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Mekni K, Baba M, Haddad I, Aaraar M, Mejri O, ElFekih C. [Applicability of the Adnex score in predicting the malignancy of ovarian cysts]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:398-402. [PMID: 38065408 DOI: 10.1016/j.gofs.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/10/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Ovarian cancer screening is a difficult problem due to the anatomy of the ovaries. Only histology allows a definite diagnosis. Our objective was to study the contribution of the Adnex score in the histological characterization of adnexal images for adequate management. METHODS It was a retrospective, mono-center, descriptive and analytical. Sixty-five patients were included, those operated for an ovarian cyst and meeting the Adnex criteria: clinical, ultrasound and laboratory. RESULTS The mean age of the patients was 38.6 years. They were nulliparous in 43 % of cases, and only four had a history of operation on ovarian cyst. Abdominal pelvic pain was the most frequent reason for consultation in 48 % of cases. An abdominopelvic mass was found on abdominal examination in 11 % of cases. Pelvic ultrasound made it possible to objectify the presence of an ovarian mass in all cases, with an average size of 79.66mm and a reassuring appearance in 66 % of cases. The calculation of the Adnex score was done in all patients preoperatively, for a 10 % cut-off, the model showed an 86 % chance of benignity for tumors proven to be histologically benign. The main route of entry was laparoscopy, in 61 % of cases. The treatment was in most cases conservative consisting essentially of a cystectomy. CONCLUSION The Adnex score discriminated well between benign and malignant masses, allowing for a better diagnosis preoperatively. It thus deserves its applicability in the clinical setting.
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Affiliation(s)
- Karima Mekni
- Service de gynéco-obstétrique, hôpital Mahmoud El Matri, 2080 Ariana, Tunisie; Faculté of Médicine, Université Tunis El Manar, Tunis, Tunisia; Laboratoire de recherche LR18SP05, Tunis, Tunisia.
| | - Meriam Baba
- Service de gynéco-obstétrique, hôpital Mahmoud El Matri, 2080 Ariana, Tunisie
| | - Ines Haddad
- Service de gynéco-obstétrique, hôpital Mahmoud El Matri, 2080 Ariana, Tunisie
| | - Monia Aaraar
- Service de gynéco-obstétrique, hôpital Mahmoud El Matri, 2080 Ariana, Tunisie
| | - Oumayma Mejri
- Service de gynéco-obstétrique, hôpital Mahmoud El Matri, 2080 Ariana, Tunisie; Faculté of Médicine, Université Tunis El Manar, Tunis, Tunisia
| | - Chiraz ElFekih
- Service de gynéco-obstétrique, hôpital Mahmoud El Matri, 2080 Ariana, Tunisie; Faculté of Médicine, Université Tunis El Manar, Tunis, Tunisia
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Akçay A, Peker AA, Oran Z, Toprak H, Toluk Ö, Balsak S, Badur BA, Gültekin MA. Role of magnetic resonance imaging to differentiate between borderline and malignant serous epithelial ovarian tumors. Abdom Radiol (NY) 2024; 49:229-236. [PMID: 37857912 DOI: 10.1007/s00261-023-04076-9] [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: 08/09/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE We aimed to differentiate serous borderline ovarian tumors (SBOT) from serous epithelial ovarian carcinomas (SEOC) using morphological and functional MRI findings, to improve the patient management. METHOD We retrospectively investigated 24 ovarian lesions diagnosed with SBOT and 64 ovarian lesions diagnosed with SEOC. Additional to the demographic and morphological findings T2W signal intensity ratio, mean apparent diffusion coefficient (ADCmean) and total apparent diffusion coefficient (ADCtotal) values were analyzed and compared between two groups. RESULTS Bilaterality, pelvic free fluid presence, serum CA-125 level (U/mL), presence of pelvic peritoneal implant were in favor of SEOC. Lower maximum size of solid component and solid size to maximum size ratio, dominantly cystic and solid-cystic appearance, exophytic growth pattern, presence of papiller projection and papillary architecture and internal branching pattern, higher T2W signal intensity ratio, ADCmean and ADCtotal values were in favor of SBOT. CONCLUSION Our study revealed that morphological and functional imaging findings were valuable in differentiating BSOT from SEOC.
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Affiliation(s)
- Ahmet Akçay
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, +34093, Istanbul, Turkey.
| | - Abdusselim Adil Peker
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, +34093, Istanbul, Turkey
| | - Zeynep Oran
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, +34093, Istanbul, Turkey
| | - Hüseyin Toprak
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, +34093, Istanbul, Turkey
| | - Özlem Toluk
- Department of Biostatistics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Serdar Balsak
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, +34093, Istanbul, Turkey
| | - Bahar Atasoy Badur
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, +34093, Istanbul, Turkey
| | - Mehmet Ali Gültekin
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, +34093, Istanbul, Turkey
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Moon MH, Park HS, Kim YJ, Yu MH, Park S, Jung SI. Computed Tomography Indicators for Differentiating Stage 1 Borderline Ovarian Tumors from Stage I Malignant Epithelial Ovarian Tumors. Diagnostics (Basel) 2023; 13:diagnostics13030480. [PMID: 36766584 PMCID: PMC9914279 DOI: 10.3390/diagnostics13030480] [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: 12/30/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Preoperative diagnosis of borderline ovarian tumors (BOTs) is of increasing concern. This study aimed to determine computed tomography (CT) features in differentiating stage 1 BOTs from stage I malignant epithelial ovarian tumors (MEOTs). A total of 170 ovarian masses (97 BOTs and 73 MEOTs) from 141 consecutive patients who underwent preoperative CT imaging were retrospectively analyzed. Two readers independently and retrospectively reviewed quantitative and qualitative CT features. Multivariate logistic analysis demonstrated that a larger tumor size (p = 0.0284 for reader 1, p = 0.0391 for reader 2) and a smaller solid component (p = 0.0007 for reader 1, p = 0.0003 for reader 2) were significantly associated with BOTs compared with MEOTs. In the subanalysis of cases with a solid component, smaller (p = 0.0092 for reader 1, p = 0.0014 for reader 2) and ill-defined (p = 0.0016 for reader 1, p = 0.0414 for reader 2) solid component was significantly associated with BOTs compared with MEOTs. Tumor size and the size and margin of the solid component were useful for differentiating stage 1 BOTs from stage 1 MEOTs on CT images.
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Affiliation(s)
- Min Hoan Moon
- Department of Radiology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, 5 Gil 20, Boramae-Road, Dongjak-Gu, Seoul 07061, Republic of Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
| | - Mi Hye Yu
- Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
| | - Sungeun Park
- Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
- Correspondence:
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MR Imaging of Epithelial Ovarian Neoplasms Part I: Benign and Borderline. Magn Reson Imaging Clin N Am 2022; 31:43-52. [DOI: 10.1016/j.mric.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Borderline epithelial ovarian tumors: what the radiologist should know. Abdom Radiol (NY) 2021; 46:2350-2366. [PMID: 32860524 DOI: 10.1007/s00261-020-02688-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/20/2020] [Accepted: 07/25/2020] [Indexed: 12/22/2022]
Abstract
Ovarian borderline tumors are neoplasms of epithelial origin that are typically present in young patients and tend to have a less aggressive clinical course than malignant tumors. Accurate diagnosis and staging of borderline tumors has important prognostic and management implications (like fertility-sparing procedures) for women of child-bearing age. This article will review the sonographic, CT, and MRI features of borderline epithelial ovarian tumors with histopathologic correlation. Borderline tumors have less soft tissue and thinner walls/septations than malignant tumors. Serous borderline tumors more commonly have papillary projections, which can simulate the appearance of a sea anemone. Mucinous borderline tumors often are larger, multi-cystic, and more commonly unilateral. The borderline mucinous tumors may also present with pseudomyxoma peritonei, which can make it difficult to distinguish from malignant mucinous carcinoma. Ultrasound is usually the first-line modality for imaging these tumors with MRI reserved for further characterizing indeterminate cases. CT is best used to stage tumors for both locoregional and distant metastatic disease. Overall, however, the imaging features overlap with both benign and malignant ovarian tumors. Despite this, it is important for the radiologist to be familiar with the imaging appearances of borderline tumors because they can present in younger patients and may benefit from different clinical/surgical management.
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Han X, Li B, Sun M, Li J, Li Y, Liu A. Application of contrast-enhanced dual-energy spectral CT for differentiating borderline from malignant epithelial ovarian tumours. Clin Radiol 2021; 76:585-592. [PMID: 34059294 DOI: 10.1016/j.crad.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
AIM To investigate the value of contrast-enhanced dual-energy spectral computed tomography (CT) in differentiating borderline epithelial ovarian tumours (BEOTs) from malignant epithelial ovarian tumours (MEOTs). MATERIALS AND METHODS Sixty patients who underwent pelvic contrast-enhanced spectral CT were divided into two groups for analysis based on the tumour types confirmed at histopathological examination (26 BEOTs and 34 MEOTs). The regions of interest (ROIs) were selected on solid tumour components to measure attenuation values on monochromatic image sets (40-140 keV) in all imaging phases and tumour iodine concentrations (IC) on material decomposition images. Differences in the attenuation value between the unenhanced and contrast-enhanced phases (enhancement degree) and between energy strengths (slope k, k = [attenuation at 40 keV- attenuation at 140 keV]/100) were calculated. All measurements between the two groups were compared with independent t-test. Receiver operating characteristic (ROC) curves were generated to calculate the sensitivity, specificity and area under the ROC curve (AUC). Logistic regression analysis was used to evaluate the diagnostic efficacy of using combined parameters in two-phase contrast-enhanced images. RESULTS In the arterial phase (AP) and venous phase (VP), the BEOTs had significantly lower enhancement than MEOTs from 40 to 100 keV (p<0.05). The k values and IC values both showed significant differences in the AP and VP (p<0.05). Combining parameters in two contrast-enhanced phases provided 80.8% sensitivity and 82.4% specificity in differentiating MEOTs from BEOTs with an AUC of 0.844. CONCLUSION Dual-energy spectral CT provides a multiparametric approach in differentiating BEOTs from MEOTs with the best diagnostic efficacy using combined parameters in the AP and VP images.
