Role of ultrasound in the detection of recurrent ovarian cancer: a review of the literature

CT-Based Radiomics and Machine Learning for Differentiating Benign, Borderline, and Early-Stage Malignant Ovarian Tumors

To explore the value of CT-based radiomics model in the differential diagnosis of benign ovarian tumors (BeOTs), borderline ovarian tumors (BOTs), and early malignant ovarian tumors (eMOTs). The retrospective research was conducted with pathologically confirmed 258 ovarian tumor patients from January 2014 to February 2021. The patients were randomly allocated to a training cohort (n = 198) and a test cohort (n = 60). By providing a three-dimensional (3D) characterization of the volume of interest (VOI) at the maximum level of images, 4238 radiomic features were extracted from the VOI per patient. The Wilcoxon-Mann-Whitney (WMW) test, least absolute shrinkage and selection operator (LASSO), and support vector machine (SVM) were employed to select the radiomic features. Five machine learning (ML) algorithms were applied to construct three-class diagnostic models. Leave-one-out cross-validation (LOOCV) was implemented to evaluate the performance of the radiomics models. The test cohort was used to verify the generalization ability of the radiomics models. The receiver-operating characteristic (ROC) was used to evaluate diagnostic performance of radiomics model. Global and discrimination performance of five models was evaluated by average area under the ROC curve (AUC). The average ROC indicated that random forest (RF) diagnostic model in training cohort demonstrated the best diagnostic performance (micro/macro average AUC, 0.98/0.99), which was then confirmed with by LOOCV (micro/macro average AUC, 0.89/0.88) and external validation (test cohort) (micro/macro average AUC, 0.81/0.79). Our proposed CT-based radiomics diagnostic models may effectively assist in preoperatively differentiating BeOTs, BOTs, and eMOTs.

An Aptamer-Based Nanoflow Cytometry Method for the Molecular Detection and Classification of Ovarian Cancers through Profiling of Tumor Markers on Small Extracellular Vesicles

Molecular profiling of protein markers on small extracellular vesicles (sEVs) is a promising strategy for the precise detection and classification of ovarian cancers. However, this strategy is challenging owing to the lack of simple and practical detection methods. In this work, using an aptamer-based nanoflow cytometry (nFCM) detection strategy, a simple and rapid method for the molecular profiling of multiple protein markers on sEVs was developed. The protein markers can be easily labeled with aptamer probes and then rapidly profiled by nFCM. Seven cancer-associated protein markers, including CA125, STIP1, CD24, EpCAM, EGFR, MUC1, and HER2, on plasma sEVs were profiled for the molecular detection and classification of ovarian cancers. Profiling these seven protein markers enabled the precise detection of ovarian cancer with a high accuracy of 94.2 %. In addition, combined with machine learning algorithms, such as linear discriminant analysis (LDA) and random forest (RF), the molecular classifications of ovarian cancer cell lines and subtypes were achieved with overall accuracies of 82.9 % and 55.4 %, respectively. Therefore, this simple, rapid, and non-invasive method exhibited considerable potential for the auxiliary diagnosis and molecular classification of ovarian cancers in clinical practice.

Validation of the diagnostic efficacy of O-RADS in adnexal masses

The aim of this study was to validate the performance of the Ovarian-Adnexal Reporting and Data Systems (O-RADS) series models proposed by the American College of Radiology (ACR) in the preoperative diagnosis of adnexal masses (AMs). Two experienced sonologists examined 218 patients with AMs and gave the assessment results after the examination. Pathological findings were used as a reference standard. Of the 218 lesions, 166 were benign and 52 were malignant. Based on the receiver operating characteristic (ROC) curve, we defined a malignant lesion as O-RADS > 3 (i.e., lesions in O-RADS categories 4 and 5 were malignant). The area under the curve (AUC) of O-RADS (v2022) was 0.970 (95% CI 0.938-0.988), which wasn't statistically significantly different from the O-RADS (v1) combined Simple Rules Risk (SRR) assessment model with the largest AUC of 0.976 (95% CI 0.946-0.992) (p = 0.1534), but was significantly higher than the O-RADS (v1) (AUC = 0.959, p = 0.0133) and subjective assessment (AUC = 0.918, p = 0.0255). The O-RADS series models have good diagnostic performance for AMs. Where, O-RADS (v2022) has higher accuracy and specificity than O-RADS (v1). The accuracy and specificity of O-RADS (v1), however, can be further improved when combined with SRR assessment.

The value of ultrasonography combined with carbohydrate antigen 125 and 19-9 detection in the diagnosis of borderline ovarian tumors and prediction of recurrence

Objective

This study aimed to investigate the clinical value of ultrasonography combined with tumor markers in the diagnosis and prediction of recurrence of borderline ovarian tumors (BOTs) and analyze the value of the combination of two different auxiliary examinations in the diagnosis and prediction of recurrence of BOTs.

