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Bergus KC, Knaus ME, Onwuka AJ, Afrazi A, Breech L, Corkum KS, Dillon PA, Ehrlich PF, Fallat ME, Fraser JD, Gadepalli SK, Grabowski JE, Hertweck SP, Kabre R, Lal DR, Landman MP, Leys CM, Mak GZ, Markel TA, Merchant N, Overman RE, Rademacher BL, Raiji MT, Rymeski B, Sato TT, Wright T, Aldrink JH, Hewitt GD, Minneci PC, Deans KJ. Diagnostic Performance of Magnetic Resonance Imaging for Pediatric Ovarian Neoplasms: A Multi-Institutional Review. J Pediatr Adolesc Gynecol 2024; 37:192-197. [PMID: 38008283 DOI: 10.1016/j.jpag.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/17/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
STUDY OBJECTIVE To assess the diagnostic performance of MRI to predict ovarian malignancy alone and compared with other diagnostic studies. METHODS A retrospective analysis was conducted of patients aged 2-21 years who underwent ovarian mass resection between 2009 and 2021 at 11 pediatric hospitals. Sociodemographic information, clinical and imaging findings, tumor markers, and operative and pathology details were collected. Diagnostic performance for detecting malignancy was assessed by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for MRI with other diagnostic modalities. RESULTS One thousand and fifty-three patients, with a median age of 14.6 years, underwent resection of an ovarian mass; 10% (110/1053) had malignant disease on pathology, and 13% (136/1053) underwent preoperative MRI. MRI sensitivity, specificity, PPV, and NPV were 60%, 94%, 60%, and 94%. Ultrasound sensitivity, specificity, PPV, and NPV were 31%, 99%, 73%, and 95%. Tumor marker sensitivity, specificity, PPV, and NPV were 90%, 46%, 22%, and 96%. MRI and ultrasound concordance was 88%, with sensitivity, specificity, PPV, and NPV of 33%, 99%, 75%, and 94%. MRI sensitivity in ultrasound-discordant cases was 100%. MRI and tumor marker concordance was 88% with sensitivity, specificity, PPV, and NPV of 100%, 86%, 64%, and 100%. MRI specificity in tumor marker-discordant cases was 100%. CONCLUSION Diagnostic modalities used to assess ovarian neoplasms in pediatric patients typically agree. In cases of disagreement, MRI is more sensitive for malignancy than ultrasound and more specific than tumor markers. Selective use of MRI with preoperative ultrasound and tumor markers may be beneficial when the risk of malignancy is uncertain. CONCISE ABSTRACT This retrospective review of 1053 patients aged 2-21 years who underwent ovarian mass resection between 2009 and 2021 at 11 pediatric hospitals found that ultrasound, tumor markers, and MRI tend to agree on benign vs malignant, but in cases of disagreement, MRI is more sensitive for malignancy than ultrasound.
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Affiliation(s)
- Katherine C Bergus
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Maria E Knaus
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Amanda J Onwuka
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Amin Afrazi
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Lesley Breech
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kristine S Corkum
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patrick A Dillon
- St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Peter F Ehrlich
- C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mary E Fallat
- Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky
| | - Jason D Fraser
- Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Samir K Gadepalli
- C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan
| | - Julia E Grabowski
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S Paige Hertweck
- Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky
| | - Rashmi Kabre
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dave R Lal
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew P Landman
- Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
| | - Charles M Leys
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Grace Z Mak
- Comer Children's Hospital, The University of Chicago Medicine, Chicago, Illinois
| | - Troy A Markel
- Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
| | - Naila Merchant
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - R Elliott Overman
- C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan
| | - Brooks L Rademacher
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Manish T Raiji
- Comer Children's Hospital, The University of Chicago Medicine, Chicago, Illinois
| | - Beth Rymeski
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Thomas T Sato
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tiffany Wright
- Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky
| | - Jennifer H Aldrink
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Geri D Hewitt
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; Department of Surgery, Nemours Children's Health, Delaware Valley, Wilmington, Delaware.
| | - Katherine J Deans
- Department of Surgery, Nemours Children's Health, Delaware Valley, Wilmington, Delaware
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2
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Yang Q, Zhang H, Ma PQ, Peng B, Yin GT, Zhang NN, Wang HB. Value of ultrasound and magnetic resonance imaging combined with tumor markers in the diagnosis of ovarian tumors. World J Clin Cases 2023; 11:7553-7561. [DOI: 10.12998/wjcc.v11.i31.7553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/21/2023] [Accepted: 10/25/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Compare the diagnostic performance of ultrasound (US), magnetic resonance imaging (MRI), and serum tumor markers alone or in combination for detecting ovarian tumors.
AIM To investigate the diagnostic value of US, MRI combined with tumor markers in ovarian tumors.
METHODS The data of 110 patients with ovarian tumors, confirmed by surgery and pathology, were collected in our hospital from February 2018 to May 2023. The dataset included 60 cases of benign tumors and 50 cases of malignant tumors. Prior to surgery, all patients underwent preoperative US and MRI examinations, as well as serum tumor marker tests [carbohydrate antigen 125 (CA125), human epididymis protein 4 (HE4)]. The aim of the study was to compare the diagnostic performance of these three methods individually and in combination for ovarian tumors.
RESULTS This study found statistically significant differences in the ultrasonic imaging characteristics between benign and malignant tumors. These differences include echo characteristics, presence or absence of a capsule, blood flow resistance index, clear tumor shape, and blood flow signal display rate (P < 0.05). The apparent diffusion coefficient values of the solid and cystic parts in benign tumors were found to be higher compared to malignant tumors (P < 0.05). Additionally, the time-intensity curve image features of benign and malignant tumors showed significant statistical differences (P < 0.05). The levels of serum CA125 and HE4 in benign tumors were lower than those in malignant tumors (P < 0.05). The combined use of US, MRI, and tumor markers in the diagnosis of ovarian tumors demonstrates higher accuracy, sensitivity, and specificity compared to using each method individually (P < 0.05).
CONCLUSION US, MRI, and tumor markers each have their own advantages and disadvantages when it comes to diagnosing ovarian tumors. However, by combining these three methods, we can significantly enhance the accuracy of ovarian tumor diagnosis, enabling early detection and identification of the tumor’s nature, and providing valuable guidance for clinical treatment.
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Affiliation(s)
- Qian Yang
- The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
- Taihe Hospital of Traditional Chinese Medicine, Fuyang 236000, Anhui Province, China
| | - Hui Zhang
- The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Pei-Qi Ma
- Fuyang People’s Hospital, Fuyang 236000, Anhui Province, China
| | - Bin Peng
- Fuyang People’s Hospital, Fuyang 236000, Anhui Province, China
| | - Gui-Tao Yin
- No. 2 People’s Hospital of Fuyang City, Fuyang 236000, Anhui Province, China
| | - Nan-Nan Zhang
- Linquan People’s Hospital, Fuyang 236000, Anhui Province, China
| | - Hai-Bao Wang
- The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
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3
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Ali S, Dhobale AV, Kalambe MA, Bankar NJ, Hatgaonkar AM. Challenging Diagnosis and Management of an Ovarian Cyst Torsion in a Postmenopausal Woman: A Case Report. Cureus 2023; 15:e47693. [PMID: 38022205 PMCID: PMC10674073 DOI: 10.7759/cureus.47693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Ovarian masses are rare in the postmenopausal age group, and ovarian torsion is a gynecological emergency. We present a case report of a 63-year-old postmenopausal woman who presented a massive abdominal mass with pain that gradually increased during the previous 12 months. A contrast-enhanced computed tomography scan of the abdomen and pelvis suggested a 16.6 cm × 14 cm × 13 cm originating from the right ovary. Total abdominal hysterectomy, bilateral salphingo-oophorectomy, and partial omentectomy were performed in an emergency as the patient's symptoms worsened. A massive cyst was visualized from the right ovary, which had undergone a torsion of three turns. Histopathological analysis revealed a serous cystadenoma. The twisted ovarian cyst typically manifests as an acute abdomen, although there are cases where this presentation can cause a significant delay in diagnosis. Therefore, high clinical suspicion is often necessary to prevent morbidity and mortality.
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Affiliation(s)
- Sara Ali
- Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Anupama V Dhobale
- Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Minal A Kalambe
- Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Nandkishor J Bankar
- Microbiology, Jawarhal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Anand M Hatgaonkar
- Radiodiagnosis, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
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4
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Wu M, Zhang M, Cao J, Wu S, Chen Y, Luo L, Lin X, Su M, Zhang X. Predictive accuracy and reproducibility of the O-RADS US scoring system among sonologists with different training levels. Arch Gynecol Obstet 2023; 308:631-637. [PMID: 35994107 DOI: 10.1007/s00404-022-06752-5] [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: 04/26/2022] [Accepted: 08/12/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To investigate the predictive performance and reproducibility of Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound (US) system in evaluating adnexal masses between sonologists with varying levels of expertise. METHODS This was a single-center retrospective study conducted between May 2019 and May 2020, which included 147 adnexal mases with pathological results. Four sonologists with varying experiences independently assigned an O-RADS US category to each adnexal mass twice. The intra- and inter-observer agreement was assessed using weighted kappa values. The area under the curve (AUC), sensitivity, specificity, positive and negative predictive value (PPV and NPV) were assessed for each sonologist. RESULTS Of the 147 adnexal mases, 115 (78.2%) lesions were benign and 32 (21.8%) lesions were malignant. Considering O-RADS > 3 as a predictor for adnexal malignancy, the predictive accuracies of the four sonologists were excellent, with AUCs ranging from 0.831 to 0.926. The predictive accuracies of O-RADS US by experienced sonologists were significantly higher compared to inexperienced sonologists (all P values < 0.005). The O-RADS US presented high sensitivity and NPV value for each sonologist. With regard to the reproducibility of O-RADS, the intra- and inter-observer agreement among experienced sonologists performed better than inexperienced sonologists. CONCLUSION O-RADS showed difference in the predictive accuracy and reproducibility in the evaluation of adnexal masses among sonologists with different levels of expertise. Training is required for inexperienced sonologists before the generalization of O-RADS classification system in clinical practice.