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Affiliation(s)
- X Han
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - B Li
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - M Sun
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - J Li
- GE Healthcare, Shanghai, China
| | - Y Li
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - A Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Cai SQ, Li Y, Li YA, Wang L, Zhu J, Zhao SH, Qiang JW. Perfusion-based functional magnetic resonance imaging for differentiating serous borderline ovarian tumors from early serous ovarian cancers in a rat model. Acta Radiol 2021; 62:129-138. [PMID: 32276553 DOI: 10.1177/0284185120913711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Differentiation of borderline tumors from early ovarian cancer has recently received increasing attention, since borderline tumors often affect young women of childbearing age who desire to preserve fertility. However, previous studies have demonstrated that non-enhanced magnetic resonance imaging (MRI) sequences cannot sufficiently differentiate these tumors. PURPOSE To investigate the value of dynamic contrast-enhanced MRI (DCE-MRI) and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in differentiating serous borderline ovarian tumors (SBOT) from early serous ovarian cancers (eSOCA). MATERIAL AND METHODS Twenty SBOT and 20 eSOCA rat models were performed with DCE-MRI and IVIM-DWI at 3.0-T MR scanner. Qualitative and quantitative parameters of DCE-MRI were acquired and compared between two groups and correlated with the microvessel density (MVD). The receiver operating characteristic (ROC) curve analyses were conducted to determine their differentiating performances. RESULTS SBOTs presented significantly lower values of the initial area under the enhancement curve (iAUC), volume transfer constant (Ktrans), and extracellular extravascular volume fraction (ve) (P < 0.05) and a significantly higher value of true diffusion (D) (P = 0.001) compared with eSOCAs. The diagnostic effectiveness of ve combined with D was significantly better than that of ve or Ktrans alone (P ≤ 0.039). CONCLUSION DCE-MRI may represent a promising tool for differentiating SBOTs from eSOCAs and may not be replaced by IVIM-DWI. Combining DCE-MRI with DWI may improve the diagnostic performance of ovarian tumors.
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Affiliation(s)
- Song-Qi Cai
- Department of Radiology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China
- Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Yong-Ai Li
- Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Li Wang
- Department of Pathology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Jian Zhu
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Shu-Hui Zhao
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Jin-Wei Qiang
- Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China
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Adnexal masses characterized on 3 tesla magnetic resonance imaging - added value of diffusion techniques. Radiol Oncol 2020; 54:419-428. [PMID: 33085642 PMCID: PMC7585339 DOI: 10.2478/raon-2020-0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/14/2020] [Indexed: 11/23/2022] Open
Abstract
Background To assess different types of adnexal masses as identified by 3T MRI and to discuss the added value of diffusion techniques compared with conventional sequences. Patients and methods 174 women age between 13 and 87 underwent an MRI examination of the pelvis for a period of three years. Patients were examined in two radiology departments – 135 of them on 3 Tesla MRI Siemens Verio and 39 on 3 Tesla MRI Philips Ingenia. At least one adnexal mass was diagnosed in 98 patients and they are subject to this study. Some of them were reviewed retrospectively. Data from patients’ history, physical examination and laboratory tests were reviewed as well. Results 124 ovarian masses in 98 females’ group of average age 47.2 years were detected. Following the MRI criteria, 59.2% of the cases were considered benign, 30.6% malignant and 10.2% borderline. Out of all masses 58.1% were classified as cystic, 12.9% as solid and 29% as mixed. Оf histologically proven tumors 74.4% were benign and 25.6% were malignant. All of the malignant tumors had restricted diffusion. 64 out of all patients underwent contrast enhancement. (34 there were a subject of contraindications). 39 (61%) of the masses showed contrast enhancement. Conclusions Classifying adnexal masses is essential for the preoperative management of the patients. 3T MRI protocols, in particular diffusion techniques, increase significantly the accuracy of the diagnostic assessment.
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Differentiation of borderline tumors from type I ovarian epithelial cancers on CT and MR imaging. Abdom Radiol (NY) 2020; 45:3230-3238. [PMID: 32162020 DOI: 10.1007/s00261-020-02467-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate the value of CT and MR imaging features in differentiating borderline ovarian tumor (BOT) from type I ovarian epithelial cancer (OEC), which could be significant for suitable clinical treatment and assessment of the prognosis of the patient. METHODS Thirty-three patients with BOTs and 35 patients with type I OECs proven by pathology were retrospectively evaluated. The clinico-pathological information (age, premenopausal status, CA-125, and Ki-67) and imaging characteristics were compared between two groups of ovarian tumors. The diagnostic performance of the imaging features was evaluated using receiver operating characteristic analysis. The best predictor variables for type I EOCs were recognized via multivariate analyses. RESULTS BOTs are more likely to involve younger patients and frequently show lower CA-125 values and lower proliferation indices (Ki-67 < 15%) than type I OECs. Compared with type I OECs, BOTs were more often purely cystic (15/33, 45.45% vs. 1/35, 2.86%; p < 0.001) and displayed less frequent mural nodules (16/33, 48.48% vs. 28/35, 80.00%; p = 0.007), less frequently unclear margin (3/33, 9.09% vs. 11/35, 31.43%; p = 0.023), smaller solid portion (0.56 ± 2.66 vs. 4.51 ± 3.88; p < 0.001), and thinner walls (0.3 ± 0.17 vs. 0.55 ± 0.24; p < 0.001). The maximum wall thickness presented the largest area under the curve (AUC, 0.848). Multivariate analysis revealed that the solid portion size (OR 10.822, p = 0.002) and maximum wall thickness (OR 9.130, p = 0.001) were independent indicators for the differential diagnosis between the two groups of lesions. CONCLUSION The solid portion size and maximum wall thickness significantly influenced the classification of the two groups of ovarian tumors.
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Ye R, Weng S, Li Y, Yan C, Chen J, Zhu Y, Wen L. Texture Analysis of Three-Dimensional MRI Images May Differentiate Borderline and Malignant Epithelial Ovarian Tumors. Korean J Radiol 2020; 22:106-117. [PMID: 32932563 PMCID: PMC7772386 DOI: 10.3348/kjr.2020.0121] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 01/06/2023] Open
Abstract
Objective To explore the value of magnetic resonance imaging (MRI)-based whole tumor texture analysis in differentiating borderline epithelial ovarian tumors (BEOTs) from FIGO stage I/II malignant epithelial ovarian tumors (MEOTs). Materials and Methods A total of 88 patients with histopathologically confirmed ovarian epithelial tumors after surgical resection, including 30 BEOT and 58 MEOT patients, were divided into a training group (n = 62) and a test group (n = 26). The clinical and conventional MRI features were retrospectively reviewed. The texture features of tumors, based on T2-weighted imaging, diffusion-weighted imaging, and contrast-enhanced T1-weighted imaging, were extracted using MaZda software and the three top weighted texture features were selected by using the Random Forest algorithm. A non-texture logistic regression model in the training group was built to include those clinical and conventional MRI variables with p value < 0.10. Subsequently, a combined model integrating non-texture information and texture features was built for the training group. The model, evaluated using patients in the training group, was then applied to patients in the test group. Finally, receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of the models. Results The combined model showed superior performance in categorizing BEOTs and MEOTs (sensitivity, 92.5%; specificity, 86.4%; accuracy, 90.3%; area under the ROC curve [AUC], 0.962) than the non-texture model (sensitivity, 78.3%; specificity, 84.6%; accuracy, 82.3%; AUC, 0.818). The AUCs were statistically different (p value = 0.038). In the test group, the AUCs, sensitivity, specificity, and accuracy were 0.840, 73.3%, 90.1%, and 80.8% when the non-texture model was used and 0.896, 75.0%, 94.0%, and 88.5% when the combined model was used. Conclusion MRI-based texture features combined with clinical and conventional MRI features may assist in differentitating between BEOT and FIGO stage I/II MEOT patients.
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Affiliation(s)
- Rongping Ye
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shuping Weng
- Department of Radiology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Yueming Li
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Key Laboratory of Radiation Biology (Fujian Medical University), Fujian Province University, Fuzhou, China.
| | - Chuan Yan
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jianwei Chen
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuemin Zhu
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Liting Wen
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Yu XP, Liu Y, Jiao JW, Yang HJ, Wang RJ, Zhang S. Evaluation of Ovarian Tumors with Multidetector Computed Tomography and Tumor Markers: Differentiation of Stage I Serous Borderline Tumors and Stage I Serous Malignant Tumors Presenting as Solid-Cystic Mass. Med Sci Monit 2020; 26:e924497. [PMID: 32801292 PMCID: PMC7450786 DOI: 10.12659/msm.924497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The aim of this study was to determine multidetector computed tomography (MDCT) features and tumor markers for differentiating stage I serous borderline ovarian tumors (SBOTs) from stage I serous malignant ovarian tumors (SMOTs). Material/Methods In total, 48 patients with stage I SBOTs and 54 patients with stage I SMOTs who underwent MDCT and tumor markers analysis were analyzed. MDCT features included location, shape, margins, texture, papillary projections, vascular abnormalities, size, and attenuation value. Tumor markers included serum cancer antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA), and human epididymis protein 4 (HE4). Parameters of clinical characteristic, MDCT features, and tumor markers were compared using a chi-square test and Mann-Whitney U tests. A binary logistic regression analysis was performed to detect predictors for SMOTs. A receiver operating characteristic (ROC) curve analysis was used to assess the potential diagnostic value of the quantitative parameters. Kappa and intraclass correlation coefficients were used to evaluate interobserver reproducibility for MDCT features. Results Median ages between patients with SBOTs and SMOTs were significantly different. Compared with SBOTs, vascular abnormalities were significantly more common in SMOTs. CA125, HE4, the maximum thickness of the wall, the maximum thickness of the septa, and the maximum diameter of the solid portions were significantly higher in patients with SMOTs. A binary logistic regression analysis revealed that age, vascular abnormalities, and the maximum diameter of the solid portion were independent factors of SMOTs. ROC analysis was used to assess the potential diagnostic value for predicting SMOTs. Moderate or good interobserver reproducibility for MDCT features were identified. Conclusions Age, vascular abnormalities, and the maximum diameter of the solid portion were independent factors for differentiating SBOTs from SMOTs. The combined analysis of age, vascular abnormalities, and the maximum diameter of the solid portion may allow better differentiation between SBOTs and SMOTs.
