Evaluation Of Ovarian Tumors Research Articles

Evaluation of Ovarian Tumours using International Ovarian Tumour Analysis (IOTA) Simple Ultrasound Rules and its Correlation with Histopathological Examination

Evaluation of Ovarian Tumours using International Ovarian Tumour Analysis (IOTA) Simple Ultrasound Rules and its Correlation with Histopathological Examination

Role of dynamic contrast enhanced magnetic resonance imaging and diffusion weighted imaging in evaluation of ovarian tumors

Background: Ovarian cancer has been a leading malignancy endangering women’s health with high rate of worldwide prevalence. For the best possible outcome from treatment, the ovarian tumor must be accurately staged and characterized before surgery. To better characterize female pelvic masses, imaging techniques have developed significantly. Objective: To assess the value of adding dynamic contrast enhanced (DCE) and diffusion weighted images (DWI) to the conventional magnetic resonance imaging (MRI) in the evaluation of ovarian cancer. Patients and Methods: From January 2019 to March 2020, 50 patients with ovarian cancers participated in this prospective trial at Ain Shams university hospital. Results: DWI MRI revealed diffusion restriction in 37 instances (78.7%) and facilitated diffusion in 10 cases (21.3%). the ADC value range (0.5 to 3.2) with a mean of 1.1 0.5. 16 instances (34%) out of the 47 cases displayed type 1 curves, 15 cases (31.9%) displayed type 2 curves, and 16 cases (34%) displayed type 3 curves. On histological diagnosis, type 1 curve cases all presented benign instances. There were statistically significant differences between the three diagnostic techniques and the pathological diagnosis. However, compared to conventional based diagnosis, diffusion-based diagnosis and perfusion-based diagnostic had greater AUC, sensitivity, specificity, and accuracy. Both perfusion- and diffusion-based diagnoses use the same values on the ROC curve. Conclusion: The diagnostic accuracy of conventional MRI has significantly increased with the addition of DWI and DCE-MR sequences.

Diagnostic Accuracy Value of Intraoperative Frozen Section for Ovarian Neoplasms

PurposeAccuracy of intraoperative frozen section diagnosis is extremely important in the evaluation of ovarian tumors so that suitable surgical procedures can be chosen. Therefore, the current study was aimed at measuring the diagnostic accuracy of the intraoperative frozen section to determine the surgical course of tumors.MethodsThis retrospective diagnostic accuracy study was conducted in the Department of Obstetrics and Gynecology, Emam Hossein Hospital. The case records of patients with ovarian mass who underwent surgery and intraoperatively frozen section assessments between September 2006 and December 2014 were analyzed. Demographic and clinical data, operative details, frozen section, and final histopathology examination were reviewed from the medical records.ResultsOne hundred and ninety-three patients with ovarian masses undergoing surgery and frozen section were included. The frozen section diagnoses were benign in 155 (80.31%), borderline in 10 (5.18%), and malignant in 28 (14.51%), whereas the final diagnosis was benign in 154 (79.80%), borderline in 9 (4.66%), and malignant in 30 (15.54%). The overall accuracy of intraoperative frozen section diagnosis was 98.9%. The sensitivity for frozen section diagnosis was 100% for benign, 89% for borderline, and 93.3% for malignant category, whereas the specificity was 97%, 99%, and 100%, respectively. There were three cases with discordance between the frozen section diagnoses and the final diagnoses, all of which were under-diagnosed by frozen section.ConclusionFrozen section was found to be accurate and useful in the intraoperative assessment of patients with ovarian neoplasm. The results may help to determine the type and extent of surgery.

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.

BackgroundThe 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/MethodsIn 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.ResultsMedian 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.ConclusionsAge, 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.

