Abstract
Whole-body computed tomography (WBCT) serves as the first-line imaging modality for breast cancer follow-up. To investigate the imaging characteristics and diagnostic accuracy of WBCT for incidental ovarian tumors in patients with prior breast cancer, we retrospectively reviewed a consecutive cohort of 13,845 patients with breast cancer, of whom 149 had pathologically-proven ovarian lesions. We excluded patients with ovarian diagnosis before breast cancer, CT scan not including ovary, CT-pathology interval >30 days, and severe CT artifact. Among our 60 breast cancer patients (median age, 46 years) with pathologically proven ovarian lesions, 49 patients had benign diseases, seven had primary ovarian cancer and four had ovarian metastasis from breast cancer. The histologic types of breast cancer with ovarian metastases included invasive ductal carcinoma, lobular carcinoma and angiosarcoma. Cystic ovarian lesions identified on WBCT during the breast cancer follow-up are more likely to be benign, while solid-cystic lesions are likely to be primary ovarian cancers, and solid lesions may indicate ovarian metastasis. The diagnostic accuracy, sensitivity, specificity, and areas under the receiver operating characteristic curve of WBCT were 98.3%, 100.0%, 98.0%, and 0.99 (malignant vs. benign); 90.0%, 100.0%, 85.7%, and 0.93 (metastasis vs. primary ovarian cancer), respectively. The only false positive solid lesion was a Sertoli–Leydig tumor. In conclusion, WBCT may help diagnose incidental ovarian tumors in patients with prior breast cancers and guide disease management.
Highlights
Breast cancer is the most common malignancy in women [1]
Before obtaining the cancer tissue, the selection of neoadjuvant chemotherapy depends on this decision: alternative endocrine agents can be considered for the treatment of ovarian metastasis, whereas bevacizumab may be selected for primary ovarian cancer [2]
Prophylactic oophorectomy was offered for BRCA mutation carriers (n = 2) and noncarriers (n = 2), with all the pathology results yielded to be functional cysts
Summary
Breast cancer is the most common malignancy in women [1]. Breast cancer can metastasize to bone, lungs, liver and brain, and, less frequently to the ovaries, either at diagnosis or recurrence [2]. Patients with prior breast cancer are more likely to develop primary ovarian cancer [2,4,5]. Before obtaining the cancer tissue, the selection of neoadjuvant chemotherapy depends on this decision: alternative endocrine agents can be considered for the treatment of ovarian metastasis, whereas bevacizumab may be selected for primary ovarian cancer [2]. Making this decision is clinically challenging, because of overlapping of the patient demographics, especially when patients with prior breast cancer have an increased risk for developing primary ovarian cancer [6]. Whether any subgroup of breast cancer patients carrying ovarian tumor-like lesions might obviate oophorectomy has yet to be answered because of the increasing prevalence of pre-menopausal or peri-menopausal breast cancer patients [7]
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