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Affiliation(s)
- Xin-Ping Yu
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Ying Liu
- Department of Radiology, Civil Aviation General Hospital, Civil Aviation Clinical Medical College of Peking University, Beijing, China (mainland)
| | - Jin-Wen Jiao
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Hong-Juan Yang
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Rui-Jing Wang
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Shuai Zhang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
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Sun Y, Xu J, Jia X. The Diagnosis, Treatment, Prognosis and Molecular Pathology of Borderline Ovarian Tumors: Current Status and Perspectives. Cancer Manag Res 2020; 12:3651-3659. [PMID: 32547202 PMCID: PMC7246309 DOI: 10.2147/cmar.s250394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/24/2020] [Indexed: 11/24/2022] Open
Abstract
Borderline ovarian tumors (BOTs) are a type of low malignant potential tumor that is typically associated with better outcomes than ovarian cancer. Indeed, its 10-year survival rate is as high as 95%. However, there is a small subset of patients who experience relapse and eventually die. It has been shown that the prognosis of BOTs was based on pathological diagnosis, the age at diagnosis, pre-operative carbohydrate antigen 125 level, invasive implants, and micropapillary patterns. Now the molecular-targeted therapy and molecular-genetic diagnosis have developed into a form of precision medicine. Recent studies on extensive molecular characterizations and molecular pathological mechanisms of BOTs have helped us understand the genomic landscapes of BOTs, and therefore BOTs could be reclassified into biologically and clinically more accurate and effective subtypes. The purpose of this review is to summarize current status for the diagnosis and treatment of BOTs and to describe the research progress on molecular pathologies, with a goal of providing a theoretical perspective for the diagnosis and treatment of BOTs.
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Affiliation(s)
- Yu Sun
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
| | - Juan Xu
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
| | - Xuemei Jia
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
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Yu S, Shen J, Fei J, Zhu X, Yin M, Zhou J. KNDC1 Is a Predictive Marker of Malignant Transformation in Borderline Ovarian Tumors. Onco Targets Ther 2020; 13:709-718. [PMID: 32158223 PMCID: PMC6986543 DOI: 10.2147/ott.s223304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/24/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Few screening markers for malignant transformation in borderline ovarian tumors (BOT) have been clearly established. The kinase noncatalytic C-lobe domain containing 1 (KNDC1), a brain-specific Ras guanine nucleotide exchange factor, negatively regulates dendrite growth. However, the biological role and underlying mechanism of KNDC1 in human cancers, including ovarian cancer (OC), remain unknown. METHODS Gene chip screening was used to detect the expression of KNDC1 mRNA in normal ovarian tissues, BOT tissues, and OC tissues. And results were further validated by RT-qPCR, Western blotting and immunohistochemistry. KNDC1 overexpression and knockdown ovarian cancer cells were established to study the possible pathways that KNDC1 was involved. The effects of KNDC1 on the malignant behaviors of ovarian tumors were also investigated both in vitro and in vivo. RESULTS We observed that the expression of KNDC1 mRNA and KNDC1 protein in OC was significantly downregulated compared with BOT. Subsequent investigation revealed that knockdown of KNDC1 enhanced the proliferation of ovarian cancer cells in vitro via induction of ERK1/2 phosphorylation, whereas reinforcing the expression of KNDC1 attenuated the ERK1/2 activity. Similarly, knockdown of KNDC1 also promoted cell proliferation in vivo. Survival analysis showed that lower KNDC1 predicted a poor progression-free survival (PFS) for patients. CONCLUSION Collectively, we conclude that KNDC1 might function as a tumor suppressor in ovarian tumors, inhibiting the proliferation of ovarian cells by suppressing ERK1/2 activity and hindering the malignant transformation of BOT.
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Affiliation(s)
- Shuqian Yu
- Department of Gynecology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang310012, People’s Republic of China
| | - Jiayu Shen
- Department of Gynecology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang310051, People’s Republic of China
| | - Jing Fei
- Department of Gynecology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang310051, People’s Republic of China
| | - Xiaoqing Zhu
- Department of Gynecology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang310051, People’s Republic of China
| | - Meichen Yin
- Department of Gynecology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang310051, People’s Republic of China
| | - Jianwei Zhou
- Department of Gynecology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang310051, People’s Republic of China
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Mansour SM, Gomma MMM, Shafik PN. Proton MR spectroscopy and the detection of malignancy in ovarian masses. Br J Radiol 2019; 92:20190134. [PMID: 31287729 DOI: 10.1259/bjr.20190134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess the impact of MR spectroscopy (MRS) on the detection of malignancy in ovarian masses. METHODS This prospective work included 230 females that had 245 adnexal/ovarian masses. Tumours were spotted by preliminary pelvic ultrasound. Masses assessed by MRI, multi- or single-voxel spectroscopy. Patients' spectra were assessed for peaks of lactate (Lac, 1.31 ppm), lipid (Lip, 1.33 ppm), N-acetyl aspartate (2.0 ppm), acetone (A, 2.05 ppm), choline (Cho, 3.23 ppm) and creatinine (Cr, 3.4 ppm) and the mean values of the (Cho/Cr) ratios were performed by a semi-quantitative approach. The operative pathology served as the standard of reference. RESULTS Cho peak twofold higher than the average noise level was detected in 72% of the malignant and only 5.4% of the benign masses with an accuracy of 83%. Adding lactate to the choline enhanced the accuracy to 93%. The mean Cho/Cr ratios of the malignant ovarian masses (2.8) were significantly higher than that of the benign ones (1.2) . We used a receiver operating characteristic curve to determine the best cut-off value (1.7) for the mean Cho/Cr ratio to discriminate malignancy with sensitivity: 81.2%, specificity: 93.3 %, positive-predictive value: 92.9 %, negative-predictive value: 82.4% and accuracy: 87.1%. CONCLUSION The simultaneous presence of choline and lactate peaks in MRS examination of the ovarian masses minimizes the overlap between benign and malignant categories. N-acetyl aspartate and acetone are the metabolites for diagnosing complex cystic masses as benign teratoma, endomterioma and tubo- ovarian abscess. ADVANCES IN KNOWLEDGE MRS is a non-contrast based and fast MR sequence that gives an idea about tissue components could be used to improve the sensitivity and the accuracy of detecting malignancy in ovarian masses.
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Affiliation(s)
- Sahar Mahmoud Mansour
- 1Department of Radiology (Women's imaging unit), Kasr ElAiny Hospital - Faculty of Medicine - Cairo University, Cairo, Egypt
| | | | - Peter Nashaat Shafik
- 2Department of Radiology, National Cancer Institute- Faculty of Medicine - Cairo University, Cairo, Egypt
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15
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Han X, Sun M, Wang M, Fan R, Chen D, Xie L, Liu A. The enhanced T 2 star weighted angiography (ESWAN) value for differentiating borderline from malignant epithelial ovarian tumors. Eur J Radiol 2019; 118:187-193. [PMID: 31439240 DOI: 10.1016/j.ejrad.2019.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To investigate the potential of ESWAN in differentiating borderline epithelial ovarian tumors (BEOTs) from malignant epithelial ovarian tumors (MEOTs). METHOD Thirty-four patients with 37 lesions were enrolled, including 14 BEOTs and 23 MEOTs. The magnitude, phase, R2* and T2* maps were analyzed by two observers. The regions of interest were drawn along the boundaries of tumors on the slice with maximal solid area, according to fat suppression T2WI and T1WI. The consistency among the three measurements taken by two observers was tested by intra-class correlation coefficients. Agreement of average values measured by two observers was evaluated by Bland-Altman plots. All the data of BEOTs and MEOTs were compared using the independent-sample t test. The receiver operating characteristic curve was used to evaluate the diagnostic performance. RESULTS No statistical differences were observed in the magnitude and phase values between two tumor groups. The R2* value of BEOTs was lower than that of MEOTs (P < 0.001), whereas the T2* value of BEOTs was higher than that of MEOTs (P = 0.01). The area under the curve of R2* values was 0.894 and the corresponding cutoff value was 7.50 Hz, with the sensitivity, specificity and accuracy of 85.7%, 82.6% and 86.5%, respectively. The AUC of T2* values was 0.776 and the corresponding cutoff value was 143.73 ms with the sensitivity, specificity and accuracy of 71.4%, 82.6% and 78.4%, respectively. CONCLUSIONS R2* and T2* values can be used for quantificationally differentiating BEOTs from MEOTs and the R2* has better diagnostic performance.