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Affiliation(s)
- Manli Wu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, People's Republic of China
| | - Man Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, People's Republic of China
| | - Junyan Cao
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, People's Republic of China
| | - Shuangyu Wu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, People's Republic of China
| | - Ying Chen
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, People's Republic of China
| | - Liping Luo
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, People's Republic of China
| | - Xin Lin
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, People's Republic of China
| | - Manting Su
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, People's Republic of China
| | - Xinling Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, People's Republic of China.
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5
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Shin KH, Kim HH, Yoon HJ, Kim ET, Suh DS, Kim KH. The Discrepancy between Preoperative Tumor Markers and Imaging Outcomes in Predicting Ovarian Malignancy. Cancers (Basel) 2022; 14:cancers14235821. [PMID: 36497302 PMCID: PMC9737674 DOI: 10.3390/cancers14235821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Preoperative tumor markers and imaging often differ in predicting whether an ovarian tumor is malignant. Therefore, we evaluated the correlation between the predictive values of imaging and tumor markers for diagnosing ovarian tumors, especially when there were discrepancies between the two. We enrolled 1047 patients with ovarian tumors. The predictive values and concordance rates between the preoperative risk of ovarian malignancy algorithm (ROMA) and imaging, including CT and MRI, were evaluated. Diagnoses of 561 CT (77.9%) and 322 MRI group (69.2%) participants were consistent with the ROMA. Among them, 96.4% of the CT (541/561) and 92.5% of the MRI (298/322) group predicted an accurate diagnosis. In contrast, 67.3% (101/150) of CT and 75.2% (100/133) of MRI cases accurately predicted the diagnosis in cases with discrepancies between ROMA and CT or MRI; a total of 32% (48/150) of the CT and 25.5% (34/133) of the MRI group showed an accurate ROMA diagnosis in cases with discrepancies between ROMA and imaging. In the event of a discrepancy between ROMA and imaging when ovarian tumor malignancy prediction, the question is which method should take precedence. This study demonstrates that MRI has the greatest diagnostic accuracy, followed by CT and ROMA. It is also important to understand underlying diseases and benign conditions and rare histopathologies of malignant tumors.
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Affiliation(s)
- Kyung-Hwa Shin
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan 49241, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
| | - Hyung-Hoi Kim
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan 49241, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
| | - Hyung Joon Yoon
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan 49241, Republic of Korea
| | - Eun Taeg Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan 49241, Republic of Korea
| | - Dong Soo Suh
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan 49241, Republic of Korea
| | - Ki Hyung Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan 49241, Republic of Korea
- Correspondence:
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Ma Y, Mao J, Qin H, Liang P, Huang W, Liu C, Gao J. Nano-Metal-Organic Framework Decorated With Pt Nanoparticles as an Efficient Theranostic Nanoprobe for CT/MRI/PAI Imaging-Guided Radio-Photothermal Synergistic Cancer Therapy. Front Bioeng Biotechnol 2022; 10:927461. [PMID: 35875484 PMCID: PMC9298652 DOI: 10.3389/fbioe.2022.927461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/23/2022] [Indexed: 11/21/2022] Open
Abstract
The multifunctional theranostic nanoplatforms, which can realize changing the contrasts of medical images and enhance cancer therapies simultaneously, have attracted tremendous attention from chemists and medicine in past decades. Herein, a nanoscale metal–organic framework-based material was first synthesized and then decorated with platinum (NMOF545@Pt) successfully for multimodal imaging-guided synergistic cancer therapy. The obtained NMOF545@Pt is advantageous in shortening the longitudinal relaxation time (T1), enhancing photoacoustic effects, and elevating X-ray absorption efficiently. Thus, the enchantments of tripe imaging modalities, computed tomography (CT)/magnetic resonance imaging (MRI)/photoacoustic imaging (PAI), were realized with NMOF545@Pt administration simultaneously and can be cleared from the mice. Meanwhile, in vitro and in vivo experiments demonstrate that the synthesized NMOF545@Pt can dramatically increase photothermal therapy (PTT) and radiotherapy (RT) efficacy. Convincing evidence proves that tumor growth can be wholly inhibited without noticeable side effects or organ damage. The results demonstrated the promise of multifunctional nanocomposites NMOF545@Pt to improve biomedical imaging and synergistic tumor treatments.
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Affiliation(s)
- Yingjian Ma
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Jing Mao
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou, China
| | - Haojie Qin
- Forensic Medicine School of Henan University of Science and Technology, Luoyang, China
| | - Pan Liang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenpeng Huang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chenchen Liu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Raja Navaneethan P, Abraham A, Abraham K, Jagannathan A. Biliary cystadenoma masquerading as an adnexal cyst in pregnancy. BMJ Case Rep 2021; 14:e246392. [PMID: 34906958 PMCID: PMC8671909 DOI: 10.1136/bcr-2021-246392] [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] [Accepted: 11/18/2021] [Indexed: 11/03/2022] Open
Abstract
The aetiological diagnosis of cystic masses detected on routine ultrasound during pregnancy can be challenging. Unless approached cautiously with a detailed history and adequate use of imaging techniques, misdiagnosis of these cystic masses are not uncommon. Cystic masses diagnosed during pregnancy are mostly of ovarian origin; however, other non-ovarian cystic masses are also detected incidentally or at laparotomy/laparoscopy. We report a rare case of ruptured biliary cystadenoma in a pregnant woman diagnosed at emergency laparotomy. She was taken up for surgery with a provisional impression of ruptured adnexal cyst. However, the cyst was found to be arising from the liver and the histology of the cyst wall was reported as biliary cystadenoma.
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Affiliation(s)
- Preethi Raja Navaneethan
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital Vellore, Vellore, India
| | - Anuja Abraham
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital Vellore, Vellore, India
| | - Kavitha Abraham
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital Vellore, Vellore, India
| | - Aparna Jagannathan
- Department of Hepato Pancreato Biliary Surgery, Christian Medical College Vellore, Vellore, India
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8
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Hakoun AM, AbouAl-Shaar I, Zaza KJ, Abou-Al-Shaar H, A Salloum MN. Adnexal masses in pregnancy: An updated review. Avicenna J Med 2021; 7:153-157. [PMID: 29119081 PMCID: PMC5655645 DOI: 10.4103/ajm.ajm_22_17] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Adnexal masses in pregnancy are not commonly encountered. The majority of these masses are discovered incidentally during routine follow-up. However, some of these masses become symptomatic due to their size, location, and impingement of adjacent structures. Several diagnostic modalities can be utilized for the detection of adnexal masses with different sensitivity and specificity rates. The differential diagnosis of adnexal masses discovered during pregnancy is broad and includes both benign and malignant lesions. The management of such lesions has been a subject of debate for years with no consensus regarding the best management plan. Tumor size, site, and the trimester of mass detection are all crucial in management. In this account, we review adnexal masses discovered in pregnancy, the diagnostic modalities utilized for detecting these lesions, their differential diagnosis, and management strategies.
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Affiliation(s)
| | - Iyad AbouAl-Shaar
- School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khaled J Zaza
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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9
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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: 38] [Impact Index Per Article: 12.7] [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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10
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Ștefan PA, Lupean RA, Mihu CM, Lebovici A, Oancea MD, Hîțu L, Duma D, Csutak C. Ultrasonography in the Diagnosis of Adnexal Lesions: The Role of Texture Analysis. Diagnostics (Basel) 2021; 11:diagnostics11050812. [PMID: 33947150 PMCID: PMC8145244 DOI: 10.3390/diagnostics11050812] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 12/31/2022] Open
Abstract
The classic ultrasonographic differentiation between benign and malignant adnexal masses encounters several limitations. Ultrasonography-based texture analysis (USTA) offers a new perspective, but its role has been incompletely evaluated. This study aimed to further investigate USTA’s capacity in differentiating benign from malignant adnexal tumors, as well as comparing the workflow and the results with previously-published research. A total of 123 adnexal lesions (benign, 88; malignant, 35) were retrospectively included. The USTA was performed on dedicated software. By applying three reduction techniques, 23 features with the highest discriminatory potential were selected. The features’ ability to identify ovarian malignancies was evaluated through univariate, multivariate, and receiver operating characteristics analyses, and also by the use of the k-nearest neighbor (KNN) classifier. Three parameters were independent predictors for ovarian neoplasms (sum variance, and two variations of the sum of squares). Benign and malignant lesions were differentiated with 90.48% sensitivity and 93.1% specificity by the prediction model (which included the three independent predictors), and with 71.43–80% sensitivity and 87.5–89.77% specificity by the KNN classifier. The USTA shows statistically significant differences between the textures of the two groups, but it is unclear whether the parameters can reflect the true histopathological characteristics of adnexal lesions.