Methods

Here, 221 patients with BOTs confirmed by postoperative pathology were enrolled. Their clinical data, including the ultrasonography features, tumor markers, and clinicopathological data, were retrospectively analyzed.

Results

The statistical data of the 221 cases with BOTs were as follows: 94 (42.5%) with left-sided lesions, 102 (46.2%) with right-sided lesions, and 25 (11.3%) with bilateral lesions. Moreover, 93 cases (42.1%) had a borderline serous tumor, 110 (49.8%) had a borderline mucinous tumor, 12 (5.4%) had a borderline serous mucinous tumor, 2 (0.9%) had a borderline endometrioid tumor, 1 (0.5%) had a borderline Brenner tumor, and 2 (0.9%) had a clear cell BOT. There were 104 cases (47.1%) with a tumor diameter of ≤10 cm and 117 cases (52.9%) with a tumor diameter of >10 cm as suggested by ultrasonography. There were 89 cases (40.3%) with septation, 44 (19.9%) with papilla, and 97 (43.9%) with blood flow as demonstrated by ultrasonography. Carbohydrate antigen 125 (CA 125) was elevated in 132 cases (59.7%), and CA 19-9 was elevated in 52 cases (23.5%).

Conclusion

In general, BOTs are difficult to diagnose preoperatively and have a certain recurrence rate. Ultrasonography combined with CA 125 and CA 19-9 is significant for the preoperative diagnosis and selection of surgical modality for BOTs and could be used as a guideline to achieve good preoperative preparation and avoid secondary surgery.

Diagnostic Value of Two-Dimensional Transvaginal Ultrasound Combined with Contrast-Enhanced Ultrasound in Ovarian Cancer

Objective

Explore the value of two-dimensional transvaginal ultrasound combined with contrast-enhanced ultrasound in the differential diagnosis of ovarian cancer, so as to provide the basis for clinical diagnosis and treatment of ovarian cancer.

Methods

A total of 100 suspected ovarian cancer patients who were admitted to our hospital from January 2019 to December 2021 were selected as the research subjects, including 62 ovarian cancer patients (ovarian cancer group) and 38 ovarian benign tumor patients (benign group). Two-dimensional vaginal ultrasound and contrast-enhanced ultrasound were performed in both groups. The differences in PI, RI, EDV, PSV, and VM parameters of the two groups as well as those of patients with ovarian cancer of different grades were compared. Record the contrast-enhanced ultrasound parameters such as AT, TTP and IMAX, and determine the diagnostic value.

Results

The PI and RI of the ovarian cancer group were lower than those of the benign ovarian tumor group, and the EDV, PSV and VM of the ovarian cancer group were higher than those of the benign ovarian tumor group (p < 0.05). The PI and RI of the patients in stage I–II of the ovarian cancer group were higher than those in stage III–IV, and the EDV, PSV and VM were lower than those in the patients in stage III–IV, with statistical significance (p < 0.05). The results of contrast-enhanced ultrasound showed that the AT and TTP values in the ovarian cancer group were significantly shorter than those in the benign group, and the peak intensity was significantly higher than that in the benign group, and the differences were statistically significant (p < 0.05). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of two-dimensional ultrasound combined with contrast-enhanced ultrasound in the diagnosis of ovarian cancer were high, 95.16%(59/62), 86.84%(33/38), 92.19%(59/64), 91.67%(33/36) and 92.00%(92/100), respectively.

Conclusion

Contrast-enhanced ultrasound to some extent makes up for the deficiencies of conventional ultrasound, is helpful to detect early ovarian cancer, and can be used for the differential diagnosis of small ovarian tumors with difficult two-dimensional ultrasound diagnosis. Two-dimensional ultrasound combined with contrast-enhanced ultrasound can effectively improve the detection rate and differential diagnosis value of ovarian cancer, which is of great significance in the early diagnosis and differentiation of ovarian cancer.

Ultrasound-Guided Tru-Cut Biopsy in Gynecological and Non-Gynecological Pelvic Masses: A Single-Center Experience