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Affiliation(s)
- Xu Han
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Meiyu Sun
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Mengyao Wang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Rui Fan
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Dan Chen
- Department of Pathology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Lizhi Xie
- GE Healthcare, MR Research China, Beijing, China.
| | - Ailian Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
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16
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Value of normalized apparent diffusion coefficients in differentiating between borderline and malignant epithelial ovarian tumors. Eur J Radiol 2019; 118:44-50. [PMID: 31439257 DOI: 10.1016/j.ejrad.2019.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/21/2019] [Accepted: 06/25/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare the diagnostic performance of normalized apparent diffusion coefficients (nADCs) of different references with that of ADCs at differentb factors in differentiating borderline epithelial ovarian tumors (BEOTs) from malignant epithelial ovarian tumors (MEOTs). METHOD This retrospective study included 53 BEOTs and 148 MEOTs. Conventional magnetic resonance and diffusion-weighted imaging withb factors of 800 and 1000s/mm2 were performed. ADC was measured three times at solid components of tumors, gluteus maximus muscle (GMM), iliopsoas muscle (IM) and urine and then averaged. ADCtumor, nADCs were then obtained. Differences and the diagnostic performance of ADCtumor and nADCs between BEOTs and MEOTs with different b factors were compared. RESULTS ADCtumor, nADCs regardless of b factors were significantly higher in BEOTs than MEOTs. The diagnostic performance of nADCurine regardless of b factors was significantly larger than that of nADCGMM and nADCIM. There was no significant difference in the diagnostic performance between ADCtumor and nADCurine regardless of b factors. A significantly lower ADCtumor and a larger diagnostic performance for ADCtumor was found with a b factor of 1000s/mm2 than 800 s/mm2. There were no significant differences in nADCurine of BEOTs or MEOTs or in the diagnostic performance of nADCurine with b factors between 800 and 1000s/mm2. CONCLUSIONS ADCtumor and nADCs were both capable of differentiating BEOTs from MEOTs. nADCurine was the best of all nADCs and was superior to ADCtumor because of its stable performance in differentiating BEOTs from MEOTs, regardless of b factors.
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Kim SH. Assessment of solid components of borderline ovarian tumor and stage I carcinoma: added value of combined diffusion- and perfusion-weighted magnetic resonance imaging. Yeungnam Univ J Med 2019; 36:231-240. [PMID: 31620638 PMCID: PMC6784647 DOI: 10.12701/yujm.2019.00234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 01/29/2023] Open
Abstract
Background We sought to determine the value of combining diffusion-weighted (DW) and perfusion-weighted (PW) sequences with a conventional magnetic resonance (MR) sequence to assess solid components of borderline ovarian tumors (BOTs) and stage I carcinomas. Methods Conventional, DW, and PW sequences in the tumor imaging studies of 70 patients (BOTs, n=38; stage I carcinomas, n=32) who underwent surgery with pathologic correlation were assessed. Two independent radiologists calculated the parameters apparent diffusion coefficient (ADC), Ktrans (vessel permeability), and Ve (cell density) for the solid components. The distribution on conventional MR sequence and mean, standard deviation, and 95% confidence interval of each DW and PW parameter were calculated. The inter-observer agreement among the two radiologists was assessed. Area under the receiver operating characteristic curve (AUC) and multivariate logistic regression were performed to compare the effectiveness of DW and PW sequences for average values and to characterize the diagnostic performance of combined DW and PW sequences. Results There were excellent agreements for DW and PW parameters between radiologists. The distributions of ADC, Ktrans, and Ve values were significantly different between BOTs and stage I carcinomas, yielding AUCs of 0.58 and 0.68, 0.78 and 0.82, and 0.70 and 0.72, respectively, with ADC yielding the lowest diagnostic performance. The AUCs of the DW, PW, and combined PW and DW sequences were 0.71±0.05, 0.80±0.05, and 0.85±0.05, respectively. Conclusion Combining PW and DW sequences to a conventional sequence potentially improves the diagnostic accuracy in the differentiation of BOTs and stage I carcinomas.
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Affiliation(s)
- See Hyung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea
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18
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Cai SQ, Li Y, Li YA, Wang L, Zhu J, Zhao SH, Li X, Qiang JW. A rat model of serous borderline ovarian tumors induced by 7,12-dimethylbenz[a]anthracene. Exp Anim 2019; 68:257-265. [PMID: 30760660 PMCID: PMC6699968 DOI: 10.1538/expanim.18-0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Serous borderline ovarian tumors (SBOTs) behave between benign cystadenomas and
carcinomas, and the effective detection and clinical management of SBOTs remain clinical
challenges. Because it is difficult to isolate and enrich borderline tumor cells, a
borderline animal model is in need. 7,12-dimethylbenz[a]anthracene (DMBA) is capable of
inducing the initiation, promotion, and progression of serous ovarian tumors. This study
aims to investigate the proper dosage and induction time of DMBA for rat models of SBOTs,
and explore their morphological features demonstrated by magnetic resonance (MR) imaging
and molecular genetic characteristics. Rats were randomly divided into six groups (1 mg/70
D, 2 mg/70 D, 3 mg/70 D, 2 mg/50 D, 2 mg/90 D, and 2 mg/110 D). The 3 mg/70 D group
induced the most SBOTs (50.0%, 12/24). The micropapillary projections were shown on MR
imaging, which was the characteristic of SBOTs. The Cyclin D1 characterizing an early
pathogenetic event strongly expressed in induced serous benign tumors (SBTs). The
immunoreactivity staining scores of P53 expression significantly increased from SBTs,
SBOTs to serous ovarian carcinomas (SCAs), which elucidate that P53 might be a promising
biomarker to grade serous ovarian tumors. Based on morphological and molecular genetic
similarities, this rodent SBOT model was suitable for investigating the pathogenesis of
serous ovarian tumors and developing an early detection strategy.
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Affiliation(s)
- Song-Qi Cai
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xvhui District, Shanghai 200032, China.,Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai 201508, China
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai 201508, China
| | - Yong-Ai Li
- Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai 201508, China
| | - Li Wang
- Department of Pathology, Jinshan Hospital, Shanghai Medical College, Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai 201508, China
| | - Jian Zhu
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, Zhejiang 325003, China
| | - Shu-Hui Zhao
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University, No. 1665 Kongjiang Road, Yangpu District, Shanghai 200092, China
| | - Xin Li
- Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai 201508, China
| | - Jin-Wei Qiang
- Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai 201508, China
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The diagnostic potential of diffusion weighted and dynamic contrast enhanced MR imaging in the characterization of complex ovarian lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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20
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MRI features and score for differentiating borderline from malignant epithelial ovarian tumors. Eur J Radiol 2017; 98:136-142. [PMID: 29279152 DOI: 10.1016/j.ejrad.2017.11.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 11/04/2017] [Accepted: 11/19/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE To identify the MRI features of borderline epithelial ovarian tumors (BEOTs) and to differentiate BEOTs from malignant epithelial ovarian tumors (MEOTs). MATERIALS AND METHODS The clinical and MRI data of 89 patients with a BEOT and 109 patients with a MEOT proven by surgery and histopathology were retrospectively reviewed. MRI features, including bilaterality, size, shape, margin, cystic-solid interface, configuration, papillae or nodules, signal intensity, enhancement, presence of an ipsilateral ovary, peritoneal implants and ascites were analyzed and compared. Based on the odds ratio (OR) values, the significant risk features for BEOTs were scored as 3 (OR≈∞), 2 (5≤OR<∞) or 1 (OR<5). RESULTS There were 89 BEOT patients with 113 tumors [mean size of (13±6.7)cm], with bilateral ovary involvement in 24 cases. There were 109 MEOT patients with 142 tumors [(9.3±4.2)cm] with bilateral ovary involvement in 33 cases. There were eight significant risk factors for BEOTs, including round or oval shape (OR=2.714), well-defined margins (OR=3.318), clear cystic-solid interfaces (OR=5.593), purely cystic (OR=15.206), predominantly cystic with papillae or nodules (OR=2.579), exophytic papillae or nodules (OR=5.351), branching papilla (OR≈∞) and the presence of an ipsilateral ovary (OR≈∞). Based on the scoring of the eight risk factors, a cut-off score of 3.5 yielded a differential sensitivity, specificity, and accuracy of 82%, 85% and 84%, respectively. CONCLUSION In contrast to MEOTs, BEOTs frequently had the following features on MRI: round or oval, with well-defined margins and clear cystic-solid interfaces, purely cystic or predominantly cystic with papillae or nodules, branching or exophytic papillae, with the presence of an ipsilateral ovary. MRI can reveal the distinct morphological features of BEOTs and MEOTs and facilitate their discrimination.
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21
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Smereczyński A, Kołaczyk K, Bernatowicz E. Difficulties in differentiating the nature of ascites based on ultrasound imaging. J Ultrason 2017; 17:96-100. [PMID: 28856016 PMCID: PMC5516078 DOI: 10.15557/jou.2017.0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/13/2016] [Accepted: 09/18/2016] [Indexed: 01/26/2023] Open
Abstract
Transabdominal ultrasound not always allows to determine the nature of ascites based solely on its characteristics.
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Affiliation(s)
- Andrzej Smereczyński
- Self-Education Ultrasound Study Group, Department Genetics and Pathomorphology of the Pomeranian Medical University in Szczecin, Poland
| | - Katarzyna Kołaczyk
- Self-Education Ultrasound Study Group, Department Genetics and Pathomorphology of the Pomeranian Medical University in Szczecin, Poland
| | - Elżbieta Bernatowicz
- Self-Education Ultrasound Study Group, Department Genetics and Pathomorphology of the Pomeranian Medical University in Szczecin, Poland
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Multiparametric MRI for differentiation of borderline ovarian tumors from stage I malignant epithelial ovarian tumors using multivariate logistic regression analysis. Eur J Radiol 2017. [PMID: 28629557 DOI: 10.1016/j.ejrad.2017.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the value of contrast-enhanced MRI, apparent diffusion coefficient (ADC) measurement, and CA-125 measurement for differentiating borderline ovarian tumors (BOTs) from stage I malignant epithelial ovarian tumors (MEOTs). MATERIAL AND METHODS This retrospective study included 43 patients with BOTs and 43 patients with stage I MEOTs who underwent contrast-enhanced MRI with DWI and CA-125 analysis. Two radiologists evaluated the MRI findings in consensus. Univariate and multivariate analyses were performed to detect the best predictor variables for MEOTs. RESULTS Mixed cystic/solid and predominantly solid appearances, as well as thickened irregular septa, were more frequent in MEOTs. A papillary architecture and internal branching (PA&IB) pattern was more frequent in BOTs. MEOTs had thicker walls and septa, larger solid components, and higher CA-125 values. The mean ADC value of solid components (ADCmean) and minimum ADC value of whole lesions (ADCmin) were lower in MEOTs. Multivariate analysis revealed that ADCmin and maximum diameter of the solid components were independent indicators of MEOTs with an AUC, sensitivity, and specificity of 0.86, 81%, and 84%, respectively. CONCLUSION ADCmin and maximum diameter of solid components were useful for differentiating BOTs from MEOTs.