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Affiliation(s)
- Paul-Andrei Ștefan
- Anatomy and Embryology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Victor Babes Street 8, 400012 Cluj-Napoca, Romania;
- Radiology and Imaging Department, County Emergency Hospital, Clinicilor Street 5, 400006 Cluj-Napoca, Romania; (C.M.M.); (A.L.); (D.D.); (C.C.)
| | - Roxana-Adelina Lupean
- Histology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Louis Pasteur Street 4, 400349 Cluj-Napoca, Romania
- Obstetrics and Gynecology Clinic “Dominic Stanca”, County Emergency Hospital, 21 Decembrie 1989 Boulevard 55, 400094 Cluj-Napoca, Romania;
- Correspondence: ; Tel.: +40-7464-31286
| | - Carmen Mihaela Mihu
- Radiology and Imaging Department, County Emergency Hospital, Clinicilor Street 5, 400006 Cluj-Napoca, Romania; (C.M.M.); (A.L.); (D.D.); (C.C.)
- Histology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Louis Pasteur Street 4, 400349 Cluj-Napoca, Romania
| | - Andrei Lebovici
- Radiology and Imaging Department, County Emergency Hospital, Clinicilor Street 5, 400006 Cluj-Napoca, Romania; (C.M.M.); (A.L.); (D.D.); (C.C.)
- Radiology, Surgical Specialties Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Clinicilor Street 3–5, 400006 Cluj-Napoca, Romania
| | - Mihaela Daniela Oancea
- Obstetrics and Gynecology Clinic “Dominic Stanca”, County Emergency Hospital, 21 Decembrie 1989 Boulevard 55, 400094 Cluj-Napoca, Romania;
- Obstetrics and Gynecology Clinic II, Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, 21 Decembrie 1989 Boulevard 55, 400094 Cluj-Napoca, Romania
| | - Liviu Hîțu
- Doctoral School, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Daniel Duma
- Radiology and Imaging Department, County Emergency Hospital, Clinicilor Street 5, 400006 Cluj-Napoca, Romania; (C.M.M.); (A.L.); (D.D.); (C.C.)
- Doctoral School, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Csaba Csutak
- Radiology and Imaging Department, County Emergency Hospital, Clinicilor Street 5, 400006 Cluj-Napoca, Romania; (C.M.M.); (A.L.); (D.D.); (C.C.)
- Radiology, Surgical Specialties Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Clinicilor Street 3–5, 400006 Cluj-Napoca, Romania
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11
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Zhang X, Li M, Tang Z, Li X, Song T. Differentiation between endometriosis-associated ovarian cancers and non- endometriosis-associated ovarian cancers based on magnetic resonance imaging. Br J Radiol 2021; 94:20201441. [PMID: 33882252 DOI: 10.1259/bjr.20201441] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Endometriosis-associated ovarian cancer (EAOC) patients show different clinical characteristics compared with non-EAOC patients. However, a few studies are focused on the imaging characteristics of EAOC until now. We assessed MRI characteristics in differentiating EAOC and non-EAOC. METHODS We retrospectively analyzed clinical and MRI characteristics from 54 patients with 67 lesions diagnosed with primary epithelial ovarian carcinoma at the Third Affiliated Hospital of Guangzhou Medical University between January 2012 and October 2020. We studied MRI findings such as maximum diameter, morphology, configuration, locularity, features of mural nodules, lymphadenopathy, peritoneal implants, the presence of hyperintensity on T1WI, and hypointensity on T2WI. We also studied the clinical characteristics. Significant MRI variables in univariate analysis were selected for subsequent multivariate regression analysis. This study evaluated the diagnostic performance of the significant MRI variables in univariate analysis. RESULTS We found that the patients with EAOC, compared with those with non-EAOC, were younger, more unilateral, and had earlier FIGO stage. Univariate analysis revealed that morphology, locularity, growth pattern of mural nodules, and hypointensity on T2WI were factors that significantly differed between EAOC and non-EAOC. In the multivariate logistic regression analysis, locularity and hypointensity on T2WI were independent predictors to distinguish EAOC from non-EAOC. CONCLUSIONS EAOC typically presented as a unilocular mass with hypointensity on T2WI in cystic components. MRI could help distinguish EAOC from non-EAOC. ADVANCES IN KNOWLEDGE MRI is a promising tool for preoperative diagnosis of EAOC.
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Affiliation(s)
- Ximing Zhang
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Min Li
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhuopeng Tang
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xinyi Li
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ting Song
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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12
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Li L, Wu J, Yang L, Wang H, Xu Y, Shen K. Fourier Transform Infrared Spectroscopy: An Innovative Method for the Diagnosis of Ovarian Cancer. Cancer Manag Res 2021; 13:2389-2399. [PMID: 33737836 PMCID: PMC7965685 DOI: 10.2147/cmar.s291906] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/03/2021] [Indexed: 12/24/2022] Open
Abstract
Ovarian cancer is the most lethal gynecologic malignancy due to the late diagnoses at advanced stages, drug resistance and the high recurrence rate. Thus, there is an urgent need to develop new techniques to diagnose and monitor ovarian cancer patients. Fourier transform infrared (FTIR) spectroscopy has great potential in the diagnosis of this disease, as well as the real-time monitoring of cancer development and chemoresistance. As a noninvasive, simple and convenient technique, it can not only distinguish the molecular differences between normal and malignant tissues, but also be used to identify the characteristics of different types of ovarian cancer. FTIR spectroscopy is also widely used in monitoring cancer cells in response to antitumor drugs, distinguishing cells in different growth states, and identifying new synthetic drugs. In this paper, the applications of FTIR spectroscopy for ovarian cancer diagnosis and other works carried out so far are described in detail.
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Affiliation(s)
- Lei Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Jinguang Wu
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory for Rare Earth Materials Chemistry and Applications, College of Chemistry and Molecular Engineering, Peking University, Beijing, People's Republic of China
| | - Limin Yang
- State Key Laboratory of Nuclear Physics and Technology, Institute of Heavy Ion Physics, School of Physics, Peking University, Beijing, People's Republic of China
| | - Huizi Wang
- Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Yizhuang Xu
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory for Rare Earth Materials Chemistry and Applications, College of Chemistry and Molecular Engineering, Peking University, Beijing, People's Republic of China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
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13
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Ali MN, Habib D, Hassanien AI, Abbas AM. Comparison of the four malignancy risk indices in the discrimination of malignant ovarian masses: A cross-sectional study. J Gynecol Obstet Hum Reprod 2020; 50:101986. [PMID: 33197624 DOI: 10.1016/j.jogoh.2020.101986] [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: 07/23/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the accuracy of the four malignancy risk indices to distinguish benign from malignant ovarian masses MATERIALS AND METHODS: This was an observational cross-sectional study conducted on 155 patients between January 2016 and January 2019. Women with ovarian masses planned for surgical management were recruited from the outpatient Gynecology clinic of the hospital. The risk of malignancy index (RMI 1-4) was calculated for all women with ovarian masses. Biopsies obtained from the ovarian masses after the surgical intervention was sent to the pathology lab for histopathological examination. The histopathologic diagnosis of the ovarian masses was considered the gold standard for diagnosis. RESULTS The participants' mean age in the group of patients with benign masses was 33.50 ± 14.53 years versus 45.09 ± 13.67 years in the malignant group. The two most prominent features in the malignant group were solid areas in 85.3 % of malignant masses and about 91.2 % of malignant masses showing size <7 cm in their largest diameter. The RMI's most sensitive individual parameter was the CA-125 level, while the lowest sensitivity was for the menopausal status. RMI 2 had the highest sensitivity of 76.47 %, while RMI 1 and 3 had the highest specificity, 92.56 %. RMI 2 had the highest AUC, 0.83. CONCLUSIONS RMI 2 is a simple and reliable tool and had the best performance among all RMIs in benign discrimination from malignant ovarian masses with high sensitivity and accuracy.
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Affiliation(s)
- Mustafa N Ali
- Department of Obstetrics & Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt
| | - Dina Habib
- Department of Obstetrics & Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt
| | - Ahmed I Hassanien
- Department of Obstetrics & Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics & Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt.
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14
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Computer Tomography in the Diagnosis of Ovarian Cysts: The Role of Fluid Attenuation Values. Healthcare (Basel) 2020; 8:healthcare8040398. [PMID: 33066370 PMCID: PMC7711840 DOI: 10.3390/healthcare8040398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 11/18/2022] Open
Abstract
Pathological analysis of ovarian cysts shows specific fluid characteristics that cannot be standardly evaluated on computer tomography (CT) examinations. This study aimed to assess the ovarian cysts’ fluid attenuation values on the native (Np), arterial (Ap), and venous (Vp) contrast phases of seventy patients with ovarian cysts who underwent CT examinations and were retrospectively included in this study. Patients were divided according to their final diagnosis into the benign group (n = 32) and malignant group (n = 38; of which 27 were primary and 11 were secondary lesions). Two radiologists measured the fluid attenuation values on each contrast phase, and the average values were used to discriminate between benign and malignant groups and primary tumors and metastases via univariate, multivariate, multiple regression, and receiver operating characteristics analyses. The Ap densities (p = 0.0002) were independently associated with malignant cysts. Based on the densities measured on all three phases, neoplastic lesions could be diagnosed with 89.47% sensitivity and 62.5% specificity. The Np densities (p = 0.0005) were able to identify metastases with 90.91% sensitivity and 70.37% specificity, while the combined densities of all three phases diagnosed secondary lesions with 72.73% sensitivity and 92.59% specificity. The ovarian cysts’ fluid densities could function as an adjuvant criterion to the classic CT evaluation of ovarian cysts.
