, Division of Breast and Women's Imaging and Interventions, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India
,
1   Department of Diagnostic and Interventional Radiology, Division of Breast and Women's Imaging and Interventions, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India
,
Palak Bhavesh Popat
2   Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Smita Manchanda
3   Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
,
Kasi Venkatesh
4   Department of Diagnostic and Interventional Radiology, Division of Abdominal Imaging and ablative therapies, Kovai Medical Center and Hospitals, Coimbatore, India
,
5   Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
,
Anbukkani Subbian
6   Department of Gynecological Oncology, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India
,
Bharath Rangarajan
7   Department of Medical Oncology, KMCHIMSR, Coimbatore, Tamil Nadu, India
› Author Affiliations
Funding None.

Abstract

Ovarian 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.



Publication History

Article published online:
24 January 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65 (02) 87-108
  • 2 Forstner R, Hricak H, Occhipinti KA, Powell CB, Frankel SD, Stern JL. Ovarian cancer: staging with CT and MR imaging. Radiology 1995; 197 (03) 619-626
  • 3 NCCN Clinical Practice Guidelines in Oncology. Epithelial ovarian cancer (including fallopian tube cancer and primary peritoneal cancer). Version 1.2022. Accessed November 09, 2022, at: https://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf
  • 4 Duska LR, Kohn EC. The new classifications of ovarian, fallopian tube, and primary peritoneal cancer and their clinical implications. Ann Oncol 2017; 28 (suppl_8): viii8-viii12 DOI: 10.1093/annonc/mdx445.
  • 5 Momenimovahed Z, Tiznobaik A, Taheri S, Salehiniya H. Ovarian cancer in the world: epidemiology and risk factors. Int J Womens Health 2019; 11: 287-299 DOI: 10.2147/IJWH.S197604.
  • 6 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (06) 394-424 DOI: 10.3322/caac.21492.
  • 7 Malvezzi M, Carioli G, Rodriguez T, Negri E, La Vecchia C. Global trends and predictions in ovarian cancer mortality. Ann Oncol 2016; 27 (11) 2017-2025 DOI: 10.1093/annonc/mdw306.
  • 8 Mathur P, Sathishkumar K, Chaturvedi M. et al; ICMR-NCDIR-NCRP Investigator Group. Cancer Statistics, 2020: Report From National Cancer Registry Programme, India. JCO Glob Oncol 2020; 6 (06) 1063-1075 DOI: 10.1200/GO.20.00122.
  • 9 Menon U, Gentry-Maharaj A, Burnell M. et al. Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet 2021; 397 (10290): 2182-2193 DOI: 10.1016/S0140-6736(21)00731-5.
  • 10 Daly MB, Pal T, Berry MP. et al; Genetic/familial high-risk assessment: breast, ovarian, and pancreatic, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19 (01) 77-102 DOI: 10.6004/jnccn.2021.0001.
  • 11 Atri M, Alabousi A, Reinhold C. et al; Expert Panel on Women's Imaging. ACR appropriateness criteria® clinically suspected adnexal mass, no acute symptoms. J Am Coll Radiol 2019; 16 (5S): S77-S93 DOI: 10.1016/j.jacr.2019.02.011.
  • 12 Schmidt S, Meuli RA, Achtari C, Prior JO. Peritoneal carcinomatosis in primary ovarian cancer staging: comparison between MDCT, MRI, and 18F-FDG PET/CT. Clin Nucl Med 2015; 40 (05) 371-377
  • 13 Liu J, Xu Y, Wang J. Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis of ovarian carcinoma. Eur J Radiol 2007; 62 (03) 328-334
  • 14 Kang SK, Reinhold C, Atri M. et al; Expert Panel on Women's Imaging. ACR appropriateness criteria® staging and follow-up of ovarian cancer. J Am Coll Radiol 2018; 15 (5S): S198-S207 DOI: 10.1016/j.jacr.2018.03.015.
  • 15 Rockall A, Munari A, Avril N. New ways of assessing ovarian cancer response: metabolic imaging and beyond. Cancer Imaging 2012; 12 (02) 310-314 DOI: 10.1102/1470-7330.2012.9004.