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Kafer I, Sun M, Pellerito J. Breaking Borders: A Case Report of Borderline Ovarian Tumor in the Pregnant Patient. Ultrasound Q 2016; 32:380-383. [DOI: 10.1097/ruq.0000000000000211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Park SY, Oh YT, Jung DC. Differentiation between borderline and benign ovarian tumors: combined analysis of MRI with tumor markers for large cystic masses (≥5 cm). Acta Radiol 2016; 57:633-9. [PMID: 26231948 DOI: 10.1177/0284185115597266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is overlap in imaging features between borderline and benign ovarian tumors. PURPOSE To analyze diagnostic performance of magnetic resonance imaging (MRI) combined with tumor markers for differentiating borderline from benign ovarian tumor. MATERIAL AND METHODS Ninety-nine patient with MRI and surgically confirmed ovarian tumors 5 cm or larger (borderline, n = 37; benign, n = 62) were included. On MRI, tumor size, septal number (0; 1-4; 5 or more), and presence of solid portion such as papillary projection or septal thickening 0.5 cm or larger were investigated. Serum tumor markers (carbohydrate antigen 125 [CA 125] and CA 19-9) were recorded. Multivariate analysis was conducted for assessing whether combined MRI with tumor markers could differentiate borderline from benign tumor. The diagnostic performance was also analyzed. RESULTS Incidence of solid portion was 67.6% (25/37) in borderline and 3.2% (2/62) in benign tumors (P < 0.05). In all patients, without combined analysis of MRI with tumor markers, multivariate analysis revealed solid portion (P < 0.001) and CA 125 (P = 0.039) were significant for predicting borderline tumors. When combined analysis of MRI with CA 125 ((i) the presence of solid portion or (ii) CA 125 > 44.1 U/mL with septal number ≥5 for borderline tumor) is incorporated to multivariate analysis, it was only significant (P = 0.001). The sensitivity, specificity, PPV, NPV, and accuracy of combined analysis of MRI with CA 125 were 89.1%, 91.9%, 86.8%, 93.4, and 90.9%, respectively. CONCLUSION Combined analysis of MRI with CA 125 may allow better differentiation between borderline and benign ovarian tumor compared with MRI alone.
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Affiliation(s)
- Sung Yoon Park
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Taik Oh
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Chul Jung
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
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25
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Mimura R, Kato F, Tha KK, Kudo K, Konno Y, Oyama-Manabe N, Kato T, Watari H, Sakuragi N, Shirato H. Comparison between borderline ovarian tumors and carcinomas using semi-automated histogram analysis of diffusion-weighted imaging: focusing on solid components. Jpn J Radiol 2016; 34:229-37. [PMID: 26798066 DOI: 10.1007/s11604-016-0518-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/04/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to evaluate whether histogram analysis of the apparent diffusion coefficient (ADC) of a solid tumor component could distinguish borderline ovarian tumors from ovarian carcinoma. MATERIALS AND METHODS Sixteen pathologically proven borderline tumors and 21 carcinomas were retrospectively examined. Magnetic resonance (1.5-T) image data sets were coregistered, and the solid components of each tumor were semiautomatically segmented. ADC histograms of the solid components were extracted; modes, minimums, means, and 10th, 25th, 50th, 75th, and 90th percentiles of the histograms were compared between the two tumor types, and receiver-operating characteristic (ROC) analysis was performed. RESULTS The mode, minimum, mean, 10th, 25th, 50th, and 75th percentile ADC values of solid components of borderline tumors were significantly larger than those of carcinomas. Among these, the 10th percentile values had the lowest p value (p = 0.0003). At ROC analysis, the area under the curve (AUC) in the 10th percentile was the greatest (0.854), and the best cutoff value in the 10th percentile provided the highest specificity (93.8 %). CONCLUSIONS ADC histograms of solid tumor components facilitated the distinction between borderline ovarian tumors and carcinoma. The 10th percentile ADC values had the best diagnostic performance.
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Affiliation(s)
- Rie Mimura
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Fumi Kato
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo, 060-8648, Japan.
| | - Khin Khin Tha
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Kohsuke Kudo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo, 060-8648, Japan
| | - Yosuke Konno
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N14, W5, Sapporo, 060-8648, Japan
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo, 060-8648, Japan
| | - Tatsuya Kato
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N14, W5, Sapporo, 060-8648, Japan
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N14, W5, Sapporo, 060-8648, Japan
| | - Noriaki Sakuragi
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N14, W5, Sapporo, 060-8648, Japan
| | - Hiroki Shirato
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
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Mansour SM, Saraya S, El-Faissal Y. Semi-quantitative contrast-enhanced MR analysis of indeterminate ovarian tumours: when to say malignancy? Br J Radiol 2015; 88:20150099. [PMID: 26083260 DOI: 10.1259/bjr.20150099] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To evaluate the ability of dynamic post-contrast sequence to specify indeterminate ovarian masses with inconclusive MR features of malignancy. Since management is dramatically different, special focus on the ability to differentiate borderline from invasive malignancy was considered. METHODS 150 ovarian masses were detected by pelvic ultrasound in 124 patients. Masses had been considered for dynamic post-contrast MRI. We expressed the kinetic parameters (i.e. enhancement amplitude, time peak of maximal uptake and maximal slope) in the form of maximum relative enhancement percentage (MRE%), time of maximal peak of contrast uptake (Tmax) and slope enhancement ratio (SER) curves. Histological findings were the gold standard of reference. RESULTS Malignant ovarian masses showed higher MRE% than benign and borderline masses (p < 0.001). Tmax was shorter for malignant than benign (p < 0.01) and borderline (p < 0.001) ovarian masses. SER curves were the most suggestive of malignancy with a specificity and accuracy of 85.7% and 84.7%, respectively. CONCLUSION Dynamic contrast-enhanced MRI could be a specific sequence to differentiate ovarian masses with indeterminate MR morphology with a special discrimination for low potential from invasive ovarian malignancy. ADVANCES IN KNOWLEDGE The study evaluated the diagnostic performance of the individual parameters of dynamic post-contrast MR sequence in evaluating ovarian masses. Management divert between benign, borderline and invasive malignant masses; our work presented a cut-off value for the peak of contrast uptake of 120%, which helped in the differentiation between benign and malignant tumours; the SER curves with Type III (early washout) pattern that was indicative of invasive malignancy was more specific than borderline malignancy.
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Affiliation(s)
- S M Mansour
- 1 Radiology Department (Women's Imaging Unit), Faculty of Medicine, Cairo University, Kasr El Aini Hospital, Cairo, Egypt
| | - S Saraya
- 2 Radiology Department, Faculty of Medicine, Cairo University, Egypt
| | - Y El-Faissal
- 3 Obstetrics and Gynaecology Department, Faculty of Medicine, Cairo University, Egypt
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Jalaguier-Coudray A, Jacquemier J, Villard-Mahjoub R, Delarbre B, Thomassin-Piana J. Pourquoi la macroscopie est-elle essentielle pour comprendre et analyser les tumeurs ovariennes ? IMAGERIE DE LA FEMME 2015. [DOI: 10.1016/j.femme.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Alvarez RM, Vazquez-Vicente D. Fertility sparing treatment in borderline ovarian tumours. Ecancermedicalscience 2015; 9:507. [PMID: 25729420 PMCID: PMC4335965 DOI: 10.3332/ecancer.2015.507] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Indexed: 01/24/2023] Open
Abstract
Borderline ovarian tumours are low malignant potential tumours. They represent 10-15% of all epithelial ovarian malignancies. Patients with this type of tumour are younger at the time of diagnosis than patients with invasive ovarian cancer. Most of them are diagnosed in the early stages and have an excellent prognosis. It has been quite clearly established that the majority of borderline ovarian tumours should be managed with surgery alone. Because a high proportion of women with this malignancy are young and the prognosis is excellent, the preservation of fertility is an important issue in the management of these tumours. In this systemic review of the literature, we have evaluated in-depth oncological safety and reproductive outcomes in women with borderline ovarian tumours treated with fertility-sparing surgery, reviewing the indications, benefits, and disadvantages of each type of conservative surgery, as well as new alternative options to surgery to preserve fertility.
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Affiliation(s)
- Rosa Maria Alvarez
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London EC1A 7BE, UK
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Naqvi J, Nagaraju E, Ahmad S. MRI appearances of pure epithelial papillary serous borderline ovarian tumours. Clin Radiol 2014; 70:424-32. [PMID: 25515794 DOI: 10.1016/j.crad.2014.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 11/01/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
Abstract
Borderline epithelial ovarian tumours (BOT) represent 15-20% of all non-benign ovarian epithelial neoplasms. Compared to malignant ovarian tumours, they usually present at a younger age and carry a far superior prognosis. Fertility-conserving surgery is an important treatment option for patients with BOT. Ultrasound and CT are both widely available and play roles in the initial investigation and staging of BOT, respectively. However, lack of soft-tissue contrast limits their ability to characterize BOT. MRI can facilitate recognition of pure epithelial serous BOT (SBOT), including the cystic papillary and surface papillary subtypes. An abundance of hyperintense papillary projections with low signal internal branching and ovarian stroma preservation with a hypointense ovarian capsular margin on T2-weighted imaging are features strongly suggestive of SBOT. In this review we will discuss the general morphological features of SBOT, the benefits and drawbacks of ultrasound and CT in the initial work-up, and the principal MRI features enabling recognition of surface papillary and cystic papillary SBOT.