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15
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ACR Appropriateness Criteria ® Clinically Suspected Adnexal Mass, No Acute Symptoms. J Am Coll Radiol 2020; 16:S77-S93. [PMID: 31054761 DOI: 10.1016/j.jacr.2019.02.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 01/30/2023]
Abstract
There are approximately 9.1 pelvic surgeries performed for every histologically confirmed adnexal malignancy in the United States, compared to 2.3 surgeries per malignancy (in oncology centers) and 5.9 surgeries per malignancy (in other centers) in Europe. An important prognostic factor in the long-term survival in patients with ovarian malignancy is the initial management by a gynecological oncologist. With high accuracy of imaging for adnexal mass characterization and consequent appropriate triage to subspecialty referral, the better use of gynecologic oncology can improve treatment outcomes. Ultrasound, including transabdominal, transvaginal, and duplex ultrasound, combined with MRI with contrast can diagnose adnexal masses as benign with specific features (ie, functional masses, dermoid, endometrioma, fibroma, pedunculated fibroid, hydrosalpinx, peritoneal inclusion cyst, Tarlov cyst), malignant, or indeterminate. 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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16
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Elsherif SB, Zheng S, Ganeshan D, Iyer R, Wei W, Bhosale PR. Does dual-energy CT differentiate benign and malignant ovarian tumours? Clin Radiol 2020; 75:606-614. [PMID: 32252992 DOI: 10.1016/j.crad.2020.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 03/09/2020] [Indexed: 01/19/2023]
Abstract
AIM To assess the ability of dual-energy computed tomography (DECT) to distinguish benign from malignant ovarian tumours (OTs). MATERIALS AND METHODS Following approval of the institutional review board, the institutional database was mined for treatment-naive patients who underwent primary cytoreduction for OT. Thirty-seven patients were included and divided into those with benign OTs (n = 11) and malignant OTs (n = 26), including high-grade (n = 20) and low-grade (n = 6) malignant OTs. Advanced processing and region of interest delineation on the ovarian mass were performed using the preoperative staging DECT examination using the Advantage Workstation. The pixel-level data of the CT attenuation values at 50, 70, and 120 keV and the effective atomic number (Zeff), water content (WC), and iodine content (IC) in the ovarian mass were recorded. The Wilcoxon rank-sum test was used to compare CT attenuation data at different voltages, Zeff, and WC and IC levels between benign and malignant OTs and between high- and low-grade malignant OTs. Simple logistic regression was used to correlate the imaging characteristics with malignant status and grade. RESULTS Malignant OTs had significantly higher Zeff and IC compared with benign OTs. The threshold values for the diagnosis of malignant OT were IC≥9.74 (100 μg/cm3) with 81% sensitivity and 73% specificity and Zeff ≥8.16 with 85% sensitivity and 73% specificity. High-grade OTs had significantly higher WC compared with low-grade OTs, and a threshold of ≥1,013.92 mg/cm3 differentiated them with 80% sensitivity and 83% specificity. CONCLUSION DECT may be a tool to help distinguish malignant and benign OTs and predict tumour grade.
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Affiliation(s)
- S B Elsherif
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA.
| | - S Zheng
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston McGovern Medical School, MSB 2.130B, 6431 Fannin Street, Houston, TX 77030 Houston, Texas, USA
| | - D Ganeshan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
| | - R Iyer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
| | - W Wei
- Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
| | - P R Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
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Evaluation of adnexal tumours in the International Ovarian Tumor Analysis system in reference to histopathological results. MENOPAUSE REVIEW 2020; 18:141-145. [PMID: 31975980 PMCID: PMC6970421 DOI: 10.5114/pm.2019.90812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/07/2019] [Indexed: 11/21/2022]
Abstract
Aim of the study To retrospectively evaluate how the International Ovarian Tumor Analysis (IOTA) simple rules used in ultrasound examinations estimate the probability of malignant and benign tumour occurrence in the studied population. Material and methods The study was performed on a group of 425 patients with ovarian tumours operated in the Clinic of Surgical and Oncological Gynecology at the Medical University of Lodz in the years 2014-2015. Adnexal tumours were rated according to IOTA simple rules, classifying them as probably malignant, probably benign, or unclassified. The results of the study were compared with final histopathological results. The statistical analysis was performed using STATISTICA 13 PL with Medical Pack. Results We analysed data on n = 43 (11%) patients with malignant, n = 346 (86%) patients with benign, and n = 12 (3%) patients with borderline tumours, respectively. Malignant tumour patients were significantly older (mean age 61.0 ±11.6 vs. 43.6 ±16.2 years, p< 0.001), had higher BMI (mean 27.3 ±7.0 vs. 25.2 ±5.2, p< 0.05), more pregnancies (median 2 vs. 1, p = 0.001), and higher cancer antigen 125 (CA 125) concentrations (median 251.5 vs. 18.5, p< 0.001) than patients with a benign tumour. Also, they more often suffered from diabetes mellitus (19% vs. 8%, p = 0.02) and arterial hypertension (60% vs. 42%, p< 0.01) than benign tumour patients. Conclusions In our study, IOTA performance in predicting or ruling out a malignant tumour was highly satisfactory and similar to that of CA 125. Both the methods may be complementary and used to assess the risk of malignant vs. benign ovarian neoplasm, although the context of other clinical variables may also be important.
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18
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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 2019; 39:982-997. [PMID: 31283462 PMCID: PMC6677283 DOI: 10.1148/rg.2019180221] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/03/2019] [Accepted: 03/15/2019] [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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Capriglione S, Manzano A, Gulino FA, Lopez S. Management of gynecological cancer in pregnant patients. ACTA ACUST UNITED AC 2018; 71:133-145. [PMID: 30318875 DOI: 10.23736/s0026-4784.18.04324-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cancer during pregnancy is a rare but challenging condition. More women delay childbearing and consequently the incidence of cancer during pregnancy is constantly increasing. EVIDENCE ACQUISITION An extensive electronic search was performed in PubMed and Scopus. Only studies written after 1985 were considered eligible for this review. Abstracts, conference papers, book chapters, animal studies, commentaries as well as editorials articles were excluded from this review. EVIDENCE SYNTHESIS Cancer treatment during pregnancy is possible, but both maternal and fetal conditions need to be preserved. Randomized clinical trials are not feasible and current evidence are mainly based on case-series, small case reports and expert opinion. Cervical and ovarian cancers are the most common gynecological cancers diagnosed during pregnancy. Surgery and chemotherapy after the first trimester seem to be relatively safe for the newborn. Platinum-based chemotherapy administered during the 2nd-3rd trimester showed comparable adverse effects in newborns to those in the general population. Babies exposed to antenatal chemotherapy might be more likely to develop small for gestational age and NICU admission, than babies not exposed. CONCLUSIONS Management of pregnant women with cancer should be performed in specialized cancer centers and all cases should be discussed with a multidisciplinary approach. In the present review, we discuss the current recommendations for the management of pregnancies complicated by cancer and neonatal outcomes.
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Affiliation(s)
- Stella Capriglione
- Department of Obstetrics and Gynecology, Institute for Social Security, Borgo Maggiore, San Marino
| | - Aranzazu Manzano
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | | | - Salvatore Lopez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA - .,Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
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Li L, Bi X, Sun H, Liu S, Yu M, Zhang Y, Weng S, Yang L, Bao Y, Wu J, Xu Y, Shen K. Characterization of ovarian cancer cells and tissues by Fourier transform infrared spectroscopy. J Ovarian Res 2018; 11:64. [PMID: 30071867 PMCID: PMC6090913 DOI: 10.1186/s13048-018-0434-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/18/2018] [Indexed: 12/31/2022] Open
Abstract
Background Ovarian cancer is the most lethal of gynecological malignancies. Fourier Transform Infrared (FTIR) spectroscopy has gradually developed as a convenient, inexpensive and non-destructive technique for the study of many diseases. In this study, FTIR spectra of normal and several heterogeneous ovarian cancer cell lines as well as ovarian cancer tissue samples were compared in the spectral region of 4000 cm− 1 - 600 cm− 1. Methods Cell samples were collected from human ovarian surface epithelial cell line (HOSEpiC) and five ovarian cancer cell lines (ES2, A2780, OVCAR3, SKOV3 and IGROV1). Validation spectra were performed on normal and cancerous tissue samples from 12 ovarian cancer patients. FTIR spectra were collected from a NICOLET iN10 MX spectrometer and the spectral data were analyzed by OMNIC 8.0 software. Results Spectral features discriminating malignant tissues from normal tissues were integrated by cell line data and tissue data. In particular changes in cancerous tissues, the decrease in the amount of lipids and nucleic acids were observed. Protein conformation and composition were also altered in some cancer cells. The band intensity ratio of 1454/1400 was higher in normal cells/tissues and lower in cancer cells/tissues. Conclusion The spectral features revealed the important molecular characteristics about ovarian cancer cells/tissues. These findings demonstrate the possible diagnostic use of FTIR spectroscopy, providing the research model and evidences, and supporting the future study on more tissue samples to establish a data bank of spectra features for the possible discrimination of ovarian cancers.
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Affiliation(s)
- Lei Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuai Fu Yuan, Eastern District, Beijing, 100730, China
| | - Xiaoning Bi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuai Fu Yuan, Eastern District, Beijing, 100730, China
| | - Hengzi Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuai Fu Yuan, Eastern District, Beijing, 100730, China
| | - Simiao Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuai Fu Yuan, Eastern District, Beijing, 100730, China
| | - Mei Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuai Fu Yuan, Eastern District, Beijing, 100730, China
| | - Ying Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuai Fu Yuan, Eastern District, Beijing, 100730, China
| | - Shifu Weng
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory for Rare Earth Materials Chemistry and Applications, College of Chemistry and Molecular Engineering, Peking University, No. 202 Chengfu Road, Haidian District, Beijing, 100871, China
| | - Limin Yang
- State Key Laboratory of Nuclear Physics and Technology, Institute of Heavy Ion Physics, School of Physics, Peking University, No. 202 Chengfu Road, Haidian District, Beijing, 100871, China
| | - Yanan Bao
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory for Rare Earth Materials Chemistry and Applications, College of Chemistry and Molecular Engineering, Peking University, No. 202 Chengfu Road, Haidian District, Beijing, 100871, China
| | - Jinguang Wu
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory for Rare Earth Materials Chemistry and Applications, College of Chemistry and Molecular Engineering, Peking University, No. 202 Chengfu Road, Haidian District, Beijing, 100871, China
| | - Yizhuang Xu
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory for Rare Earth Materials Chemistry and Applications, College of Chemistry and Molecular Engineering, Peking University, No. 202 Chengfu Road, Haidian District, Beijing, 100871, China.
