STRATEGY OF IMAGING FOR EVALUATION OF EARLY OVARIAN CANCER
Rasha Ahmed Abd Elmoaty;
Abstract
Theetiology ofovariancancerisstillpoorly understood; however, someriskfactorsaredescribed,and family history isconsideredthestrongestriskfactor. Epithelial tumorsrepresentapproximately 90% ofprimary ovarian cancers, while the germcell tumor is the most frequentovarianmalignanciesinthe youngfemales.
Ovarian cancer is currently the most common leading causeof death among the gynecologic malignancies.Itsprevalencein the population,andthefact that diagnosisat an earlier stage leads to markedly improvedsurvival, makesitanidealcandidatefora screeningprogram.
Trials have incorporatedmultimodal screening protocolswhichutilizetransvaginal ultrasound and measurementofserum CA125levels.Eithertobeuse concurrently,oroneofthem asfirstline,andtheotheras secondline.Serum CA125asthefirstlineandtransvaginal ultrasoundasthe secondaryline achievedahigh specificity andpositive predictive valueandcanpositively impactthe survival.
Currently,screeningfor ovariancancerisnot recommendedfor thegeneralpopulation. Untilthere isa valid screeningtest, the symptom index may serve an
importantrole indetectingcancers;andaftera testis identified,theindexmay beusefulasatoolincombination withothermethodstocontributetoearly detection.A symptomindexwasconsideredpositiveifany ofthese6 symptoms pelvic/abdominalpain,increased abdominal size/bloating,anddifficultyeating/feelingfulloccurred
>12timesper monthbutwerepresentfor<1year.
Trans-vaginalultrasoundisa primarymodality for adnexalmassdetectionandcharacterization. The current combined technique,which includes assessmentof morphologicfeatures andDopplercharacteristics, givesthe mostaccuratepredictionofmalignancy.Many scoring systems areused to standardize diagnosis of ovarian cancer.Thescoringsystem thatdidbestistheriskof malignantindex(RMI).RMIcalculatedusingtheproduct oftheserumCA125level,theultrasoundscanresultand the menopausalstatus.
AlthoughcontrastenhancedUSmay bea promising modality indetectovariancancer,atpresent,US morphologicassessmentstill isthemostimportantand common modalityin detecting ovarian cancer. Central colorDopplerflow withinsolidcomponentsofanovarian masshasbeenshowntobeanaccuratepredictor of malignancy.PulsedDopplerultrasonography isnotan independent indicatorfor malignancy. It isproved that
3DPDwasnotabetterdiagnostictestforovariancancer than2DPD.
MR imaging is preferable to combined gray-scale and Doppler US or to CT for the diagnosis of ovarian cancer before treatment planning. Gadolinium-enhanced MRimagingservesasaproblem-solvingmodality incases ofindeterminateadnexal masses.A combinationofT1- weighted images and T1-weighted images with fat saturationhelpsto differentiatemost commonbenign adnexalmassesfrom malignantones.
Ovarian cancer is currently the most common leading causeof death among the gynecologic malignancies.Itsprevalencein the population,andthefact that diagnosisat an earlier stage leads to markedly improvedsurvival, makesitanidealcandidatefora screeningprogram.
Trials have incorporatedmultimodal screening protocolswhichutilizetransvaginal ultrasound and measurementofserum CA125levels.Eithertobeuse concurrently,oroneofthem asfirstline,andtheotheras secondline.Serum CA125asthefirstlineandtransvaginal ultrasoundasthe secondaryline achievedahigh specificity andpositive predictive valueandcanpositively impactthe survival.
Currently,screeningfor ovariancancerisnot recommendedfor thegeneralpopulation. Untilthere isa valid screeningtest, the symptom index may serve an
importantrole indetectingcancers;andaftera testis identified,theindexmay beusefulasatoolincombination withothermethodstocontributetoearly detection.A symptomindexwasconsideredpositiveifany ofthese6 symptoms pelvic/abdominalpain,increased abdominal size/bloating,anddifficultyeating/feelingfulloccurred
>12timesper monthbutwerepresentfor<1year.
Trans-vaginalultrasoundisa primarymodality for adnexalmassdetectionandcharacterization. The current combined technique,which includes assessmentof morphologicfeatures andDopplercharacteristics, givesthe mostaccuratepredictionofmalignancy.Many scoring systems areused to standardize diagnosis of ovarian cancer.Thescoringsystem thatdidbestistheriskof malignantindex(RMI).RMIcalculatedusingtheproduct oftheserumCA125level,theultrasoundscanresultand the menopausalstatus.
AlthoughcontrastenhancedUSmay bea promising modality indetectovariancancer,atpresent,US morphologicassessmentstill isthemostimportantand common modalityin detecting ovarian cancer. Central colorDopplerflow withinsolidcomponentsofanovarian masshasbeenshowntobeanaccuratepredictor of malignancy.PulsedDopplerultrasonography isnotan independent indicatorfor malignancy. It isproved that
3DPDwasnotabetterdiagnostictestforovariancancer than2DPD.
MR imaging is preferable to combined gray-scale and Doppler US or to CT for the diagnosis of ovarian cancer before treatment planning. Gadolinium-enhanced MRimagingservesasaproblem-solvingmodality incases ofindeterminateadnexal masses.A combinationofT1- weighted images and T1-weighted images with fat saturationhelpsto differentiatemost commonbenign adnexalmassesfrom malignantones.
Other data
| Title | STRATEGY OF IMAGING FOR EVALUATION OF EARLY OVARIAN CANCER | Other Titles | استراتيجية التصويرلتقييم سرطان المبيض المبكر | Authors | Rasha Ahmed Abd Elmoaty | Issue Date | 2016 |
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