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Affiliation(s)
- J Naqvi
- Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Haslingden Road, Blackburn BB2 3HH, UK.
| | - E Nagaraju
- Burnley General Hospital, East Lancashire Hospitals NHS Trust, Casterton Avenue, Burnley BB10 2PQ, UK
| | - S Ahmad
- Burnley General Hospital, East Lancashire Hospitals NHS Trust, Casterton Avenue, Burnley BB10 2PQ, UK
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Magnetic resonance imaging findings of mucinous borderline ovarian tumors: comparison of intestinal and endocervical subtypes. ACTA ACUST UNITED AC 2014; 40:1753-60. [DOI: 10.1007/s00261-014-0325-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Assessment of Combination of Contrast-Enhanced Magnetic Resonance Imaging and Positron Emission Tomography/Computed Tomography for Evaluation of Ovarian Masses. Invest Radiol 2014; 49:524-31. [DOI: 10.1097/rli.0000000000000050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Differentiation of ovarian cancers from borderline ovarian tumors on the basis of evaluation of tumor vascularity in multi-row detector computed tomography--comparison with histopathology. Int J Gynecol Cancer 2014; 23:1597-602. [PMID: 24172096 DOI: 10.1097/igc.0b013e3182a80a41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility of multi-detector row computed tomography (MDCT) in the differentiation between borderline ovarian tumors and ovarian cancer on the basis of tumor morphology and specific features of tumor vascularity in correlation with the results at pathology. METHODS A triphasic MDCT protocol was used for the analysis of tumor vascularity. The following features were taken into account: (1) The number of vessels in papillary projections, solid-tissue component, and septa (2 vs >2), (2) serpentine and chaotic configuration of vessels, (3) presence of microaneurysms, and (4) presence of arteriovenous microfistulas. Masses with at least 3 of 4 features were considered ovarian cancer (group A) and masses with 2 features or less as borderline tumor (group B). Radiological findings were compared with results of postoperative pathology. RESULTS Pathologic vessels were found in all 56 patients. Thirty-two patients were included in group A and 24 in group B. The results of pathology were as follows: in group A: 31 malignant tumors, including 31 ovarian carcinomas and 1 benign cystadenoma; in group B: 22 borderline ovarian tumors, 1 benign cystadenoma, and 1 ovarian cancer. CONCLUSIONS Morphological evaluation of tumor vascularity in MDCT seems to be an efficient method of differentiating between borderline ovarian tumors and ovarian carcinomas. Because of a small number of cases in the current study, a further research seems justified to confirm our results. The presented MDCT-angiographic criteria showed high sensitivity (97%) and specificity (96%) in differentiation of borderline ovarian tumors and ovarian cancers as compared with pathology. The presented CT-angiographic criteria of malignancy showed an excellent interobserver agreement.
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Zhao SH, Qiang JW, Zhang GF, Ma FH, Cai SQ, Li HM, Wang L. Diffusion-weighted MR imaging for differentiating borderline from malignant epithelial tumours of the ovary: pathological correlation. Eur Radiol 2014; 24:2292-9. [PMID: 24871335 DOI: 10.1007/s00330-014-3236-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 03/15/2014] [Accepted: 05/12/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate diffusion-weighted (DW) magnetic resonance (MR) imaging for differentiating borderline from malignant epithelial tumours of the ovary. METHODS This retrospective study included 60 borderline epithelial ovarian tumours (BEOTs) in 48 patients and 65 malignant epithelial ovarian tumours (MEOTs) in 54 patients. DW imaging as well as conventional MR imaging was performed. Signal intensity on DW imaging was assessed and apparent diffusion coefficient (ADC) value was measured. The results were correlated with histopathology and cell density. RESULTS The majority of MEOTs showed high signal intensity on DW imaging, whereas most BEOTs showed low or moderate signal intensity (P = 0.000). The mean ADC value of the solid components in BEOTs (1.562 ± 0.346 × 10(-3) mm(2)/s) was significantly higher than in MEOTs (0.841 ± 0.209 × 10(-3) mm(2)/s). A threshold value of 1.039 × 10(-3) mm(2)/s permitted the distinction with a sensitivity of 97.0%, a specificity of 92.2% and an accuracy of 96.4%. There was an inverse correlation between ADC value and cell density (r = -0.609; P = 0.0000) which was significantly lower in BEOTs than in MEOTs. CONCLUSIONS DW imaging is useful for differentiating borderline from malignant epithelial tumours of the ovary. KEY POINTS DW MR imaging is useful for differentiating BEOTs from MEOTs. Patients with BEOTs are treated differently from patients with MEOTs. Conservative fertility-sparing laparoscopic surgery can be performed in patients with BEOTs. BEOTs often affect young women of childbearing age.
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Affiliation(s)
- Shu Hui Zhao
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, China
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Ma FH, Zhao SH, Qiang JW, Zhang GF, Wang XZ, Wang L. MRI appearances of mucinous borderline ovarian tumors: pathological correlation. J Magn Reson Imaging 2013; 40:745-51. [PMID: 24395397 DOI: 10.1002/jmri.24408] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 08/21/2013] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate the MRI features of mucinous borderline ovarian tumors (MBOT). MATERIALS AND METHODS MRI morphology of 30 MBOT proven MBOT by surgery and pathology was retrospectively studied and correlated with the histopathological findings. On MRI, tumors were classified into three morphological categories: (i) unilocular cyst in five (17%) tumors. (ii) multilocular cyst in 23 (76%) tumors. (iii) solid mass in 2 (7%) tumors. MRI features of tumors were identified including the multilocularity (23/30, 77%), honeycomb loculi (15/30, 50%), signal discrepancy (different signal intensity on T1WI and T2WI) (19/30, 63%), thickened wall or septa (>3 mm) (16/30, 53%). RESULTS Intestinal type and endocervical type of MBOT, two distinctly histologic subtypes, were found in 20 (67%) and 10 (33%) tumors respectively. There were a higher prevalence of multilocularity (P = 0.026), honeycomb loculi (P = 0.025), and signal discrepancy (P = 0.024) in intestinal type than endocervical type of MBOT. CONCLUSION Typical MRI features of MBOT are large multilocular tumors with honeycomb loculi, heterogeneous signal intensity of the loculi, and thickened wall or septa.
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Affiliation(s)
- Feng Hua Ma
- Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Zhao SH, Qiang JW, Zhang GF, Boyko OB, Wang SJ, Cai SQ, Wang L. MRI appearances of ovarian serous borderline tumor: pathological correlation. J Magn Reson Imaging 2013; 40:151-6. [PMID: 24923479 DOI: 10.1002/jmri.24339] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 07/10/2013] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To investigate the spectrum of MRI appearances of ovarian serous borderline tumor (SBT). MATERIALS AND METHODS Following ethics approval, 31 patients with 51 histologically proven ovarian SBTs underwent preoperative MRI. Images were evaluated, by two observers for the location, shape, size, internal architecture, signal intensity, and extent or stage of the tumors. The MRI findings were correlated with pathological findings. RESULTS Twenty of 31 patients (65%) demonstrated bilateral ovarian SBTs on MRI. Three MRI morphological patterns of ovarian SBT were identified: (i) Mainly cystic mass with multiple intracystic papillary projections from the wall and septations was observed in 24 (47%) tumors. (ii) Solid mass with hierarchical branching papillary and fibrous stalk architecture was observed in 8 (16%) tumors. The branching papillary projections were hyperintensity on T2WI, intermediate intense on DWI, and enhanced intensely after the administration of Gd-DTPA. The internal branching fibrous stalks were hypointensity on T2WI and enhanced slightly. (iii) Mixed cystic-solid mass was observed in 19 (37%) tumors. The cystic and solid components had the architecture and signal intensity similar to those of cystic and solid SBTs. Papillary projections were the common architecture of all three types of tumors. CONCLUSION On MRI, the ovarian SBT has some morphological distinguishing features. The solid papillary architecture with internal branching fibrous stalk is a somewhat more characteristic MRI appearance.
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Affiliation(s)
- Shu Hui Zhao
- Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Zhao SH, Qiang JW, Zhang GF, Wang SJ, Qiu HY, Wang L. MRI in differentiating ovarian borderline from benign mucinous cystadenoma: pathological correlation. J Magn Reson Imaging 2013; 39:162-6. [PMID: 24123278 DOI: 10.1002/jmri.24083] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 01/22/2013] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To investigate MRI in differentiating borderline mucinous cystadenoma (MC) from benign MC of the ovary. MATERIALS AND METHODS We studied MR images of 26 benign MCs and 24 borderline MCs of the ovary. The following MRI features of tumors were evaluated and compared between two groups: laterality, shape, size, loculation, signal intensity of the fluid, thickness of the septation and the wall, and vegetations. The results of the MRI were then compared with the pathological findings. RESULTS Honeycomb loculi, high signal intensity on T1WI, and low signal intensity on T2WI of the intracystic content, thickened septation or wall (≥5 mm), and vegetations (≥5 mm) were significantly more common in borderline MC than in benign MC with the sensitivity and specificity of identifying borderline MC of 50.0% and 80.8%, 41.7% and 96.2%, 45.8% and 96.2%, and 62.5% and 96.2%, respectively. The presence of any one of the following features-honeycomb loculi with a low signal intensity on T2WI, thickened septation or wall (≥5 mm), and vegetations (≥5 mm)-yielded the sensitivity, specificity, and accuracy of identifying borderline MC of 91.7%, 92.3%, and 92.0%, respectively. CONCLUSION MRI has the ability to accurately demonstrate the morphological characteristics of ovarian MC and reliably differentiate borderline MC from benign MC.