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuai Fu Yuan, Eastern District, Beijing, 100730, China.
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The Role of Computed Tomography and Magnetic Resonance Imaging in Gynecologic Oncology. PET Clin 2018; 13:127-141. [DOI: 10.1016/j.cpet.2017.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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PAULINI FERNANDA, CHAVES SACHAB, RÔLO JOSÉLUIZJ, AZEVEDO RICARDOBDE, LUCCI CAROLINAM. Evaluation of ovarian structures using computerized microtomography. ACTA ACUST UNITED AC 2017; 89:2131-2139. [DOI: 10.1590/0001-3765201720150864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 06/22/2016] [Indexed: 12/19/2022]
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Foti PV, Attinà G, Spadola S, Caltabiano R, Farina R, Palmucci S, Zarbo G, Zarbo R, D'Arrigo M, Milone P, Ettorre GC. MR imaging of ovarian masses: classification and differential diagnosis. Insights Imaging 2016; 7:21-41. [PMID: 26671276 PMCID: PMC4729709 DOI: 10.1007/s13244-015-0455-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/18/2015] [Accepted: 11/27/2015] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE We propose a Magnetic Resonance Imaging (MRI) guided approach to differential diagnosis of ovarian tumours based on morphological appearance. BACKGROUND Characterization of ovarian lesions is of great importance in order to plan adequate therapeutic procedures, and may influence patient's management. Optimal assessment of adnexal masses requires a multidisciplinary approach, based on physical examination, laboratory tests and imaging techniques. Primary ovarian tumours can be classified into three main categories according to tumour origin: epithelial, germ cell and sex cord-stromal tumours. Ovarian neoplasms may be benign, borderline or malignant. Using an imaging-guided approach based on morphological appearance, we classified adnexal masses into four main groups: unilocular cyst, multilocular cyst, cystic and solid, predominantly solid. We describe MR signal intensity features and enhancement behaviour of ovarian lesions using pathologically proven examples from our institution. CONCLUSION MRI is an essential problem-solving tool to determine the site of origin of a pelvic mass, to characterize an adnexal mass, and to detect local invasion. The main advantages of MRI are the high contrast resolution and lack of ionizing radiation exposure. Although different pathological conditions may show similar radiologic manifestations, radiologists should be aware of MRI features of ovarian lesions that may orientate differential diagnosis. TEACHING POINTS • Diagnostic imaging plays a crucial role in detection, characterization and staging of adnexal masses. • Characterization of an ovarian lesion may influence patient's management. • Different pathological conditions may have similar radiologic manifestations. • Non-neoplastic lesions should always be taken into consideration.
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Affiliation(s)
- Pietro Valerio Foti
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Giancarlo Attinà
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Saveria Spadola
- Department G.F. Ingrassia - Institute of Pathology, University of Catania, Catania, Italy
| | - Rosario Caltabiano
- Department G.F. Ingrassia - Institute of Pathology, University of Catania, Catania, Italy
| | - Renato Farina
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Stefano Palmucci
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Giuseppe Zarbo
- Department of General Surgery and Medical-Surgical Specialties - Institute of Obstetrics and Ginecology, University of Catania, Catania, Italy
| | - Rosario Zarbo
- Department of General Surgery and Medical-Surgical Specialties - Institute of Obstetrics and Ginecology, University of Catania, Catania, Italy
| | - Maria D'Arrigo
- Pathology Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Pietro Milone
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Giovanni Carlo Ettorre
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
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Correlation of Pelvic Magnetic Resonance Imaging Diagnosis With Pathology for Indeterminate Adnexal Masses. Int J Gynecol Cancer 2014; 24:1215-21. [DOI: 10.1097/igc.0000000000000203] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectivesThe aim of this study was to determine the accuracy of pelvic magnetic resonance imaging (MRI) diagnoses compared with the final pathology diagnoses for a series of women with indeterminate adnexal masses.Materials and MethodsWe performed a retrospective cohort study of women who underwent pelvic MRI with a diagnosis of an adnexal mass between June 2009 and 2010 after indeterminate ultrasound at our tertiary care institution. Chart abstraction was performed for demographic information and radiologic interpretations (benign or malignant) and favored a specific histologic subtype on MRI reports. The radiologic diagnoses were compared with the diagnoses by surgical pathology.ResultsData from 237 female patients who underwent pelvic MRI were included, and 41.35% underwent surgical intervention for the adnexal mass. Pelvic MRI (n = 88) was determined to have a sensitivity of 95.0% and specificity of 94.1%. The predicted specific histologic subtype by MRI (n = 84) was accurate in 56 (98.25%) of 57 women with an anticipated benign diagnosis and in 23 (85.19%) of 27 women with an anticipated malignancy. The agreement between a benign diagnosis from MRI and benign final surgical pathology was 0.85 (95% confidence interval, 0.716–0.976).ConclusionsIn our tertiary care center, MRI is used to further characterize indeterminate adnexal masses and can accurately differentiate benign versus malignant adnexal masses. The diagnosis on MRI was highly correlative with the final histopathology. The majority of the cohort (59%) were able to be managed expectantly based on reassuring results of the MRI. Magnetic resonance imaging offered diagnostic value, more detailed patient counseling, appropriate subspecialty referral, and surgical planning, as well as reassurance to pursue conservative management of benign masses by MRI.
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Zhang J, Cheng X, Han C, Li Z, Wang M, Zhu Y. Krukenberg tumor in a pregnant patient with severe preeclampsia. Exp Ther Med 2014; 7:1476-1480. [PMID: 24926329 PMCID: PMC4043597 DOI: 10.3892/etm.2014.1616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 02/10/2014] [Indexed: 12/31/2022] Open
Abstract
Krukenberg tumors accompanied by gestational hypertension are rare and have a poor patient prognosis. A gravida 1, para 0 patient was submitted to Tianjin Medical University General Hospital (Tianjin, China) at 32 weeks gestation with symptoms of nausea, vomiting and hypertension. Diagnosis from the gastroscopic biopsy was of a gastric ulcer. A unilateral ovarian mass was identified with B-scan ultrasonography and magnetic resonance imaging, but was confirmed pathologically as a bilateral Krukenberg tumor. Positron emission tomography-computed tomography revealed a high radioactive uptake in the lesser curvature wall of the stomach, and postoperative pathology revealed poorly differentiated adenocarcinoma of the stomach. As Krukenberg tumors are difficult to diagnose, exhibit fast progression and have a poor clinical outcome, developing a greater understanding of Krukenberg tumors is crucial. Imaging manifestations combined with serological examination may aid in early detection, which may lead to improved patient management.
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Affiliation(s)
- Jie Zhang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Xinyu Cheng
- Tianjin Medical University, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Cha Han
- Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Zengyan Li
- Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Min Wang
- Tianjin Medical University, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Yue Zhu
- Tianjin Medical University, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
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Zhang X, Mao Y, Zheng R, Zheng Z, Huang Z, Huang D, Zhang J, Dai Q, Zhou X, Wen Y. The contribution of qualitative CEUS to the determination of malignancy in adnexal masses, indeterminate on conventional US - a multicenter study. PLoS One 2014; 9:e93843. [PMID: 24736589 PMCID: PMC3988034 DOI: 10.1371/journal.pone.0093843] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/07/2014] [Indexed: 12/27/2022] Open
Abstract
The aim of this study is to evaluate the efficacy of qualitative analysis of contrast-enhanced ultrasound (CEUS) in discrimination of adnexal masses which were undetermined by conventional ultrasound (US). A total of 120 patients underwent transabdominal CEUS. The initial enhancement time and intensity compared with the uterine myometrium, contrast agent distribution patterns and dynamic changes of enhancement were assessed. The sensitivity (Sen), specificity (Spe), positive predictive value (PPV), negative predictive value (NPV), accuracy (ACC) and Youden’s index were calculated for contrast variables. The gold standard was the histological diagnosis. There were 48 malignant tumors and 72 benign tumors. The enhancement features of malignant masses were different from benign ones. Earlier or simultaneous enhancement with inhomogeneous enhancement yielded the highest capability in differential diagnosis, and Sen, Spe, PPV, NPV, ACC, Youden’s index was 89.6%, 97.2%, 93.2%, 95.6%, 93.3%, and 0.88, respectively. The qualitative evaluation of CEUS is useful in the differential diagnosis of adnexal masses where conventional US is indeterminate.
