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Sadowski EA, Paroder V, Patel-Lippmann K, Robbins JB, Barroilhet L, Maddox E, McMahon T, Sampene E, Wasnik AP, Blaty AD, Maturen KE. Indeterminate Adnexal Cysts at US: Prevalence and Characteristics of Ovarian Cancer. Radiology 2018; 287:1041-1049. [PMID: 29480762 DOI: 10.1148/radiol.2018172271] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To assess the prevalence of indeterminate adnexal cysts in women presenting to academic medical centers for pelvic ultrasonography (US), determine the incidence of malignancy, and identify cyst and patient characteristics that are predictive of malignancy. Materials and Methods A multicenter study of US-detected adnexal cysts with appropriate follow-up (surgical pathologic examination, imaging and/or clinical examination) was conducted from January 2008 to June 2012. Indeterminate cysts were classified as category 1 (typical benign appearing cysts >5 cm) or category 2 (cysts with avascular solid components) on the basis of a combination of definitions in the existing literature. The incidence of neoplasms and malignant tumors was calculated. Patient and cyst characteristics associated with neoplasm and malignant tumors were evaluated with the χ2 test or Fisher exact test for categorical variables and the t test for continuous variables. A backward stepwise logistic regression model was performed for two outcomes: (a) the presence of any neoplasm (benign or malignant) and (b) the presence of a malignant tumor. Results There were 1637 women with an adnexal cyst at US; 391 (mean age = 41.8 years ± 13.5.1; range = 17-91 years) had an indeterminate adnexal cyst at US. The prevalence of indeterminate adnexal cysts was 23.9% (391 of 1637; 95% confidence interval [CI]: 0.22, 0.26). Three hundred three indeterminate cysts in 280 women (mean age = 42.9 years ± 14.1; range = 17-88 years) had adequate follow-up. The incidence of ovarian neoplasms (benign and malignant) was 24.8% (75 of 303 cysts; 95% CI: 0.20, 0.30), and the incidence of malignant tumors was 3.6% (11 of 303 cysts; 95% CI: 0.02, 0.06). The proportion of ovarian neoplasms differed between category 1 and category 2 cysts (17.5% [25 of 143 cysts; 95% CI: 0.12, 0.25] vs 31.3% [50 of 160 cysts; 95% CI: 0.24, 0.39], respectively; P = .001). The proportion of malignant tumors differed between categories 1 and 2 cysts (0% [0 of 143 cysts] vs 6.9% [11 of 160 cysts; 95% CI: 0.03, 0.12]; P < .001). The presence of an avascular nodular component was a significant predictor of malignancy at stepwise logistic regression analysis (odds ratio = 2.83; P ≤ .0001; 95% CI: 1.69, 4.70). Conclusion The presence of an avascular nodular component was the most significant predictor of the presence of malignancy in indeterminate adnexal cysts. The risk of malignancy is higher with category 2 cysts than with category 1 cysts. © RSNA, 2018.
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Affiliation(s)
- Elizabeth A Sadowski
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Viktoriya Paroder
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Krupa Patel-Lippmann
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Jessica B Robbins
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Lisa Barroilhet
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Elizabeth Maddox
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Timothy McMahon
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Emmanuel Sampene
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Ashish P Wasnik
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Alexander D Blaty
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Katherine E Maturen
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
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Pinker K, Shitano F, Sala E, Do RK, Young RJ, Wibmer AG, Hricak H, Sutton EJ, Morris EA. Background, current role, and potential applications of radiogenomics. J Magn Reson Imaging 2017; 47:604-620. [PMID: 29095543 DOI: 10.1002/jmri.25870] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 09/17/2017] [Accepted: 09/19/2017] [Indexed: 12/17/2022] Open
Abstract
With the genomic revolution in the early 1990s, medical research has been driven to study the basis of human disease on a genomic level and to devise precise cancer therapies tailored to the specific genetic makeup of a tumor. To match novel therapeutic concepts conceived in the era of precision medicine, diagnostic tests must be equally sufficient, multilayered, and complex to identify the relevant genetic alterations that render cancers susceptible to treatment. With significant advances in training and medical imaging techniques, image analysis and the development of high-throughput methods to extract and correlate multiple imaging parameters with genomic data, a new direction in medical research has emerged. This novel approach has been termed radiogenomics. Radiogenomics aims to correlate imaging characteristics (ie, the imaging phenotype) with gene expression patterns, gene mutations, and other genome-related characteristics and is designed to facilitate a deeper understanding of tumor biology and capture the intrinsic tumor heterogeneity. Ultimately, the goal of radiogenomics is to develop imaging biomarkers for outcome that incorporate both phenotypic and genotypic metrics. Due to the noninvasive nature of medical imaging and its ubiquitous use in clinical practice, the field of radiogenomics is rapidly evolving and initial results are encouraging. In this article, we briefly discuss the background and then summarize the current role and the potential of radiogenomics in brain, liver, prostate, gynecological, and breast tumors. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;47:604-620.
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Affiliation(s)
- Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Austria
| | - Fuki Shitano
- Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Evis Sala
- Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard K Do
- Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert J Young
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andreas G Wibmer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elizabeth J Sutton
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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109
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McEvoy SH, Nougaret S, Abu-Rustum NR, Vargas HA, Sadowski EA, Menias CO, Shitano F, Fujii S, Sosa RE, Escalon JG, Sala E, Lakhman Y. Fertility-sparing for young patients with gynecologic cancer: How MRI can guide patient selection prior to conservative management. Abdom Radiol (NY) 2017; 42:2488-2512. [PMID: 28528388 PMCID: PMC5857967 DOI: 10.1007/s00261-017-1179-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Historically, cancer treatment has emphasized measures for the "cure" regardless of the long-term consequences. Advances in cancer detection and treatment have resulted in improved outcomes bringing to the fore various quality of life considerations including future fertility. For many young cancer patients, fertility preservation is now an integral component of clinical decision-making and treatment design. Optimal fertility-sparing options for young patients with gynecologic cancer are influenced by patient age, primary cancer, treatment regimens, and patient preferences. Possible approaches include embryo or oocyte cryopreservation, ovarian transposition, conservative surgery, and conservative medical treatment to delay radical surgery. These may be used alone or in combination to maximize fertility preservation. Awareness of the various fertility-sparing options, eligibility criteria, and the central role of magnetic resonance imaging in the proper selection of patients will enable radiologists to produce complete clinically relevant imaging reports and serve as effective consultants to referring clinicians. Knowledge of the potential imaging pitfalls is essential to avoid misinterpretation and guide appropriate management.
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Affiliation(s)
- Sinead H McEvoy
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Radiology, The Christie NHS Foundation, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
| | - Stephanie Nougaret
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM, U1194, Montpellier, France
| | - Nadeem R Abu-Rustum
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Fuki Shitano
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ramon E Sosa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanna G Escalon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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