Role of Diffusion-Weighted Magnetic Resonance Imaging in the Evaluation of Ovarian Tumours

Characterization of adnexal masses calls for multidisciplinary involvement. Though a definitive pathological diagnosis mandates surgical intervention, a pre-interventional near-accurate characterization helps in treatment planning. Imaging is a mainstay in this regard. This study aimed at analysing ADC values of ovarian lesions observed on a DW–MRI, with an intent to arrive at a probable demarcating value differentiating benign and malignant tumours. The significance of contrast enhancement pattern of lesions was also analysed. All patients with histopathologically proven ovarian tumour (benign and malignant) who had pelvic MRI with DW sequence with b value of 0 and 1000 were included. Total patients were 62. Mean age was 44 ± 16.8 years. 33.88% were malignant. DWI and ADC values were plotted in 48 of the 62. Diffusion restriction was seen in 81.25% of malignant and 56.25% of benign lesions. The sensitivity and specificity of DWI in differentiating malignancies were 81.25% and 43.75%, respectively. The probable cut-off value of ADC differentiating a malignant and a benign lesion was found to be ≥ 1.13 × 10−3 mm2/s, statistically, using the receiver operating characteristics. 35.48% had early contrast enhancement, and 64.51% delayed enhancement. DWI has an optimal sensitivity of 81.25% and a low specificity of 43.75% in differentiating malignant from benign lesions. In our study, we found an ADC cut-off of ≥ 1.13 × 10−3 mm2/s, to differentiate between malignant and benign tumours with a sensitivity of 84.4% and specificity of 87.5%. In differentiating between benign and malignant lesions, early enhancement on dynamic contrast study had a good sensitivity.

Intra-Operative Frozen Sections for Ovarian Tumors – A Tertiary Center Experience

Background:Accuracy of diagnosis with intra-operative frozen sections is extremely important in the evaluation of ovarian tumors so that appropriate surgical procedures can be selected.Study design:All patients who with intra-operative frozen sections for ovarian masses in a tertiary center over nine years from June 2008 until April 2017 were reviewed. Frozen section diagnosis and final histopathological reports were compared.Main outcome measures:Sensitivity, specificity, positive and negative predictive values of intra-operative frozen section as compared to final histopathological results for ovarian tumors.Results:A total of 92 cases were recruited for final evaluation. The frozen section diagnoses were comparable with the final histopathological reports in 83.7% of cases. The sensitivity, specificity, positive predictive value and negative predictive value for benign and malignant ovarian tumors were 95.6%, 85.1%, 86.0% and 95.2% and 69.2%, 100%, 100% and 89.2% respectively. For borderline ovarian tumors, the sensitivity and specificity were 76.2% and 88.7%, respectively; the positive predictive value was 66.7% and the negative predictive value was 92.7%.Conclusion:The accuracy of intra-operative frozen section diagnoses for ovarian tumors is high and this approach remains a reliable option in assessing ovarian masses intra-operatively.

Evaluation of Ovarian Tumors by Ultrasound Findings

Evaluation of Ovarian Tumors by Ultrasound Findings

OVA1 improves the sensitivity of the ACOG referral guidelines for an ovarian mass

Objective: The American Congress of Obstetrics and Gynecology (ACOG) has published referral guidelines for women with a pelvic mass. The guidelines use CA-125 and are reported to be less effective in early-stage disease and premenopausal women. OVA1 is a multivariate index assay approved for the preoperative evaluation of ovarian tumors. Our objective was to evaluate the performance of the ACOG guidelines using OVA1 in place of CA-125.

Dual use of a single Wilms' tumor 1 immunohistochemistry in evaluation of ovarian tumors: a preliminary study of 20 cases

Our previous studies revealed that a single Wilms' tumor 1 (WT-1) immunohistochemistry can be used to elucidate both the myoepithelial cells and blood vessels of human breast tumors. As the human ovary is rich in blood vessels, and WT-1 has been used as a biomarker for ovarian tumors, our current study attempted to assess if a single WT-1 immunohistochemistry has dual usages in evaluation of ovarian tumor and endothelial cells. Paraffin-embedded tissue sections were prepared from 20 cases of ovarian tumors. A set of four consecutive sections from each case were subjected to immunohistochemistry with a mouse monoclonal antibody against the human WT-1 protein, a well defined ovarian tumor marker, CA-125, and a endothelial cell phenotypic marker, CD34, respectively. From each case, 4-5 randomly selected fields were photographed, and expression of these molecules in the same structures were compared. Distinct WT-1 immunoreactivities were seen in both ovarian tumor and endothelial cells. Over 90% of WT-1 positive tumor and endothelial cells were positive for CA-125 and CD34, respectively. Similarly, over 90% of CA-125 or CD34 positive cells co-express WT-1 in tumor or endothelial cells, respectively. Our findings suggest that a single WT-1 immunohistochemistry can be used to assess both the tumor cells and micro-vascular density in ovarian tumors. Our findings also suggest that as WT-1 is expressed in both tumor and endothelial cells, the development of therapeutic agents to target WT-1 may provide an effective treatment option for ovarian cancer.

