Preoperative staging of ovarian cancer: comparison between ultrasound, CT and whole‐body diffusion‐weighted MRI (ISAAC study)

• Published in: Ultrasound in obstetrics & gynecology 2022-02, Vol.59 (2), p.248-262
• Main Authors: Fischerova, D., Pinto, P., Burgetova, A., Masek, M., Slama, J., Kocian, R., Frühauf, F., Zikan, M., Dusek, L., Dundr, P., Cibula, D.
• Format: Article
• Language: English
• Subjects: Abdomen; abdominal cavity; Accuracy; Adult; Cancer; Carcinoma, Ovarian Epithelial - diagnostic imaging; Carcinoma, Ovarian Epithelial - pathology; Computed tomography; Diffusion Magnetic Resonance Imaging - statistics & numerical data; Evaluation; Female; Gastric cancer; Gynecology; Humans; Laparoscopy; laparotomy; Lymph; lymph node; Lymph Nodes - pathology; Magnetic resonance imaging; Magnetic Resonance Imaging - statistics & numerical data; Markers; Metastases; Middle Aged; Neoplasm Invasiveness; Nodes; Obstetrics; Ovarian cancer; ovarian neoplasm; Ovarian Neoplasms - diagnostic imaging; Ovarian Neoplasms - pathology; Patients; Pelvis; Peritoneal Neoplasms - diagnostic imaging; Peritoneal Neoplasms - pathology; Peritoneum; Predictions; Prospective Studies; Surgery; Ultrasonic imaging; ultrasonography; Ultrasound; Whole Body Imaging - statistics & numerical data
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.23654

Objectives To compare the performance of transvaginal and transabdominal ultrasound with that of the first‐line staging method (contrast‐enhanced computed tomography (CT)) and a novel technique, whole‐body magnetic resonance imaging with diffusion‐weighted sequence (WB‐DWI/MRI), in the assessment of peritoneal involvement (carcinomatosis), lymph‐node staging and prediction of non‐resectability in patients with suspected ovarian cancer. Methods Between March 2016 and October 2017, all consecutive patients with suspicion of ovarian cancer and surgery planned at a gynecological oncology center underwent preoperative staging and prediction of non‐resectability with ultrasound, CT and WB‐DWI/MRI. The evaluation followed a single, predefined protocol, assessing peritoneal spread at 19 sites and lymph‐node metastasis at eight sites. The prediction of non‐resectability was based on abdominal markers. Findings were compared to the reference standard (surgical findings and outcome and histopathological evaluation). Results Sixty‐seven patients with confirmed ovarian cancer were analyzed. Among them, 51 (76%) had advanced‐stage and 16 (24%) had early‐stage ovarian cancer. Diagnostic laparoscopy only was performed in 16% (11/67) of the cases and laparotomy in 84% (56/67), with no residual disease at the end of surgery in 68% (38/56), residual disease ≤ 1 cm in 16% (9/56) and residual disease > 1 cm in 16% (9/56). Ultrasound and WB‐DWI/MRI performed better than did CT in the assessment of overall peritoneal carcinomatosis (area under the receiver‐operating‐characteristics curve (AUC), 0.87, 0.86 and 0.77, respectively). Ultrasound was not inferior to CT (P = 0.002). For assessment of retroperitoneal lymph‐node staging (AUC, 0.72–0.76) and prediction of non‐resectability in the abdomen (AUC, 0.74–0.80), all three methods performed similarly. In general, ultrasound had higher or identical specificity to WB‐DWI/MRI and CT at each of the 19 peritoneal sites evaluated, but lower or equal sensitivity in the abdomen. Compared with WB‐DWI/MRI and CT, transvaginal ultrasound had higher accuracy (94% vs 91% and 85%, respectively) and sensitivity (94% vs 91% and 89%, respectively) in the detection of carcinomatosis in the pelvis. Better accuracy and sensitivity of ultrasound (93% and 100%) than WB‐DWI/MRI (83% and 75%) and CT (84% and 88%) in the evaluation of deep rectosigmoid wall infiltration, in particular, supports the potential role of ultrasound in planning rectosigmoid re