Assessment of solid components of borderline ovarian tumor and stage I carcinoma: added value of combined diffusion- and perfusion-weighted magnetic resonance imaging

Comparison of conventional diffusion-weighted imaging, diffusion kurtosis imaging and intravoxel incoherent motion in characterization of sonographically indeterminate adnexal masses

PURPOSE

To evaluate the role of conventional diffusion weighted imaging, diffusion kurtosis imaging (DKI), and intravoxel incoherent motion (IVIM) in distinguishing benign from malignant adnexal masses.

METHODS

38 patients with 45 adnexal masses were enrolled in this prospective study and assessed with multiparametric MRI, including the IVIM-DKI sequence, on a 3 T MRI system. The mean apparent diffusion coefficient (ADC) from conventional DWI, the apparent diffusion coefficient derived from DKI (Dapp), the apparent kurtosis coefficient (Kapp), true diffusion coefficient (Dt), perfusion fraction (f) and pseudo-diffusion coefficient (Dp) were measured.

RESULTS

The mean ADC, Dapp, and Dt were significantly higher in benign adnexal masses than in malignant adnexal masses (p < 0.001). f and Dp were also significantly higher in benign adnexal masses, with p values of 0.026 and 0.002, respectively. Kapp was higher in malignant masses (p < 0.001). Among mean ADC, Dapp, and Dt, mean ADC had the highest area under the curve (AUC) of 0.885. However, no statistically significant differences were observed between the ROCs of various diffusion parameters.

CONCLUSION

The mean ADC, Dapp, and Kapp are useful parameters in discriminating between benign and malignant adnexal masses. Dt derived from IVIM also helps in distinguishing benign and malignant adnexal masses; however, no incremental role of IVIM and DKI over ADC could be identified in our study.

Recurrence characteristics and clinicopathological results of borderline ovarian tumors

Background

This study aimed to investigate the clinical and pathological characteristics, and the recurrence and prognostic factors of borderline ovarian tumors (BOTs).

Methods

The data of 286 patients admitted to hospital and followed up for more than ten months were analyzed retrospectively to study the clinicopathological characteristics and related factors of recurrence.

Results

The median age of the patients was 42.06 ± 14.97 years, and the duration of the follow-up ranged from 10–109 months. During the follow-up period, 40 patients had a recurrence. Of these patients, 36 were ≤ 40 years, and patients with premenopausal recurrence accounted for 20.5% (36/176). In patients undergoing conservative treatment or radical operations, the recurrence rates were 21.3% and 1.8%, respectively, and they were 13.4% (36/268) in patients at Federation International of Gynecology and Obstetrics (FIGO) stage I, and 22.2% (4/18) in patients at an advanced stage. Postoperative pathology revealed that 40 patients had micropapillary tumors, among whom ten patients (25%) had a recurrence, and 19 patients had complications with interstitial infiltration. Of these 19 patients, six had a recurrence (31.5%). Another 22 patients had complications with calcified sand bodies; among these, eight patients (36.4%) had a recurrence. All the differences were statistically significant (P < 0.05). There were four cancer-related deaths during the follow-up period. Late FIGO stage, conservative operation, and a high level of carbohydrate antigen 125 (CA125) were independent risk factors for the recurrence of BOTs.

Conclusion

BOTs usually occur in women under 40 years, have an occult onset, and half of the patients have no obvious clinical manifestations. Serum CA125 level can be used as a tumor marker to detect BOTs and the risk of its recurrence. Operation mode and FIGO stage are important independent factors for the recurrence of BOTs.

Minimal apparent diffusion coefficient value of the solid component to differentiate borderline and malignant ovarian epithelial tumours: a preliminary report

Purpose

Ovarian tumours are the second most common cause of death from gynaecological cancer. There are three types of ovarian cancer based on histopathological examination: benign, borderline, and malignant. However, it is difficult to distinguish the borderline and malignant tumours. Several studies used the apparent diffusion coefficient value to distinguish the ovarian tumour types, with various results. This preliminary report focused more on the use of the minimal ADC (mADC) value on the solid component, to differentiate borderline and malignant ovarian tumours.

Material and methods

In 21 cases of borderline ovarian tumours, of which 11 were regarded as malignant and 10 were regarded as borderline following histopathological examination, the mADC value was measured by two different radiologists by using free-hand technique. The intraclass correlation coefficient (ICC) was used to measure the reliability and agreement between the two radiologists. Receiver-operating characteristic (ROC) curves were then calculated to determine the optimum cut-off point.

Results

There were statistically significant (p = 0.001) of the mADC value between the borderline and malignant tumours. The intraclass correlation coefficient value showed excellent reliability and agreement between the examiners. The ROC curve showed the optimum cut-off point at 0.628 × 10^–3 mm²/s (p = 0.001), which yielded 100% sensitivity and 80% specificity.

Conclusions

The use of free-hand technique to measure the mADC value on the solid component can be valuable in differentiating borderline and malignant ovarian epithelial tumours. This result may assist clinicians in considering further treatment approaches.