Are CT and MRI useful tools to distinguish between micropapillary type and typical type of ovarian serous borderline tumors?

Role of magnetic resonance imaging to differentiate between borderline and malignant serous epithelial ovarian tumors

PURPOSE

We aimed to differentiate serous borderline ovarian tumors (SBOT) from serous epithelial ovarian carcinomas (SEOC) using morphological and functional MRI findings, to improve the patient management.

METHOD

We retrospectively investigated 24 ovarian lesions diagnosed with SBOT and 64 ovarian lesions diagnosed with SEOC. Additional to the demographic and morphological findings T2W signal intensity ratio, mean apparent diffusion coefficient (ADCmean) and total apparent diffusion coefficient (ADCtotal) values were analyzed and compared between two groups.

RESULTS

Bilaterality, pelvic free fluid presence, serum CA-125 level (U/mL), presence of pelvic peritoneal implant were in favor of SEOC. Lower maximum size of solid component and solid size to maximum size ratio, dominantly cystic and solid-cystic appearance, exophytic growth pattern, presence of papiller projection and papillary architecture and internal branching pattern, higher T2W signal intensity ratio, ADCmean and ADCtotal values were in favor of SBOT.

CONCLUSION

Our study revealed that morphological and functional imaging findings were valuable in differentiating BSOT from SEOC.

Computed Tomography Indicators for Differentiating Stage 1 Borderline Ovarian Tumors from Stage I Malignant Epithelial Ovarian Tumors

Preoperative diagnosis of borderline ovarian tumors (BOTs) is of increasing concern. This study aimed to determine computed tomography (CT) features in differentiating stage 1 BOTs from stage I malignant epithelial ovarian tumors (MEOTs). A total of 170 ovarian masses (97 BOTs and 73 MEOTs) from 141 consecutive patients who underwent preoperative CT imaging were retrospectively analyzed. Two readers independently and retrospectively reviewed quantitative and qualitative CT features. Multivariate logistic analysis demonstrated that a larger tumor size (p = 0.0284 for reader 1, p = 0.0391 for reader 2) and a smaller solid component (p = 0.0007 for reader 1, p = 0.0003 for reader 2) were significantly associated with BOTs compared with MEOTs. In the subanalysis of cases with a solid component, smaller (p = 0.0092 for reader 1, p = 0.0014 for reader 2) and ill-defined (p = 0.0016 for reader 1, p = 0.0414 for reader 2) solid component was significantly associated with BOTs compared with MEOTs. Tumor size and the size and margin of the solid component were useful for differentiating stage 1 BOTs from stage 1 MEOTs on CT images.

MRI of Borderline Epithelial Ovarian Tumors: Pathologic Correlation and Diagnostic Challenges

Borderline epithelial ovarian tumors are a distinct pathologic entity characterized by increased epithelial proliferation and nuclear atypia, but without frank stromal invasion. Borderline tumor (BT) is now considered to represent an intermediate phase in the stepwise progression from benign to malignant ovarian epithelial tumor. Since BTs commonly manifest at early stages in women of reproductive age and are associated with a good prognosis, making the correct diagnosis is important in determining whether a patient is a candidate for fertility-sparing surgery. There are six histologic BT subtypes (serous, mucinous, seromucinous, endometrioid, clear cell, and Brenner), and each has different MRI features, reflecting their unique histologic architectures. Radiologists should be aware of the MRI features that can suggest BTs. These features include a hyperintense papillary architecture with hypointense internal branching, which can be observed with serous and seromucinous BTs on T2-weighted images; aggregates of microcysts that have hypointensity on T2-weighted images and reticular enhancement on contrast-enhanced T2-weighted images, which can be seen with mucinous BTs; and moderately high signal intensity on diffusion-weighted images along with relatively high apparent diffusion coefficient values, which can be observed regardless of the histologic subtype. Nevertheless, because the imaging features of BTs overlap with those of many benign lesions (eg, cystadenoma and cystadenofibroma, decidualized endometriosis, and polypoid endometriosis) and malignant tumors (ovarian cancers and metastases), histologic confirmation is required for the final diagnosis. Special emphasis is placed on the MRI features of BTs, pathologic correlation, and the challenges related to diagnosis. ^©RSNA, 2022.

Serous borderline ovarian tumours: an extensive review on MR imaging features

Serous borderline ovarian tumours (SBOTs) are an intermediate group of neoplasms, which have features between benign and malignant ovarian tumours and for which, fertility-sparing surgery can be offered. MRI in imaging of SBOTs is, therefore, crucial in raising the possibility of the diagnosis, in order to present the patient with the most appropriate treatment options. There are characteristic MRI features that SBOTs demonstrate. In addition, recent advanced techniques, and further classification into subtypes within the borderline group have been developed. The aim of this article is to review the MRI features of SBOT and provide the reporter with an awareness of the imaging tips and tricks in the differential diagnosis of SBOT.