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Affiliation(s)
- Xinling Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yongjiang Mao
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- * E-mail:
| | - Zhijuan Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zeping Huang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dongmei Huang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jing Zhang
- Department of Ultrasound, General Hospital of Chinese People’s Liberation Army, Beijing, China
| | - Qing Dai
- Department of Ultrasound, Peking Union Medical College Hospital, Beijing, China
| | - Xiaodong Zhou
- Department of Ultrasound, Xi Jing Hospital of Fourth Military Medical University, Xi’an, China
| | - Yanling Wen
- Department of Ultrasound, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Abstract
Ovarian cancer is the fifth most common cancer affecting women in the UK today, with associated statistics illustrating a steadily increasing rate, particularly in women aged 65 and over (Cancer Research UK, 2013). There are no recognised preventative measures and no effective screening tool. Although evidence suggests that the majority of women experience a variety of non-specific symptoms in the year before diagnosis, the disease it is not commonly recognised until an advanced stage, leading to increased mortality and morbidity. This highlights the need to raise awareness among health professionals and women as a whole, as early recognition undoubtedly improves ovarian cancer survival. Best clinical practice in the UK for the recognition and initial management of ovarian cancer is provided by the National Institute for Health and Care Excellence (NICE). Clinical guideline CG 122 (NICE, 2011) and quality standard QS 18 (NICE, 2012) use relevant clinical evidence to define high-quality care standards for ovarian cancer management. Accurate staging of ovarian cancer is essential to the provision of individualised care and management. However, there is currently no single test that provides a reliable indicator of ovarian malignancy. At present, risk-of-malignancy scores are calculated by serum cancer antigen 125 (CA 125) levels, ultrasound score and menopausal status. These are widely used to identify women who are at high risk and require referral to a specialised gynaecological oncology service. Women diagnosed with ovarian cancer require information and support. The clinical nurse specialist acts as a key worker, providing communication, support and holistic care throughout a woman's cancer journey. The value of this role cannot be underestimated. Surgery followed by platinum-based chemotherapy is the usual standard treatment pathway, although individualised assessment and management may deviate from it. Early disease may be successfully treated with surgery alone; advanced disease may require complex management and treatment. New treatments such as bevacizumab show promise of improving ovarian cancer outcomes.
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Jung SI, Park HS, Kim YJ, Jeon HJ. Multidetector computed tomography for the assessment of adnexal mass: is unenhanced CT scan necessary? Korean J Radiol 2014; 15:72-9. [PMID: 24497795 PMCID: PMC3909865 DOI: 10.3348/kjr.2014.15.1.72] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/16/2013] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the diagnostic performance and radiation dose between contrast-enhanced CT (ECT) alone, and combined unenhanced and contrast-enhanced CT (UE + ECT) for the assessment of adnexal mass. MATERIALS AND METHODS This retrospective study was approved by the Institutional Review Board. A total of 146 consecutive patients (mean age, 41.1 years) who underwent preoperative unenhanced and contrast-enhanced multidetector CT of the pelvis and had adnexal masses found at surgery were included. Two readers independently evaluated the likelihood of adnexal malignancy on a 5-point scale on two different imaging datasets (ECT alone and UE + ECT). The area under the receiver operating characteristic curve (AUC) was used to evaluate diagnostic performance. Radiation dose to patients was calculated by the volume CT dose index (CTDIvol) and the dose length products (DLP) on each dataset. RESULTS Of the total 178 adnexal masses, 133 masses were benign and 45 masses were malignant. For both readers, there is no significant difference of AUC values between ECT alone and UE + ECT for the detection of adnexal malignancy (reader 1, 0.93 vs. 0.95; reader 2, 0.92 vs. 0.91) (p > 0.05). The mean CTDIvol (12.6 ± 2.2 mGy) and DLP (641.2 ± 137.2 mGy) of ECT alone was significantly lower than the mean CTDIvol (21.5 ± 2.7 mGy) and DLP (923.6 ± 158.8 mGy) of UE + ECT (p < 0.0001). CONCLUSION The use of unenhanced CT scan in addition to contrast-enhanced CT scan does not improve the detection of adnexal malignancy, but increases radiation exposure.
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Affiliation(s)
- Sung Il Jung
- Department of Radiology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 143-729, Korea
| | - Hee Sun Park
- Department of Radiology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 143-729, Korea
| | - Young Jun Kim
- Department of Radiology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 143-729, Korea
| | - Hae Jeong Jeon
- Department of Radiology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 143-729, Korea
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MANGANARO LUCIA, MICHIENZI SIMONA, VINCI VALERIA, FALZARANO RENATO, SALDARI MATTEO, GRANATO TERESA, VIGGIANI VALENTINA, FRATI LUIGI, ANASTASI EMANUELA. Serum HE4 levels combined with CE CT imaging improve the management of monitoring women affected by epithelial ovarian cancer. Oncol Rep 2013; 30:2481-7. [DOI: 10.3892/or.2013.2682] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 07/25/2013] [Indexed: 11/06/2022] Open
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Zhang H, Zhang GF, He ZY, Li ZY, Zhang GX. Prospective evaluation of 3T MRI findings for primary adnexal lesions and comparison with the final histological diagnosis. Arch Gynecol Obstet 2013; 289:357-64. [PMID: 23934242 DOI: 10.1007/s00404-013-2990-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 07/31/2013] [Indexed: 12/14/2022]
Abstract
PURPOSE We prospectively investigated the diagnostic accuracy of magnetic resonance imaging (MRI) at 3.0 Tesla (3T) for the detection of suspected primary adnexal masses in a large cohort of patients. METHODS This prospective clinical study included 223 patients with suspected gynaecological disease who were referred for 3T MRI assessments before laparoscopy or laparotomy. Fifty-nine patients were excluded. All detected adnexal pathologies on MRI were categorized into the four groups (endometric cysts, teratomas, benign tumours and malignant tumours). Histological findings were used as the comparative reference standard. As measures to detect or rule out primary adnexal masses, accuracy, sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were determined by lesion-based evaluations. RESULTS The reference standard method detected 141 primary adnexal lesions in 125 patients. The areas under the receiver operating characteristic curve of the lesion-based evaluations for endometric cysts, teratomas, benign lesions and malignant lesions were 92.8, 93.6, 95.1 and 94.4 %. Lesion-based evaluation yielded an accuracy of 90.3 %, sensitivity of 92.7 %, specificity of 89.3 %, PPV of 77.6 % and NPV of 96.8 % in differentiating malignancies from non-malignant lesions. The diagnostic value of 3T MRI for detecting malignancies was superior to that for benign tumours. CONCLUSIONS 3T MRI well categorize the characteristics of primary adnexal lesions and may be a reliable modality for distinguishing malignancies from benign tumours.
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Affiliation(s)
- He Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, No. 419 Fang Xie Road, Shanghai, 200011, China
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[Diagnosis and treatment of the epithelial ovarian cancer at the West African Cancer Center of Dakar]. Bull Cancer 2013; 100:155-60. [PMID: 23407147 DOI: 10.1684/bdc.2013.1693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Epithelial ovarian cancer are the most frequent of ovarian cancer, their prognosis is very bad. The aim of this study is to describe the diagnosis, the treatment and to assess the survival rate of the patients. METHODS It was a retrospective study realized at the Cancer Institute of Dakar from December 2000 to January 2007. We have collected 117 patients with epithelial ovarian cancer. The mean age was 49 years. Patients were comprised: 22 stage I, 32 stage II, 35 stage III and 26 stage IV. Primary surgery was performed to 34 patients and the other patients were treated with chemotherapy and surgery. The survival rate was assessed by Kaplan-Meier method and the Logrank test had allowed to compare the survival among age and optimal surgery. RESULTS Optimal surgery R0 was done in 20 cases and surgical resection R2 was performed in 45 cases. Pathological exam had found 65 serous cystadenocarcinoma, 28 mucinous cystadenocarcinoma and 21 endometrioid cystadenocarcinoma, one malignant tumor of Brenner. Overall survival at five years was 13.3%. The survival among optimal surgery was 16.3 and 2.3% for suboptimal surgery. There was no significant difference of the survival among patients who were less than 40 years old (P = 0.334). CONCLUSION Prognosis of epithelial ovarian cancer is worse in Senegal as like as in the world. To improve the survival of our patients, we must detect the early diagnosis of these tumors and to introduce the neoadjuvant chemotherapy before optimal surgery.
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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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Terzic MM, Dotlic J, Likic I, Ladjevic N, Brndusic N, Arsenovic N, Maricic S, Mihailovic T, Andrijasevic S. Current diagnostic approach to patients with adnexal masses: which tools are relevant in routine praxis? Chin J Cancer Res 2013; 25:55-62. [PMID: 23372342 DOI: 10.3978/j.issn.1000-9604.2013.01.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 07/17/2012] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of the study was to investigate which anamnestic, laboratory and ultrasound parameters used in routine practice could predict the nature of adnexal mass, thus enabling referral to relevant specialist. METHODS Study involved the women treated for adnexal tumors throughout a period of 2 years. On admission, detailed anamnestic and laboratory data were obtained, expert ultrasound scan was performed, and power Doppler index (PDI), risk of malignancy index (RMI) and body mass index (BMI) were calculated for all patients. Obtained data were related to histopathological findings, and statistically analyzed. RESULTS The study included 689 women (112 malignant, 544 benignant, and 33 borderline tumors). Malignant and borderline tumors were more frequent in postmenopausal women (P=0.000). Women who had benignant tumors had the lowest BMI (P=0.000). There were significant (P<0.05) differences among tumor types regarding erythrocyte sedimentation rate, CA125 and carcinoembryonic antigen (CEA) levels. Among ultrasound findings, larger tumor diameter and ascites were more frequent in malignant tumors (P=0.000). Women with malignant tumors had highest values of RMI and PDI (P=0.000). CONCLUSIONS Anamnestic data, ultrasound parameters and laboratory analyses were all found to be good discriminating factors among malignant, benignant and borderline tumors.