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Affiliation(s)
- Shu Hui Zhao
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
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NAGRA I, TEO HG. Imaging in ovarian cancer. IMAGING 2013. [DOI: 10.1259/imaging.20100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kim C, Chung HH, Oh SW, Kang KW, Chung JK, Lee DS. Differential Diagnosis of Borderline Ovarian Tumors from Stage I Malignant Ovarian Tumors using FDG PET/CT. Nucl Med Mol Imaging 2013; 47:81-8. [PMID: 24900087 DOI: 10.1007/s13139-013-0197-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/24/2013] [Accepted: 03/05/2013] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Borderline ovarian tumors (BOTs) are more common in young women of reproductive age, and exhibit a better prognosis than malignant ovarian tumors (MOTs). Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) were compared in their ability to differentiate BOTs from stage I MOTs. METHODS Among 173 patients who had preoperative FDG PET/CT due to ovarian neoplasms between November 2006 and March 2009, there were 13 patients with BOTs or stage I MOTs. For differential diagnosis of the two tumors, cancer antigen-125 (CA-125) level, the longest diameter of tumors, metabolic indices including maximum standardized uptake value (SUVmax), and volumetric indices including metabolic tumor volume (MTV) were compared, respectively. RESULTS The BOT group (n = 7) was comprised of five mucinous and two serous tumors, and the MOT group (n = 6) was comprised of three endometrioid, two clear cell and one mucinous tumors. Among the comparisons between two groups, SUVmax of the BOT group was significantly lower than that of the MOT group (2.9 ± 1.5 vs. 6.6 ± 2.9, p = 0.0223); otherwise, no significant difference was found in age, CA-125, diameter, or MTV. By receiver-operating characteristic curve analysis, SUVmax of 3.7 was the best cutoff value to differentiate BOTs from stage I MOTs, with a sensitivity of 83.3 % and specificity of 85.7, and the area under curve of 0.893 (p = 0.0001, 95 % CI: 0.601∼0.993). CONCLUSIONS We demonstrated that SUVmax could distinguish BOTs from stage I MOTs, with a high sensitivity and specificity. Metabolic indices determined by FDG PET/CT were more suitable than volumetric indices for differential diagnosis of the two tumors.
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Affiliation(s)
- Chulhan Kim
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea ; Department of Nuclear Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - So Won Oh
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea ; Department of Nuclear Medicine, Seoul National University Boramae Medical Center, 20 Boramae-Ro-5-Gil, Dongjak-Gu, Seoul, 156-707 Seoul Republic of Korea
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - June-Key Chung
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea ; Department of Molecular Medicine and Biopharmaceutical Sciences, WCU Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
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Zacharakis D, Thomakos N, Biliatis I, Rodolakis A, Simou M, Daskalakis G, Bamias A, Antsaklis A. Ultrasonographic markers and preoperative CA-125 to distinguish between borderline ovarian tumors and stage I ovarian cancer. Acta Obstet Gynecol Scand 2012. [PMID: 23193945 DOI: 10.1111/aogs.12046] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Preoperative evaluation of ovarian masses has become increasingly important for optimal planning of treatment. The aim of this study was to assess the role of preoperative serum cancer antigen 125 (CA-125) levels in correlation with ultrasonographic features in order to distinguish between borderline ovarian tumors (BOTs) and stage I epithelial ovarian carcinoma (EOC). DESIGN Retrospective study. SETTING Tertiary University Hospital. POPULATION We reviewed all women with BOTs and stage I EOC from January 2000 to December 2010. Data from 165 women (66 BOTs and 99 stage I EOC) were analyzed. METHODS Multivariable logistic regression with stepwise selection of variables was used to determine which clinical variables, ultrasound features and CA-125 level were independently associated with invasiveness. MAIN OUTCOME MEASURES Utility of ultrasonographic markers and CA-125 in the preoperative differential diagnosis between BOTs and stage I EOC. RESULTS Women with CA-125 > 100 IU mL(-1) had almost three times greater likelihood of belonging in the EOC group [odds ratio (OR) 3.02; confidence interval (CI) 95%: 1.13-8.12]. Furthermore, the presence of large solid component (≥20% of the tumor comprised of solid components) was associated with 4.25 times greater odds of it to representing ovarian cancer rather than a BOT (OR 4.25; 95% CI: 2.05-8.82). In contrast, the presence of papillary projections was associated with a 73% lower likelihood of EOC (OR 0.27; 95% CI: 0.13-0.58). CONCLUSIONS Preoperative CA-125 > 100 IU mL(-1) combined with the presence of a large solid component and the absence of papillary projections seems to improve the discriminative ability in favor of stage I EOC.
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Affiliation(s)
- Dimitrios Zacharakis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece.
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Is MRI a useful tool to distinguish between serous and mucinous borderline ovarian tumours? Clin Radiol 2012; 68:e1-8. [PMID: 23044365 DOI: 10.1016/j.crad.2012.08.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 08/07/2012] [Accepted: 08/20/2012] [Indexed: 01/09/2023]
Abstract
AIM To analyse the morphological magnetic resonance imaging (MRI) features of borderline ovarian tumours (BOT) and to evaluate whether MRI can be used to distinguish serous from mucinous subtypes. MATERIALS AND METHODS A retrospective study of 72 patients who underwent BOT resection was undertaken. MRI images were reviewed blindly by two radiologists to assess MRI features: size, tumour type, grouped and irregular thickened septa, number of septa, loculi of different signal intensity, vegetations, solid portion, signal intensity of vegetations, normal ovarian parenchyma, and pelvic ascites. Statistical analysis was performed using Mann-Whitney and Fisher's exact tests. Logistic regression analysis was used to assess the predictive value of the MRI findings for histological subtypes. RESULTS At histology, there were 33 serous BOT (SBOT) and 39 mucinous BOT (MBOT). Predictive MRI criteria for SBOT were bilaterality, predominantly solid tumour, and the presence of vegetations, especially exophytic or with a high T2 signal (p < 0.01), whereas predictive MRI criteria for MBOT were multilocularity, number of septa, loculi of different signal intensity, and grouped and irregular thickened septa (p < 0.01). Using multivariate analysis, vegetations were independently associated with SBOT [odds ratio (OR) = 29.5] and multilocularity with MBOT (OR = 3.9). CONCLUSION Vegetations and multilocularity are two independent MRI features that can help to distinguish between SBOT and MBOT.
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Fischerova D, Zikan M, Dundr P, Cibula D. Diagnosis, treatment, and follow-up of borderline ovarian tumors. Oncologist 2012; 17:1515-33. [PMID: 23024155 PMCID: PMC3528384 DOI: 10.1634/theoncologist.2012-0139] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 08/26/2012] [Indexed: 12/22/2022] Open
Abstract
Borderline ovarian tumors represent a heterogeneous group of noninvasive tumors of uncertain malignant potential with characteristic histology. They occur in younger women, are present at an early stage, and have a favorable prognosis, but symptomatic recurrence and death may be found as long as 20 years after therapy in some patients. The molecular changes in borderline ovarian tumors indicate linkage of this disease to type I ovarian tumors (low-grade ovarian carcinomas). The pathological stage of disease and subclassification of extraovarian disease into invasive and noninvasive implants, together with the presence of postoperative macroscopic residual disease, appear to be the major predictor of recurrence and survival. However, it should be emphasized that the most important negative prognostic factor for recurrence is just the use of conservative surgery, but without any impact on patient survival because most recurrent diseases are of the borderline type-easily curable and with an excellent prognosis. Borderline tumors are difficult masses to correctly preoperatively diagnose using imaging methods because their macroscopic features may overlap with invasive and benign ovarian tumors. Over the past several decades, surgical therapy has shifted from a radical approach to more conservative treatment; however, oncologic safety must always be balanced. Follow-up is essential using routine ultrasound imaging, with special attention paid to the remaining ovary in conservatively treated patients. Current literature on this topic leads to a number of controversies that will be discussed thoroughly in this article, with the aim to provide recommendations for the clinical management of these patients.
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Affiliation(s)
- Daniela Fischerova
- Gynecological Oncology Center, Department of Obstetrics and Gynecology, Apolinaska 18, 120 00 Prague, Czech Republic.
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Allah MH, Salama ZA, El-Hindawy A, Al Kady N. Role of peritoneal ultrasonography and ultrasound-guided fine needle aspiration cytology/biopsy of extravisceral masses in the diagnosis of ascites of undetermined origin. Arab J Gastroenterol 2012; 13:116-24. [PMID: 23122452 DOI: 10.1016/j.ajg.2012.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 07/03/2012] [Accepted: 08/05/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Ascites may be of undetermined origin despite comprehensive study. This study aimed to assess the accuracy and safety of conventional and interventional high-frequency peritoneal ultrasound in the diagnosis of patients with ascites of unclear origin. PATIENTS AND METHODS A total of 62 patients were prospectively enrolled; they underwent conventional (3.5-5MHz) and high-frequency (6-8MHz) transabdominal peritoneal ultrasound to suggest the nature of ascites supplemented by fine needle aspiration cytology (FNAC) of ascites and/or core biopsy of the omentum or other extra-visceral masses for final histopathologic diagnosis. Laparoscopy or laparotomy was needed if biopsy was inconclusive. RESULTS Ultrasound-guided procedures were diagnostic in 55 (87.7%) patients. Thirty-six (58.1%) were benign, of whom 86% had tuberculous peritonitis, 26 (41.9%) were malignant, of whom 76.9% had peritoneal metastasis. High-frequency ultrasound was able to propose ultrasonographic criteria in a trial to diagnose the nature of ascites. Our proposed ultrasonographic criteria were based on the amount and texture of ascites in addition to the omental and mesenteric features. These were able to suggest the diagnosis with 80.7% sensitivity for malignant ascites and 75% specificity for benign ascites. Moreover, histopathological examination of tissues obtained by ultrasound-guided procedures increased the sensitivity to 88.5% and the specificity to 88.9% in diagnosing malignant and benign disease, respectively, with an overall diagnostic accuracy of 88.6%. These procedures were considered to be safe as only one major (haemoperitoneum) and two minor complications (temporary ascitic fistula) were reported. CONCLUSION High-frequency peritoneal ultrasound together with the minimally invasive ultrasound-guided FNAC/biopsy of extra-visceral lesions may be considered an effective and safe tool in the diagnosis of ascites of undetermined origin.
