The rational preoperative diagnosis of ovarian tumors – imaging techniques and tumor biomarkers (review)


Authors: D. Fischerová 1;  M. Zikán 1;  I. Pinkavová 1;  S. Sláma 1;  F. Frühauf 1;  P. Freitag 1;  P. Dundr 2;  A. Burgetová 3;  D. Cibula 1
Authors‘ workplace: Onkogynekologické centrum, Gynekologicko-porodnická klinika Všeobecné fakultní nemocnice a 1. lékařské fakulty Univerzity Karlovy, Praha, přednosta prof. MUDr. A. Martan, DrSc. 1;  Ústav patologie Všeobecné fakultní nemocnice a 1. lékařské fakulty Univerzity Karlovy, Praha, prof. MUDr. C. Povýšil, DrSc. 2;  Radiodiagnostická klinika Všeobecné fakultní nemocnice a 1. lékařské fakulty Univerzity Karlovy, Praha, přednosta prof. MUDr. J. Daneš, CSc. 3
Published in: Čes. Gynek.2012, 77, č. 4 s. 272-287

Overview

The majority of patients who suffer from an early-stage or advanced-stage of ovarian cancer complain about symptoms, mainly gastrointestinal ones. The pelvic examination in ovarian cancer detection is limited by the adnexal position in the pelvis and frequent extraovarian spread of disease. Recently, any reliable tumor biomarker (CA 125 and/or HE4), which can be used in diffential diagnosis between benign and malignant ovarian tumors, does not exist. According the results of the largest multicenter International Ovarian Trial Analysis (IOTA), ultrasound if performed by an experienced sonologist is an ideal diagnostic method in diferential diagnosis between benign and malignant ovarian tumors. The experienced examiner is also able to detect extraovarian tumor spread and to assess tumor operability. Magnetic resonance imaging (MRI) is used only to complement ultrasound in cases when high tissue resolution is needed. Computed tomography (CT) is a useful method for detection of extraovarian spread, especially in cases when an ultrasound examiner experienced in abdominal scanning is not available. Similarly, fusion of positron emission tomography with CT (PET/CT) is a highly accurate method for the detection of abdominal and extraabdominal tumor spread, but its use is limited by cost and the low availability of this method. On the other hand, PET/CT is not recommended for primary ovarian cancer detection because of its lower sensitivity in comparison to ultrasound and its high false positive rates as well.

Key words:
ovarian cancer, ultrasound, RMI, CT, PET, IOTA, RMI, pelvic examination, symptom, CA 125.


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