Aim: The aim of this study was to evaluate the feasibility of adequacy, accuracy, and safety of ultrasound-guided tru-cut biopsy in managing malignant and benign abdominopelvic masses in a selected population and critically discuss some issues in different situations, which deserve some reflections on those practices. Materials and Methods: This is a retrospective study involving 42 patients who underwent transvaginal or transabdominal tru-cut biopsy between August 2017 and November 2021. The inclusion criteria were poor health status or primary inoperable advanced tumor, suspicion of recurrence or metastasis to the ovaries or peritoneum in gynecological and non-gynecological pelvic malignancies. Tissue samples were considered adequate if it was possible to determine the origin of the tumor, and immunohistochemistry could be performed. Diagnostic accuracy was assessed considering the agreement between tru-cut biopsy histology and final postoperative histology. Results: It total, 44 biopsies were obtained from 42 patients (2 patients had repeat biopsies). The pathologist considered all pathological samples adequate (adequacy 100%). The final histology was consistent with tru-cut biopsy diagnosis in all but 2 cases (diagnostic accuracy 88.2%). If we consider only the cases that have carried out at least two diagnostic samples, accuracy rose to 94.1%. Pathological examinations from tru-cut samples showed 2 benign lesions (4.8%) and 40 malignant tumors (95.2%), divided into 19 advanced primary inoperable ovarian cancers, 7 primary advanced cervical cancers, 4 recurrent endometrial cancers, 3 recurrent cervical cancers, 3 recurrent ovarian cancers, 1 case of primitive peritoneal malignancy (leiomyosarcoma), and 3 non-gynecological cancers with a strong suspicion of metastases at ultrasound (2 cases of ovarian, colorectal cancer metastasis, and 1 case of pelvic site type B lymphoma metastasis). However, one case of minor complication related to the procedure was reported but not significant. Conclusions: The diagnostic adequacy, accuracy of the tru-cut biopsy, and safety were high. Pathological samples are representative of the disease and suitable for histological and immunohistochemical analysis.

Suicide and Accidental Death Among Women With Primary Ovarian Cancer: A Population-Based Study

Background

Women with ovarian cancer had the highest suicidal rate among all patients with gynecological malignancies, but no large studies about suicide and accidental death for women with ovarian cancers in detail were conducted. We aimed to determine the relative risk of suicide and accidental death among patients with ovarian cancer to that of the general population, and to identify risk factors associated with suicide and accidental death.

Methods

Data are from the SEER (surveillance, epidemiology, and end results) cancer registry of women diagnosed with ovarian cancer data from 18 registries for the years 1973–2016. The study population comprised 149,204 patients after inclusion and exclusion criteria were applied. Standardized mortality ratios (SMRs) were calculated and Fine-Gray models were fitted to identify risk factors associated with suicidal and accidental death among cancer patients, with stratifications on demographic and tumor-related characteristics.

Results

Women with ovarian cancer had a higher risk of suicide and accidental death than the cancer-free group [SMR = 1.86; 95% CI (1.54–2.25) and SMR = 1.54; 95% CI (1.39–1.71)]. Subgroup analysis indicated that only patients with type II epithelial ovarian cancer [SMR = 2.31; 95% CI (1.83–2.91)] had an increased risk of suicide, and those with type I and type II epithelial ovarian cancer [SMR = 1.65; 95% CI (1.39–1.97) and SMR = 1.49; 95% CI (1.30–1.70)] were at a higher risk of accidental death. Patients with ovarian cancer who were younger, white, diagnosed with high-grade, non-metastatic cancer and pelvic exenteration were at a higher risk of suicide. The advanced age, earlier year of diagnosis, and non-metastatic cancer were associated with a higher risk of accidental death. Additionally, pelvic exenteration increased the risk of suicide but not the risk of accidental death among women with primary ovarian cancer.

Conclusions

Women with ovarian cancer had a higher risk of suicide and accidental death compared with the general population. The findings suggested that clinicians should identify high-risk subgroups of ovarian cancer patients for suicide and accidental death as early as possible, with appropriate prevention strategies.

Machine learning-based rapid diagnosis of human borderline ovarian cancer on second-harmonic generation images

Regarding growth pattern and cytological characteristics, borderline ovarian tumors fall between benign and malignant, but they tend to develop malignancy. Currently, it is difficult to accurately diagnose ovarian cancer using common medical imaging methods, and histopathological examination is routinely used to obtain a definitive diagnosis. However, such examination requires experienced pathologists, being labor-intensive, time-consuming, and possibly leading to interobserver bias. By using second-harmonic generation imaging and k-nearest neighbors classifier in conjunction with automated machine learning tree-based pipeline optimization tool, we developed a computer-aided diagnosis method to classify ovarian tissues as being malignant, benign, borderline, and normal, obtaining areas under the receiver operating characteristic curve of 1.00, 0.99, 0.98, and 0.97, respectively. These results suggest that diagnosis based on second-harmonic generation images and machine learning can support the rapid and accurate detection of ovarian cancer in clinical practice.