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Affiliation(s)
- Milan M Terzic
- Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade 11000, Serbia; ; School of Medicine, University of Belgrade, Belgrade 11000, Serbia
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Berretta M, Di Francia R, Lleshi A, De Paoli P, Li Volti G, Bearz A, Del Pup L, Tirelli U, Michieli M. Antiblastic treatment, for solid tumors, during pregnancy: a crucial decision. Int J Immunopathol Pharmacol 2013; 25:1S-19S. [PMID: 23092516 DOI: 10.1177/03946320120250s201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cancer is the second leading cause of death during the reproductive years complicating between 0.02 percent and 0.1 percent of pregnancies. The incidence is expected to rise with the increase in age of childbearing. The most common types of pregnancy-associated cancers are: cervical cancer, breast cancer, malignant melanoma, Hodgkin's lymphoma, non-Hodgkin's lymphoma and ovarian cancer. The relatively rare occurrence of pregnancy-associated cancer precludes conducting large, prospective studies to examine diagnostic, management and outcome issues. The treatment of pregnancy-associated cancer is complex since it may be associated with adverse fatal effects. In pregnant patients diagnosed with cancer during the first trimester, treatment with multidrug anti-cancer chemotherapy is associated with an increased risk of congenital malformations, spontaneous abortions or fetal death, and therefore, should follow a strong recommendation for pregnancy termination. Second and third trimester exposure is not associated with teratogenic effect but increases the risk of intrauterine growth retardation and low birth weight. There are no sufficient data regarding the teratogenicity of most cytotoxic drugs. Almost all chemotherapeutic agents were found to be teratogenic in animals and for some drugs only experimental data exist. Moreover, no pharmacokinetic studies have been conducted in pregnant women receiving chemotherapy in order to understand whether pregnant women should be treated with different doses of chemotherapy. This article reviews the available data regarding the different aspects of the treatment of cancer during pregnancy.
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Affiliation(s)
- M Berretta
- Department of Medical Oncology, National Cancer Institute, Aviano (PN), Italy.
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Dragosavac S, Derchain S, Caserta NMG, DE Souza G. Staging recurrent ovarian cancer with (18)FDG PET/CT. Oncol Lett 2012; 5:593-597. [PMID: 23420711 PMCID: PMC3573129 DOI: 10.3892/ol.2012.1075] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 11/28/2012] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to evaluate the use of 2-deoxy-2-((18)F)-fluoro-D-glucose ((18)FDG) positron emission tomography (PET)/computed tomography (CT) in patients with suspected ovarian cancer recurrence and describe the distribution of metastasis. A total of 45 female patients who underwent PET/CT scan due to raised CA-125 levels, clinical suspicion of ovarian cancer recurrence or alterations detected on ultrasound (US), CT or magnetic resonance imaging (MRI) were included in this retrospective study. PET/CT results were compared with histological findings (n=15) or clinical, laboratory and repeated imaging techniques during subsequent follow-up for at least six months (n=30). CA-125 was elevated in 34 patients, 14 patients had clinical symptoms of disease and 23 presented with alterations on US, CT and MRI. A total of 42 patients were confirmed to have ovarian cancer recurrence, all with abnormal findings on PET/CT. Three patients remained free of disease during clinical follow-up, all with normal PET/CT findings. There were 11 patients with raised CA-125 levels and normal conventional imaging, all with positive PET/CT. Among the 11 patients with normal CA-125 levels, eight presented with positive PET/CT scan. Lymph nodes were the most frequent site of relapse of disease, followed by peritoneal implants. Distant sites of metastasis included the liver, spleen, pleura, lung and bone. PET/CT detected unsuspected lesions in 20/45 patients (44.4%). (18)FDG PET/CT was a useful tool for evaluating the extent of ovarian cancer recurrence. In the current series, lymph nodes were the most frequent site of relapse of disease, with supradiaphragmatic lymph node metastasis in a large number of cases.
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Affiliation(s)
- Sanja Dragosavac
- DIMEN Medicina Nuclear and PET/CT Campinas, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
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Zhang H, Zhang GF, He ZY, Li ZY, Zhu M, Zhang GX. Evaluation of primary adnexal masses by 3T MRI: categorization with conventional MR imaging and diffusion-weighted imaging. J Ovarian Res 2012; 5:33. [PMID: 23148860 PMCID: PMC3576319 DOI: 10.1186/1757-2215-5-33] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 10/29/2012] [Indexed: 12/15/2022] Open
Abstract
Background To investigate the 3.0-Tesla (3 T) magnetic resonance imaging (MRI) characteristics of primary adnexal lesions for discriminating benign from malignant lesions. Methods One hundred thirty-nine patients with pathologically proven primary adnexal masses referred for 3 T MRI assessment preoperatively were included. Baseline characteristics, components, and conventional MRI and diffusion-weighted imaging (DWI-MRI) signals were recorded and compared. Results There were 22 ovarian cysts, 33 endometriomas, 43 benign tumors and 42 malignant tumors. When ovarian cyst and endometrioma were excluded, there were no significant differences in patients’ age between benign and malignant tumor (P = 0.235). There were no significant differences (P = 0.606) in the conventional MRI signals and significant difference (P = 0.008) in DWI-MRI signal between the non-malignant and malignant lesions. There was a significant difference (P = 0.000) in the apparent diffusion coefficient values (ADCs) between the non-malignant and malignant lesions. Conclusions 3 T MRI categorized the characteristics of primary adnexal lesions. Conventional MRI signals were not useful for characterizing between benign and malignant lesions. DWI-MRI and ADCs were helpful for distinguishing malignant from benign ovarian lesions.
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Affiliation(s)
- He Zhang
- Department of Radiology, Shanghai First People's Hospital, Medical College, Shanghai Jiaotong University, No, 100, Hai Ning Road, Shanghai, 200080, China.
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Affiliation(s)
- Ahmed N Al-Niaimi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, H4/636 Clinical Science Center, Madison, WI 53792-6188, USA.
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Alanbay I, Akturk E, Coksuer H, Ercan M, Karaşahin E, Dede M, Yenen MC, Ozan H, Baser I. Comparison of risk of malignancy index (RMI), CA125, CA 19-9, ultrasound score, and menopausal status in borderline ovarian tumor. Gynecol Endocrinol 2012; 28:478-82. [PMID: 22122561 DOI: 10.3109/09513590.2011.633663] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the prognostic values of risk of malignancy index (RMI IV), ultrasound score, menopausal status, and serum CA125 and CA19-9 level in patients with borderline ovarian tumor (BOT). METHODS Fifty women having borderline ovarian tumor (BOT) and 5O individuals with benign adnexal mass were enrolled in this retrospective study. The sensitivity, specificity, positive predictive values, negative predictive values and diagnostic accuracy of preoperative serum levels of the CA125 and CA19-9, ultrasound findings and menopausal status, and RMI IV were calculated for prediction of discrimination between BOTs and benign adnexal masses and the results were compared. RESULTS The RMI IV was the best method for discrimination between BOTs and benign adnexal masses and was more accurate than the other parameters. When Receiver Operator Characteristic area under the curves for menopausal status was analyzed, serum CA 125 and CA19-9 level, ultrasound score, RMI IV(CA125), and RMI IV(CA19-9) were, 0.580, 0.625, 0.548, 0.694, 0.734 and 0.711, respectively. The best RMI IV cut-off was found to be 200 for discrimination of benign and BOT lesions. In the RMI formulation, replacing CA125 with CA19-9 didn't affect RMI IV sensitivity and specificity for discrimination. CONCLUSION Compared to ultrasound, menopausal status, CA-125, CA19-9, the RMI IV was found to be the best predictive method for differentiation of BOTs from benign adnexal masses. RMI IV cut-off value of 200 is suitable for differentiation of benign and BOT's.
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Affiliation(s)
- Ibrahim Alanbay
- Gulhane Military Medical Faculty, Obstetrics and Gynecology Department, Etlik, Ankara, Turkey.
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George R, Michaelides M, Brewer MA, Utzinger U. Parallel factor analysis of ovarian autofluorescence as a cancer diagnostic. Lasers Surg Med 2012; 44:282-95. [PMID: 22407572 DOI: 10.1002/lsm.22014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2012] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES Endogenous fluorescence from certain amino acids, structural proteins, and enzymatic co-factors in tissue is altered by carcinogenesis. We evaluate the potential of these changes in fluorescence to predict a diagnosis of malignancy and to estimate the risk of developing ovarian cancer. STUDY DESIGN/MATERIALS AND METHODS Ovarian biopsies were interrogated over 270-550 nm excitation and fluorescence was collected from 290 to 700 nm. Two hundred forty-nine measurements were performed on 49 IRB-consented patients undergoing oophorectomy. Data are analyzed using parallel factor analysis to determine excitation and emission spectra of the underlying fluorophores that contribute to the total detected fluorescence intensity. RESULTS Using multivariate normal distribution fits and cross-validation techniques, sensitivity and specificity of 88% and 93%, respectively, are achieved when classifying malignant samples versus others, while 88% and 80%, respectively, are achieved when classifying normal post-menopausal patients as being either at high- or low-risk of developing ovarian cancer based on their personal and family history of cancer. Performance of classifying cancer increases when the normal group does not include benign neoplasm and endometriosis samples. Performance of high- versus low-risk classification decreases when normal samples include both pre- and post-menopausal women. Excitation over 270-400 and 380-560 nm, respectively, have the best diagnostic performance for cancer detection and risk-status assessment. CONCLUSIONS Assessing the endogenous fluorescence could be useful in screening women at increased risk of developing ovarian cancer.