  • 16 Vallius T, Hynninen J, Kemppainen J. et al. 18F-FDG-PET/CT based total metabolic tumor volume change during neoadjuvant chemotherapy predicts outcome in advanced epithelial ovarian cancer. Eur J Nucl Med Mol Imaging 2018; 45 (07) 1224-1232 DOI: 10.1007/s00259-018-3961-z.
  • 17 Winfield JM, Wakefield JC, Dolling D. et al. Diffusion-weighted MRI in advanced epithelial ovarian cancer: apparent diffusion coefficient as a response marker. Radiology 2019; 293 (02) 374-383 DOI: 10.1148/radiol.2019190545.
  • 18 Sebastian S, Lee SI, Horowitz NS. et al. PET-CT vs. CT alone in ovarian cancer recurrence. Abdom Imaging 2008; 33 (01) 112-118 DOI: 10.1007/s00261-007-9218-0.
  • 19 Bast Jr RC, Klug TL, St John E. et al. A radioimmunoassay using a monoclonal antibody to monitor the course of epithelial ovarian cancer. N Engl J Med 1983; 309 (15) 883-887
  • 20 Dodge JE, Covens AL, Lacchetti C. et al; Gynecology Cancer Disease Site Group. Preoperative identification of a suspicious adnexal mass: a systematic review and meta-analysis. Gynecol Oncol 2012; 126 (01) 157-166
  • 21 Hewitt MJ, Anderson K, Hall GD. et al. Women with peritoneal carcinomatosis of unknown origin: Efficacy of image-guided biopsy to determine site-specific diagnosis. BJOG 2007; 114 (01) 46-50
  • 22 Fagotti A, Ferrandina G, Fanfani F. et al. A laparoscopy-based score to predict surgical outcome in patients with advanced ovarian carcinoma: a pilot study. Ann Surg Oncol 2006; 13 (08) 1156-1161
  • 23 Rutten MJ, van Meurs HS, van de Vrie R. et al. Laparoscopy to predict the result of primary cytoreductive surgery in patients with advanced ovarian cancer: a randomized controlled trial. J Clin Oncol 2017; 35 (06) 613-621
  • 24 Konstantinopoulos PA, Norquist B, Lacchetti C. et al. Germline and somatic tumor testing in epithelial ovarian cancer: ASCO guideline. J Clin Oncol 2020; 38 (11) 1222-1245
  • 25 Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin 2021; 71 (01) 7-33
  • 26 Buys SS, Partridge E, Black A. et al; PLCO Project Team. Effect of screening on ovarian cancer mortality: the prostate, lung, colorectal and ovarian (PLCO) cancer screening randomized controlled trial. JAMA 2011; 305 (22) 2295-2303 DOI: 10.1001/jama.2011.766.
  • 27 Grossman DC, Curry SJ, Owens DK. et al; US Preventive Services Task Force. Screening for ovarian cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2018; 319 (06) 588-594 DOI: 10.1001/jama.2017.21926.
  • 28 Committee on Gynecologic Practice, Society of Gynecologic Oncology. Committee Opinion No. 716: the role of the obstetrician-gynaecologist in the early detection of epithelial ovarian cancer in women at average risk. Obstet Gynecol 2017; 130 (03) e146-e149
  • 29 Smith RA, Andrews KS, Brooks D. et al. Cancer screening in the United States, 2017: a review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin 2017; 67 (02) 100-121 DOI: 10.3322/caac.21392.
  • 30 Andreotti RF, Timmerman D, Strachowski LM. et al. O-RADS US risk stratification and management system: a consensus guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. Radiology 2020; 294 (01) 168-185 DOI: 10.1148/radiol.2019191150.
  • 31 Sadowski EA, Thomassin-Naggara I, Rockall A. et al. O-RADS MRI risk stratification system: guide for assessing adnexal lesions from the ACR O-RADS Committee. Radiology 2022; 303 (01) 35-47 DOI: 10.1148/radiol.204371.
  • 32 Hynninen J, Kemppainen J, Lavonius M. et al. A prospective comparison of integrated FDG-PET/contrast-enhanced CT and contrast-enhanced CT for pretreatment imaging of advanced epithelial ovarian cancer. Gynecol Oncol 2013; 131 (02) 389-394
  • 33 Koh JL, Yan TD, Glenn D, Morris DL. Evaluation of preoperative computed tomography in estimating peritoneal cancer index in colorectal peritoneal carcinomatosis. Ann Surg Oncol 2009; 16 (02) 327-333 DOI: 10.1245/s10434-008-0234-2.