Subcutaneous Vulvar Flap Viability Evaluation With Near-Infrared Probe and Indocyanine Green for Vulvar Cancer Reconstructive Surgery: A Feasible Technique

Introduction: Vulvar cancer is a rare condition affecting older women and accounts for 3-5% of all gynecological cancers. Primary surgical treatment involves the removal of a large amount of tissue for which reconstructive surgery is often necessary with a high rate of postoperative complications. Despite several techniques for the evaluation of vulvar flap viability have been proposed, many methods cannot be performed during surgery and require expensive devices often missing in a gynecological clinic. This study aims to verify the feasibility and the safety of the vulvar flap viability evaluation through a near-infrared endoscopic probe and Indocyanine green (ICG) tracer in a small group of patients and to evaluate long-term vulvar flap outcomes. Methods: Patients with primary vulvar cancer who required surgical treatment and subsequent vulvar flap reconstructive surgery were prospectively included in the study. A 25 mg ICG vial diluted in 20 ml of saline solution was intravenously infused before closing the skin edges of the flaps. All patients were given 0.2 mg/kg body weight of intravenous ICG. After 10-15 min, a near-infrared endoscopic probe was used to evaluate the vulvar flap viability. Results: Of the 18 patients who underwent radical vulvectomy for vulvar cancer during the study period, 15 were included in the analysis. All packaged surgical flaps showed tracer uptake on the surgical margin. No intro-operative complications were recorded neither surgery-related nor to dye infusion. No surgical infection, dehiscence, or necrosis was recorded. Conclusions: Vulvar flap viability assessment using Indocyanine green and a laparoscopic infrared probe is a feasible method. All cases included in the analysis showed a dye uptake on the surgical edge of the flap. Further, prospective studies are needed to confirm the method in clinical practice and to evaluate its superiority over simple subjective clinical evaluation.

Novelties of ultrasound imaging for endometrial cancer preoperative workup

INTRODUCTION

Endometrial cancer (EC) is the most frequent gynecological cancer. Transvaginal ultrasound (TVU) plays a leading role in the preoperative workup and often is the first diagnostic instrumental examination. Despite expert hands' ultrasound is recommended to assess myometrial invasion in early stage EC, this method is a strictly operator-dependent examination, and varying degrees of sensitivity and specificity have been reported. The present review aims to provide an update of ultrasound imaging in the preoperative work-up for EC patients.

EVIDENCE ACQUISITION

A double-blind search was performed from May to September 2020. The following keywords: "ultrasound," "transvaginal ultrasound" and "endometrial cancer" were searched in Pubmed search engines, Scopus, and Web of Science. The Prisma statement was followed for the selection of the articles included.

EVIDENCE SYNTHESIS

The initial search provided 958 studies, of which 11 were included in the analysis. non-English articles, not relevant to the purposes of this study, case reports and articles with fewer than 40 cases were excluded.

CONCLUSIONS

TVU sensitivity and specificity in myometrial infiltration and cervical invasion is comparable to MRI but has lower costs, greater patient tolerability, and does not require contrast agents. An expert operator should perform the ultrasound examination in patients with suspected EC The presence of myometrial lesions, such as leiomyomas, could lower the diagnostic accuracy of ultrasound, so special attention should be paid to patients with concomitant uterine lesions.

Quality of life and sexual functioning of patient affected by endometrial cancer

INTRODUCTION

Thanks to timely diagnosis and medical advancement the number of endometrial cancer (EC) patients achieving long term survival is constantly increasing and here comes the necessity to move forward with the understanding of post-treatment sexual adjustment and with the strategies to enhance sexual functioning (SF) and quality of life (QoL) in this population. In this scenario we designed this study aiming to summarize and analyze the available scientific evidence regarding QoL and especially SF in patients affected by EC who underwent surgical and adjuvant treatment.

EVIDENCE ACQUISITION

A preliminary research was conducted using Pubmed database with specific keywords combinations regarding SF, QoL and endometrial cancer. The main findings considered in the present review were: the study design, the number of patients included in each study, the information about pathology (histology and stage of disease), the questionnaires administered and the principal results concerning SF and QoL.

EVIDENCE SYNTHESIS

A total of thirteen studies, between 2009 and 2018, treating the aspects of SF and QoL in patients affected by EC were extracted. The principal findings of different studies were organized in the following sections: 1) overall SF in EC patients (reasons for sexual inactivity); 2) impact of EC on SF when compared to benign gynecological disease or healthy controls-focus on surgery; 3) minimally invasive surgery versus classical laparotomic approach and SF of EC patients; 4) surgery alone versus VBT versus EBRT and SF of EC patients; 5) focus on RT; 6) the mutual correlation between sociodemographic, relational, psychological, clinical/metabolic factors and the SF of EC patients.

CONCLUSIONS

Considering the widespread diffusion of female sexual dysfunction among EC patients and the relatively good prognosis, especially in early stage disease, it undoubtedly looms the need for proactive countermeasures to maximize the sexual well-being and QoL of these patients. A wide range of intervention in a multi-modal physical and mental perspective should be considered.