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Affiliation(s)
- Ronie George
- College of Optical Sciences, University of Arizona, Tucson, Arizona 85721, USA
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Van Gorp T, Veldman J, Van Calster B, Cadron I, Leunen K, Amant F, Timmerman D, Vergote I. Subjective assessment by ultrasound is superior to the risk of malignancy index (RMI) or the risk of ovarian malignancy algorithm (ROMA) in discriminating benign from malignant adnexal masses. Eur J Cancer 2012; 48:1649-56. [PMID: 22226481 DOI: 10.1016/j.ejca.2011.12.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 12/06/2011] [Indexed: 12/13/2022]
Abstract
PURPOSE The combination of two tumour markers, CA125 and HE4, in the risk of ovarian malignancy assay (ROMA) has been shown to be successful in classifying patients into those who have a high or low risk of epithelial ovarian cancer. In the present study, the diagnostic accuracy of ROMA was assessed and compared to the diagnostic accuracy of the two most widely used ultrasound methods, namely the risk of malignancy index (RMI) and subjective assessment by ultrasound. METHODS From August, 2005 to March, 2009, 432 women with a pelvic mass who were scheduled to have surgery were enrolled in a single-centre prospective cohort study. A preoperative ultrasound was performed and preoperative CA125 and HE4 serum levels were measured. Once the final surgical pathology reports were obtained, the diagnostic accuracy and performance indices of ROMA, RMI and subjective assessment were calculated. RESULTS Of the 432 eligible patients, 374 could be analysed. Subjective assessment had the highest area under the receiver operator characteristic curve (AUC) (0.968, 95%CI:0.945-0.984), followed by the RMI (0.931, 95%CI:0.901-0.955). The subjective assessment and RMI both had significantly higher AUCs than the ROMA (0.893, 95%CI:0.857-0.922; P<0.0001 and P=0.0030, respectively). The pre- and postmenopausal populations generated similar results. CONCLUSION Although new tumour markers models are promising, they do not contribute significantly to the diagnosis of ovarian cancer. Ultrasound, especially subjective assessment by ultrasound, remains superior in discriminating malignant from benign ovarian masses.
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Affiliation(s)
- Toon Van Gorp
- Department of Obstetrics and Gynaecology, Leuven Cancer Institute, Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Relationship Among Glycolytic Phenotype, Grade, and Histological Subtype in Ovarian Carcinoma. Clin Nucl Med 2012; 37:49-53. [DOI: 10.1097/rlu.0b013e3182291e03] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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UEHARA T, TAKAHAMA J, MARUGAMI N, TAKAHASHI A, TAKEWA M, ITOH T, KITANO S, NAKAGAWA H, KICHIKAWA K. Visualization of Ovarian Tumors using 3T MR Imaging: Diagnostic Effectiveness and Difficulties. Magn Reson Med Sci 2012; 11:171-8. [DOI: 10.2463/mrms.11.171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Bilateral Tubo-Ovarian Abscess Mimics Ovarian Cancer on MRI and (18)F-FDG PET/CT. Nucl Med Mol Imaging 2011; 45:223-8. [PMID: 24900009 DOI: 10.1007/s13139-011-0089-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 06/02/2011] [Accepted: 06/03/2011] [Indexed: 10/18/2022] Open
Abstract
A 20-year-old woman, who presented with a several-week history of abdominal pain, was referred for magnetic resonance imaging (MRI) and (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) after an ultrasound showed complex cystic masses arising from both ovaries. The MRI and (18)F-FDG PET/CT imaging characteristics of the ovarian masses were strongly suspicious for malignancy, and the masses were surgically removed. Histopathological evaluation revealed a bilateral tubo-ovarian abscess, with no evidence of malignancy. This case highlights a potentially serious pitfall in the evaluation of suspicious pelvic masses by (18)F-FDG PET/CT, whereby a complex bilateral tubo-ovarian abscess may mimic the PET/CT imaging characteristics of an ovarian or pelvic malignancy.
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Lutz AM, Willmann JK, Drescher CW, Ray P, Cochran FV, Urban N, Gambhir SS. Early Diagnosis of Ovarian Carcinoma: Is a Solution in Sight? Radiology 2011; 259:329-45. [DOI: 10.1148/radiol.11090563] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Aggarwal P, Kehoe S. Ovarian tumours in pregnancy: a literature review. Eur J Obstet Gynecol Reprod Biol 2011; 155:119-24. [DOI: 10.1016/j.ejogrb.2010.11.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 10/30/2010] [Accepted: 11/30/2010] [Indexed: 10/18/2022]
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Mehrotra R, Tyagi G, Jangir DK, Dawar R, Gupta N. Analysis of ovarian tumor pathology by Fourier Transform Infrared Spectroscopy. J Ovarian Res 2010; 3:27. [PMID: 21176143 PMCID: PMC3017039 DOI: 10.1186/1757-2215-3-27] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 12/21/2010] [Indexed: 01/13/2023] Open
Abstract
Background Ovarian cancer is the second most common cancer among women and the leading cause of death among gynecologic malignancies. In recent years, infrared (IR) spectroscopy has gained attention as a simple and inexpensive method for the biomedical study of several diseases. In the present study infrared spectra of normal and malignant ovarian tissues were recorded in the 650 cm-1 to 4000 cm-1 region. Methods Post surgical tissue samples were taken from the normal and tumor sections of the tissue. Fourier Transform Infrared (FTIR) data on twelve cases of ovarian cancer with different grades of malignancy from patients of different age groups were analyzed. Results Significant spectral differences between the normal and the ovarian cancerous tissues were observed. In particular changes in frequency and intensity in the spectral region of protein, nucleic acid and lipid vibrational modes were observed. It was evident that the sample-to-sample or patient-to-patient variations were small and the spectral differences between normal and diseased tissues were reproducible. Conclusion The measured spectroscopic features, which are the spectroscopic fingerprints of the tissues, provided the important differentiating information about the malignant and normal tissues. The findings of this study demonstrate the possible use of infrared spectroscopy in differentiating normal and malignant ovarian tissues.
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Affiliation(s)
- Ranjana Mehrotra
- Optical Radiation Standards, National Physical Laboratory, (Council of Scientific and Industrial Research, New Delhi), Dr K S Krishnan Marg, New Delhi 110012, India.
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Quan G, Du X, Huo T, Li X, Wei Z, Cui H, Chang X, Cheng Y, Ye X, Cheng H. Targeted molecular imaging of antigen OC183B2 in ovarian cancers using MR molecular probes. Acad Radiol 2010; 17:1468-76. [PMID: 20869887 DOI: 10.1016/j.acra.2010.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 07/05/2010] [Accepted: 07/06/2010] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES This study was designed to develop a novel magnetic resonance (MR) probe for the antigen OC183B2 in ovarian cancer cells and investigate its imaging features in vitro and in vivo. MATERIALS AND METHODS Molecular probes were achieved through ultrasmall superparamagnetic iron oxide nanoparticles (USPIOs) conjugated to ovarian cancer monoclonal antibodies 183B2 (OCMab183B2) using a chemical method. In the control group, USPIOs were coupled with murine immunoglobulin G (mIgG) and conjugated the same way. Native polyacrylamide gel electrophoresis was used to evaluate the conjugation reaction. The cytotoxicity of the probe was measured using the methyl thiazolyl tetrazolium assay, and its cell-labeling efficiency was evaluated by Prussian blue staining. In vitro cell MR imaging was performed to evaluate the targeting of the probe to the cells. After that, the OCMab183B2 USPIOs and mIgG USPIOs were injected intravenously into nude mice implanted with ovarian cancer xenograft tumors, respectively. T2-weighted imaging and T2 mapping were then performed on a 3.0-T MR imaging system equipped with an animal birdcage coil at different times. Finally, the nude mice were sacrificed for histologic examination to confirm the imaging results. RESULTS Native polyacrylamide gel electrophoresis displayed an optimal conjugation of USPIOs to OCMab183B2 and mIgG. Various blue-staining particles were found in the cells labeled with the molecular probe at different iron concentrations, and the density of particles was positively related to the iron concentration. Its labeling rate was 96.06%, which was higher than that of USPIOs (62.5%) at the same iron concentration (20 μg/mL). The methyl thiazolyl tetrazolium assay showed that there was no difference in cellular bioactivity between OCMab183B2 USPIO-labeled and nonlabeled cells (P > .05). In vitro cell MR imaging showed that there was an obvious decrease in signal intensity for the probe-labeled cells compared to mIgG USPIO-labeled cells. For in vivo MR imaging, distinct changes of signal intensities and T2 values of ovarian cancers were detected after the injection of OCMab183B2 USPIOs compared to mIgG USPIOs. The histologic analysis showed that iron depositions were visualized in the experimental group but not in the control group. CONCLUSION OCMab183B2 USPIO conjugates have the potential to be useful as OC183B2-targeted MR imaging agents for the early detection of ovarian cancers.
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Affiliation(s)
- Guangnan Quan
- Department of Radiology, Peking University People's Hospital, Beijing, China
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Wahl RL, Javadi MS, Eslamy H, Shruti A, Bristow R. The Roles of Fluorodeoxyglucose-PET/Computed Tomography in Ovarian Cancer: Diagnosis, Assessing Response, and Detecting Recurrence. PET Clin 2010; 5:447-61. [PMID: 27157972 DOI: 10.1016/j.cpet.2010.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The potential roles of fluorodeoxyglucose positron emission tomography/computed tomography imaging in ovarian cancer include noninvasive characterization of an ovarian mass, staging, and treatment planning. This article assesses these roles for predicting and monitoring response to treatment, restaging, and early diagnosis of recurrence.
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Affiliation(s)
- Richard L Wahl
- Division of Nuclear Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Mehrbod Som Javadi
- Division of Nuclear Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hedieh Eslamy
- Division of Nuclear Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aditi Shruti
- Division of Nuclear Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert Bristow
- Division of Gynecological Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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