PP35 Dual use of single WT-1 immunohistochemistry in evaluation of ovarian tumors: a preliminary study of 20 cases

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Evaluation of Ovarian Tumors by Proton Magnetic Resonance Spectroscopy at Three Tesla

The purpose of this study was to determine the feasibility of acquiring in vivo proton magnetic resonance spectroscopy of ovarian lesions at a magnetic field strength of 3 Tesla (T). The goal was to provide potentially diagnostic biochemical information that may aid in the characterization of ovarian neoplasms detected during clinical magnetic resonance imaging scanning. Fourteen patients referred to 2 gynecologic oncologic surgeons were examined in a whole-body 3.0 T clinical scanner using an 8-element phased-array surface coil. Single voxel spectroscopy (SVS) was undertaken after identification of lesions on T1-weighted and T2-weighted imaging. SVS was performed using the point resolved spectroscopy (PRESS) localization technique using a echo time (TE) of 135 milliseconds and repetition time (TR) of 2000 milliseconds and with 192 signal averages. Resonance integrals for the prominent signals from choline-containing compounds and creatine (Cr) were studied and presence of other prominent spectroscopic signals reported. Each SVS acquisition was performed in less than 8 minutes. Magnetic resonance spectral findings were correlated with the detailed pathology reports obtained after resection of each tumor. Pathology revealed 7 patients with malignant surface epithelial-stromal tumors, 3 patients with germ cell tumors, 3 patients with benign serous cystadenomas, and 1 patient with a non-neoplastic endometrioma. Spectroscopic data were acquired from 16 voxels in 14 patients. Resonances attributable to choline-containing compounds and Cr were recorded in all malignant tumors and some of the benign tumors. When detected, a choline/Cr integral ratio of greater than 3 was found to indicate that a tumor was malignant in nature, whereas a choline/Cr integral ratio less than 1.5 was found to indicate that a tumor was benign in nature. There was 1 exception, a 13-cm serous cystadenofibroma, where the choline/Cr integral ratio was 3.13. Several other prominent metabolites were recorded including lactate, lipid, and an as yet unassigned resonance (possibly N-acetylaspartate or sialic acid) at 2.07 ppm. Spectroscopy of ovarian masses can be recorded at 3.0 T with acceptable spectral quality and good signal-to-noise ratio. There are stringent technical considerations to be considered in obtaining good spectral quality. Further experience with a larger and more biologically variable range of tumors needs to be undertaken to determine the final clinical utility of this technique, but initial results from this small cohort are promising.

Ultrasound assessment of ovarian tumors--comparison between transvaginal 3D technique and conventional 2-dimensional vaginal ultrasonography

Three-dimensional (3D) ultrasound is capable of visualising all three orthogonal planes simultaneously. With the stored volumetric data, imaging planes can be reconstructed that are not visible when using standard vaginosonographic procedures. In patients with ovarian tumours, diagnosis and the appropriate therapeutic approach depend to a crucial degree upon the results of sonographic investigations, which therefore need very exact diagnostic data. Two-dimensional (2D) vaginosonography can only yield sagittal and frontal sections of the lesser pelvis; 3D volume scanning, however, visualises all three perpendicular planes simultaneously on a monitor screen. In cystic tumours of the ovary, conspicuous parietal structures can be specifically localised and rendered three-dimensionally in the surface mode. Such imaging capabilities create new perspectives in assessing ovarian tumours. Within the framework of a prospective study at the Gynecological Clinic of the University of Mainz, we compared the sonographic findings obtained for 45 patients with ovarian tumours using 2D and 3D vaginosonography. After the transvaginal application of conventional 2D vaginosonography, the tumours were examined by means of 3D sonography. The use of 3D volume scanning was advantageous because we could image specifically targeted planes and reconstruct image planes that cannot be shown using standard vaginosonography. In addition, the volumetric technique allows 3D surface reconstruction of conspicuous parietal structures from a wide variety of different perspectives. These advantages allow one to better assess the grading of tumours especially of those that are cystic. Problems associated with the application of this transvaginal 3D technique module orientation within a given volume, the overlapping of sonographic planes, increase the time required for surface calculations and increased data storage capacity. Transvaginal 3D sonography represents a new technique of imaging. Owing to its ability to register all three imaging planes simultaneously as well as to visualise surfaces three-dimensionally, this technique opens up new sonomorphologic possibilities in the evaluation of ovarian tumours.