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Affiliation(s)
- Maha Hasab Allah
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Bazot M, Cortez A, Daraï É, Froment-Leonetti V, Nassar-Slaba J, Haouy D, Morel A, Dechoux-Vodovar S, Thomassin-Naggara I. Imagerie des tumeurs ovariennes épithéliales frontières. IMAGERIE DE LA FEMME 2012. [DOI: 10.1016/j.femme.2012.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Morotti M, Menada MV, Gillott DJ, Venturini PL, Ferrero S. The preoperative diagnosis of borderline ovarian tumors: a review of current literature. Arch Gynecol Obstet 2011; 285:1103-12. [DOI: 10.1007/s00404-011-2194-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 12/19/2011] [Indexed: 12/14/2022]
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Lalwani N, Prasad SR, Vikram R, Shanbhogue AK, Huettner PC, Fasih N. Histologic, molecular, and cytogenetic features of ovarian cancers: implications for diagnosis and treatment. Radiographics 2011; 31:625-46. [PMID: 21571648 DOI: 10.1148/rg.313105066] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ovarian epithelial carcinoma (OEC), the most common ovarian malignancy, is a heterogeneous disease with several histologic subtypes that show characteristic cytogenetic features, molecular signatures, oncologic signaling pathways, and clinical-biologic behavior. Recent advances in histopathology and cytogenetics have provided insights into pathophysiologic features and natural history of OECs. Several studies have shown that high- or low-grade serous, endometrioid, and clear cell carcinomas are characterized by mutations involving the TP53, K-ras/BRAF, CTNNB1, and PIK3CA genes, respectively. High-grade serous carcinomas, the most common subtype, often manifest with early transcoelomic spread of disease beyond the ovaries, whereas low-grade serous and mucinous carcinomas commonly manifest with early-stage disease, with a resultant excellent prognosis. On the basis of pathogenetic mechanisms, recent findings suggest a dualistic model of ovarian carcinogenesis consisting of types I and II. Type I (low-grade serous, mucinous, and endometrioid) cancers commonly arise from well-described, genetically stable precursor lesions (usually borderline tumors); manifest as large adnexal masses with early-stage disease; and have a relatively indolent clinical course, with an overall good prognosis. In contrast, type II carcinomas (high-grade serous, endometrioid, mixed, and undifferentiated variants) originate de novo from the adnexal epithelia, often demonstrate chromosomal instability, and have aggressive biologic behavior. Better knowledge of hereditary ovarian cancer syndromes and associated cytogenetic abnormalities has led to increased interest in novel biomarkers and molecular therapeutics. Genetic changes, pathologic features, imaging findings, and natural histories of a variety of histologic subtypes of OEC are discussed in this article.
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Affiliation(s)
- Neeraj Lalwani
- Department of Radiology, University of Texas Health Science Center, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA
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Shin JE, Choi HJ, Kim MH, Cho KS. The serum CA-125 concentration data assists in evaluating CT imaging information when used to differentiate borderline ovarian tumor from malignant epithelial ovarian tumors. Korean J Radiol 2011; 12:456-62. [PMID: 21852906 PMCID: PMC3150673 DOI: 10.3348/kjr.2011.12.4.456] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 03/09/2011] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We wanted to evaluate the diagnostic value of serum CA-125 concentration, when used in combination with the preoperative contrast-enhanced CT results, to differentiate borderline ovarian tumors (BOTs) from stage I malignant epithelial ovarian tumors (MEOTs). MATERIALS AND METHODS Ninety-eight masses (46 BOTs and 52 stage I MEOTs) from 87 consecutive patients (49 with BOTs and 38 with stage I MEOTs) who had undergone preoperative contrast-enhanced computed tomography (CT) and surgical staging were evaluated retrospectively and independently by two radiologists. The preoperative serum CA-125 concentration was measured in all patients. The utility of analyzing serum CA-125 concentration in combination with the CT results was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS An irregular tumor surface and lymphadenopathy were predictive of a MEOT. ROC analysis showed that the combination of CT data and the serum CA-125 level resulted in a higher diagnostic performance than did using the CT alone for differentiating BOTs from MEOTs. The areas under the curves (AUCs) without and with the use of the serum CA-125 level data were 0.67 (95% confidence interval [CI]: 0.57-0.77) and 0.78 (95% CI: 0.68-0.85), respectively, for reader 1 (p = 0.029) and 0.71 (95% CI: 0.61-0.80) and 0.81 (95% CI: 0.72-0.89), respectively, for reader 2 (p = 0.009). CONCLUSION The serum CA-125 concentration is of additional diagnostic value when used in conjunction with the CT imaging results for differentiating BOTs from MEOTs.
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Affiliation(s)
- Ji-Eun Shin
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, Korea
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Lee EJ, Kim SH, Kim YH, Lee HJ. Is CA-125 an additional help to radiologic findings for differentiation borderline ovarian tumor from stage I carcinoma? Acta Radiol 2011; 52:458-62. [PMID: 21498310 DOI: 10.1258/ar.2011.100318] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Borderline ovarian tumors (BOTs) are difficult to differentiate from stage I carcinoma using radiological findings. Little is known about the correlation between CA-125 levels and radiological findings for predicting BOTs or carcinoma. PURPOSE To assess the role of CA-125, in addition to that of radiological findings, in differentiating BOTs from stage I carcinoma. MATERIAL AND METHODS The study received institutional review board approval, with waiver of informed consent. We evaluated 100 patients (two groups: BOT, 58 patients; stage I carcinoma, 42 patients) using radiological findings, including location and size of each tumor, number and size of septations, papillary projections and vegetations, peritoneal implants, ascites, and preoperative CA-125 levels. The differences in CA-125 levels according to bilateral location, solid components, and thickness of septations between the two groups were evaluated using the McNemar test. Correlations of CA-125 level to size and number of septations were evaluated by the independent sample t test. RESULTS No statistical correlation was found between CA-125 level and location, size, and number of septations between the two groups. Solid components within the tumors were similar in the two groups, but the CA-125 level was significantly higher in stage I carcinoma than in BOTs. The number of septations per tumor was similar in the two groups; thick septations were more frequent in stage I carcinoma than in BOTs, and a significantly higher titer of CA-125 was found in stage I carcinoma. Discriminant analysis of solid components and thickness of septations resulted in accurate diagnosis of 70.6% of the tumors (80.6% of BOTs and 69.7% of stage I carcinomas). CONCLUSION CA-125 levels for solid components and thickness of septations are lower in BOTs. These may be helpful in predicting the risk of carcinoma, even if BOTs cannot be conclusively differentiated from stage I carcinoma.
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Affiliation(s)
- Eun Joo Lee
- Department of Radiology, Keimyung University Dongsan Hospital, College of Medicine, Daegu, Korea
| | - See Hyung Kim
- Department of Radiology, Keimyung University Dongsan Hospital, College of Medicine, Daegu, Korea
| | - Young Hwan Kim
- Department of Radiology, Keimyung University Dongsan Hospital, College of Medicine, Daegu, Korea
| | - Hee Jung Lee
- Department of Radiology, Keimyung University Dongsan Hospital, College of Medicine, Daegu, Korea
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Tanaka YO, Okada S, Satoh T, Matsumoto K, Oki A, Nishida M, Yoshikawa H, Saida T, Minami M. Ovarian serous surface papillary borderline tumors form sea anemone-like masses. J Magn Reson Imaging 2011; 33:633-40. [PMID: 21287653 DOI: 10.1002/jmri.22430] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 10/20/2010] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To clarify the imaging characteristics of ovarian serous surface papillary borderline tumor (SSPBT), whose prognosis is far better than that of serous surface papillary adenocarcinoma (SSPC). MATERIALS AND METHODS We retrospectively reviewed the clinical and imaging findings of six cases (age range, 26-58 years; mean, 43 years) with SSPBT encountered at our institute from 1996 to 2008. RESULTS Serum levels of CA125 were elevated, and they were clinically suspected to have ovarian cancer. All masses were almost entirely solid and showed hyperintense papillary architecture with hypointense internal branching on T2-weighted MRI. Five patients had peritoneal implants, and two had lymph node enlargement, and all tumors were accompanied by ascites. In all cases, contralateral ovaries had cystic masses with mural nodules or mixed solid and cystic masses, of which the solid part was similar to the contralateral mass. No evidence of recurrence was noted at a follow-up of >12 months postoperatively. CONCLUSION SSPBT, which has more favorable prognosis than those of flank ovarian carcinoma, is characterized by a solid mass with papillary architecture and internal branching resembling a sea anemone on MR.
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Affiliation(s)
- Yumiko Oishi Tanaka
- Department of Radiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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Abstract
OBJECTIVE Borderline ovarian tumors comprise a unique group of noninvasive ovarian neoplasms with characteristic histology and variable tumor biology that typically manifest as low-stage disease in younger women with resultant excellent prognosis. CONCLUSION Borderline tumors are considered to be precursors of low-grade ovarian cancers. Accurate diagnosis and staging facilitate optimal patient management particularly in patients desiring to preserve fertility.
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