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Abstract
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Imaging
is used to detect and characterize adnexal masses and to stage ovarian
cancer both before and after initial treatment, although the role for
imaging in screening for ovarian cancer has not been established. CT and
MRI have been used to determine the resectability of tumors, the
candidacy of patients for effective cytoreductive surgery, the need for
postoperative chemotherapy if debulking is suboptimal, and the need for
referral to a gynecologic oncologist. Radiographic studies such as
contrast enema and urography have been replaced by CT and other
cross-sectional imaging for staging ovarian cancer. Contrast-enhanced CT
is the procedure of choice for preoperative staging of ovarian cancer.
MRI without and with contrast may be useful after equivocal CT, but is
usually not the best initial procedure for ovarian cancer staging.
Fluorine-18-2-fluoro-2-deoxy-D-glucose–PET/CT may not be needed
preoperatively, but its use is appropriate for detecting and defining
post-treatment recurrence. Ultrasound is useful for evaluating adnexal
disease, but has limited utility for staging ovarian cancer.
The
ACR Appropriateness Criteria are evidence-based guidelines for specific
clinical conditions that are reviewed every 2 years by a
multidisciplinary expert panel. The guideline development and review
include an extensive analysis of current medical literature from
peer-reviewed journals and the application of a well-established
consensus methodology (modified Delphi) to rate the appropriateness of
imaging and treatment procedures by the panel. In those instances where
evidence is lacking or not definitive, expert opinion may be used to
recommend imaging or treatment.
Figures and tables from this article: (requires paid subscription)
Figures and tables from this article: (requires paid subscription)
- Rating scale: 1, 2, 3 = usually not appropriate; 4, 5, 6 = may be appropriate; 7, 8, 9 = usually appropriate.
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