Immunohistochemistry as a diagnostic aid in the evaluation of ovarian tumors

Aspects of immunohistochemistry (IHC), which are useful in the diagnosis of ovarian tumors (mostly neoplasms but also a few tumor-like lesions), are discussed. The topic is first approached by considering the different growth patterns and cell types that may be encountered. Then a few other specific situations in which IHC may assist are reviewed. Selected findings largely, or only, of academic interest are also mentioned. One of the most common situations in which IHC may aid is in the evaluation of tumors with follicles or other patterns which bring a sex cord-stromal tumor into the differential. The distinction between a sex cord tumor and an endometrioid carcinoma with sex-cord-like patterns may be greatly aided by the triad of epithelial membrane antigen (EMA), inhibin, and calretinin, the latter two being typically positive and EMA negative in sex cord tumors, the converse being typical of endometrioid carcinoma. It should be emphasized that granulosa cell tumors may be inhibin negative and, albeit less specific, calretinin is more reliable in evaluating this particular issue. Lack of staining for inhibin and calretinin may also be supportive in leading to consideration of diverse other neoplasms that may form follicles, including metastatic tumors as varied as carcinoid and melanoma. The well-known staining of the latter neoplasm for S-100 protein and HMB-45 may be very helpful in evaluating melanomas with follicular or other unusual patterns, a challenging aspect of ovarian tumor interpretation. The most common monodermal teratoma, struma ovarii, usually has an overt follicular pattern and is easily recognized, but recognition of unusual appearances ranging from oxyphilic to clear cell to various patterns of malignant struma may be greatly aided by a thyroglobulin or TTF 1 stain. IHC for neuroendocrine markers may assist in the diagnosis of primary and metastatic carcinoid tumor. The broad differential diagnosis of glandular neoplasms with an endometrioid-pseudoendometrioid morphology, or mucinous cell type, has been the subject of much exploration in recent years, particularly the distinction between primary and metastatic neoplasms. The well-known CK7 positive, CK20 negative phenotype of primary endometrioid carcinoma, and the converse profile in most metastatic large intestinal adenocarcinomas with a pseudoendometrioid morphology, has been much publicized but albeit an appropriate supportive adjunct in many cases, exceptions from the typical staining pattern may be encountered. It is even less helpful in the case of primary versus metastatic mucinous neoplasia. Evaluation of the expression of mucin gene products has shown mixed, essentially unreliable, results. Experience with other new markers, such as CDX-2, villin, beta catenin, and P504S (racemase), is limited but is in aggregate promising with regard to providing some aid in this area. The rare differential of metastatic cervical adenocarcinoma versus primary ovarian mucinous or endometrioid carcinoma may be aided by strong p16 staining of the former. Staining for alpha-fetoprotein may aid in confirming the diagnosis of endometrioid-like (and hepatoid) variants of yolk sac tumor. Ependymoma of the ovary may also have an endometrioid-like glandular pattern, but positive stains for glial fibrillary acidic protein contrast with the negative results in others neoplasms with a similar pattern. Immunostains may be very helpful in the evaluation of oxyphilic tumors and tumor-like lesions and in some unusual forms of clear cell neoplasia, such as clear cell struma, both subjects being reviewed herein. Immunostains may highlight both the presence and extent of epithelial cells in a variety of circumstances, including microinvasive foci in cases of serous borderline tumors and mucinous carcinomas, and in determining the extent of carcinoma cells and reactive cells within mural nodules of mucinous neoplasms. As in tumor pathology in general, various markers may be crucial in the diagnosis of small round cell tumors of the ovary, and familiar markers of epithelial, lymphoid, leukemic, and melanocytic neoplasms may assist in the analysis of high grade tumors with a poorly differentiated carcinoma, lymphoma-granulocytic sarcoma, malignant melanoma differential. The evaluation of ovarian cystic lesions may be aided by thyroglobulin or TTF 1 (cystic struma), glial fibrillary acid protein (ependymal cysts), and inhibin-calretinin (follicle cysts and unilocular granulosa cell tumors). Stains for trophoblast markers may occasionally aid in the evaluation of germ cell tumors, although routine stains should usually suffice; they may be of academic interest in confirming trophoblastic differentiation in some high grade surface epithelial carcinomas.