  • 34 Low RN, Barone RM. Combined diffusion-weighted and gadolinium-enhanced MRI can accurately predict the peritoneal cancer index preoperatively in patients being considered for cytoreductive surgical procedures. Ann Surg Oncol 2012; 19 (05) 1394-1401
  • 35 Castellucci P, Perrone AM, Picchio M. et al. 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 2007; 28 (08) 589-595 DOI: 10.1097/MNM.0b013e3281afa256.
  • 36 Nam EJ, Yun MJ, Oh YT. et al. Diagnosis and staging of primary ovarian cancer: correlation between PET/CT, Doppler US, and CT or MRI. Gynecol Oncol 2010; 116 (03) 389-394
  • 37 Mutch DG, Prat J. 2014 FIGO staging for ovarian, fallopian tube and peritoneal cancer. Gynecol Oncol 2014; 133 (03) 401-404
  • 38 Berek JS, Renz M, Kehoe S, Kumar L, Friedlander M. Cancer of the ovary, fallopian tube, and peritoneum: 2021 update. Int J Gynaecol Obstet 2021; 155 (Suppl 1): 61-85 DOI: 10.1002/ijgo.13878.
  • 39 Tawakol A, Abdelhafez YG, Osama A, Hamada E, El Refaei S. Diagnostic performance of 18F-FDG PET/contrast-enhanced CT versus contrast-enhanced CT alone for post-treatment detection of ovarian malignancy. Nucl Med Commun 2016; 37 (05) 453-460
  • 40 Gu P, Pan LL, Wu SQ, Sun L, Huang G. CA 125, PET alone, PET-CT, CT and MRI in diagnosing recurrent ovarian carcinoma: a systematic review and meta-analysis. Eur J Radiol 2009; 71 (01) 164-174
  • 41 Nakamoto Y, Saga T, Ishimori T. et al. Clinical value of positron emission tomography with FDG for recurrent ovarian cancer. Am J Roentgenol 2001; 176 (06) 1449-1454
  • 42 Salani R, Backes FJ, Fung MFK. et al. Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. Am J Obstet Gynecol 2011; 204 (06) 466-478
  • 43 Chi DS, Eisenhauer EL, Zivanovic O. et al. Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm. Gynecol Oncol 2009; 114 (01) 26-31 DOI: 10.1016/j.ygyno.2009.03.018.
  • 44 Elattar A, Bryant A, Winter-Roach BA, Hatem M, Naik R. Optimal primary surgical treatment for advanced epithelial ovarian cancer. Cochrane Database Syst Rev 2011; (08) CD007565 DOI: 10.1002/14651858.CD007565.pub2.
  • 45 Kehoe S, Hook J, Nankivell M. et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet 2015; 386 (9990): 249-257 DOI: 10.1016/S0140-6736(14)62223-6.
  • 46 Makar AP, Tropé CG, Tummers P, Denys H, Vandecasteele K. Advanced ovarian cancer: primary or interval debulking? Five categories of patients in view of the results of randomized trials and tumor biology: primary debulking surgery and interval debulking surgery for advanced ovarian cancer. Oncologist 2016; 21 (06) 745-754 DOI: 10.1634/theoncologist.2015-0239.
  • 47 Tewari KS, Burger RA, Enserro D. et al. Final overall survival of a randomized trial of bevacizumab for primary treatment of ovarian cancer. J Clin Oncol 2019; 37 (26) 2317-2328 DOI: 10.1200/JCO.19.01009.
  • 48 Moore K, Colombo N, Scambia G. et al. Maintenance olaparib in patients with newly diagnosed advanced ovarian cancer. N Engl J Med 2018; 379 (26) 2495-2505 DOI: 10.1056/NEJMoa1810858.
  • 49 Rustin GJS. Follow-up with CA125 after primary therapy of advanced ovarian cancer has major implications for treatment outcome and trial performances and should not be routinely performed. Ann Oncol 2011; 22 (Suppl 8) viii45-viii48 DOI: 10.1093/annonc/mdr471.
  • 50 Esselen KM, Cronin AM, Bixel K. et al. Use of CA-125 tests and computed tomographic scans for surveillance in ovarian cancer. JAMA Oncol 2016; 2 (11) 1427-1433 DOI: 10.1001/jamaoncol.2016.1842.