Three-dimensional ultrasound and three-dimensional power Doppler in the assessment of adnexal masses

ABSTRACTThree-dimensional ultrasound is a new, emerging technology that provides additional information for the evaluation of ovarian tumors. Multiplanar and volume-rendering display methods combined with the ability to rotate volume data into standard orientations are essential components of the current and future success of three-dimensional ultrasound.Increasing knowledge about three-dimensional ultrasound, as well as improved handling allow application of this method to the field of gynecological oncology. The recent development of real-time three-dimensional ultrasound imaging will further advance the clinical applications, particularly in the assessment of pelvic tumors. The introduction of the three-dimensional power Doppler systems may improve the information available on ovarian tumor vascularity and speed up the entire patient management process.

What is the ideal evaluation of ovarian tumours?

What is the ideal evaluation of ovarian tumours?

Localization of blood vessels and qualitative assessment of blood flow in ovarian tumors

To study the localization of blood vessels within a tumor and the shape of the flow curve as a method of assessing ovarian neoplasms. We studied 39 patients with malignant tumors and 63 patients with benign ovarian tumors by means of vaginal color Doppler ultrasound, noting the localization of blood vessels in the tumors, the shape of the flow curve, and peripheral resistance. Blood vessels could be visualized in 95% of the malignant tumors and in 70% of the benign tumors. Blood vessels tended to be localized centrally (65 versus 5%) in malignant tumors and peripherally in benign tumors (65 versus 0%). A diastolic notch was seen in 89% of the benign tumors, but in none of the malignant tumors. The mean resistance index (RI) +/- standard deviation was 0.48 +/- 0.19 in malignant and 0.69 +/- 0.09 in benign tumors (P < .05). The corresponding values for the pulsatility index (PI) were 0.56 +/- 0.13 and 1.06 +/- 0.07, respectively (P < .01). Low RI and PI values are general indicators of tumor growth. The localization of blood vessels within an ovarian tumor and the presence or absence of a diastolic notch are the most useful variables in the evaluation of ovarian tumors.

Endometrial Cyst, Dermoid Cyst and Mucinous Cystadenoma Sonographically Evidenced in the Same Ovary

We treated a patient with an ovarian tumor histologically consisting of an endometrial cyst, dermoid cyst and mucinous cystadenoma, in the same ovary. A comparative study between ultrasonic and histological findings was done. The usefulness, drawbacks and limitations in the ultrasonic evaluation of ovarian tumors are discussed.

MRI of the female pelvis: a review.

MRI of the female pelvis offers a unique display of pelvic anatomy. On the T2-weighted images, uterine zonal anatomy and temporal changes under hormonal stimuli are well displayed. Benign and malignant uterine neoplasms are accurately demonstrated. However, tumor type cannot be diagnosed. In the staging of endometrial and cervical carcinoma, MRI offers distinct advantages over sonography and/or CT. The main advantages are the abilities to depict tumor and to provide great tissue contrast between the tumor and surrounding normal tissue. In the evaluation of ovarian tumors, experience with MRI is still limited. This is only the beginning of the clinical applications of MRI. Much more work needs to be done to explore fully the value of this versatile and powerful technique.