abstract: Preoperative Identification of a Suspicious Adnexal Mass: A Systematic Review and Meta-analysis. PET/MRI/U/S

 Blogger's Note: this abstract provides little comprehensive information (as per most abstracts)  noting that the journal of Gynecologic Oncology is a subscriber-based journal ($$$); 'nail in the coffin'  for ovarian cancer/pre-surgical assessment ??
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abstract: Preoperative Identification of a Suspicious Adnexal Mass: A Systematic Review and Meta-analysis [Gynecol Oncol. 2012] - PubMed - NCBI

Abstract

OBJECTIVE:

To systematically review the existing literature in order to determine the optimal strategy for preoperative identification of the adnexal mass suspicious for ovarian cancer.

METHODS:

A review of all systematic reviews and guidelines published between 1999 and 2009 was conducted as a first step. After the identification of a 2004 AHRQ systematic review on the topic, searches of MEDLINE for studies published since 2004 was also conducted to update and supplement the evidentiary base. A bivariate, random-effects meta-regression model was used to produce summary estimates of sensitivity and specificity and to plot summary ROC curves with 95% confidence regions.

RESULTS:

Four meta-analyses and 53 primary studies were included in this review. The diagnostic performance of each technology was compared and contrasted based on the summary data on sensitivity and specificity obtained from the meta-analysis. Results suggest that 3D ultrasonography has both a higher sensitivity and specificity when compared to 2D ultrasound. Established morphological scoring systems also performed with respectable sensitivity and specificity, each with equivalent diagnostic competence. Explicit scoring systems did not perform as well as other diagnostic testing methods. Assessment of an adnexal mass by colour Doppler technology was neither as sensitive nor as specific as simple ultrasonography. Of the three imaging modalities considered, MRI appeared to perform the best, although results were not statistically different from CT. PET did not perform as well as either MRI or CT. The measurement of the CA-125 tumour marker appears to be less reliable than do other available assessment methods.

CONCLUSION:

The best available evidence was collected and included in this rigorous systematic review and meta-analysis. The abundant evidentiary base provided the context and direction for the diagnosis of early-staged ovarian cancer.

abstract: Adnexal masses in women with breast cancer

Adnexal masses in women with breast cancer:

Background

Adnexal masses detected in breast cancer survivors are of particular concern because of the increased risk of ovarian malignancy.

Aims

This study was performed to analyse adnexal masses among women with breast cancer with regard to variables predictive of malignancy.

Methods

The study included women with breast cancer who had undergone surgery for an adnexal mass between 2002 and 2010 at Hacettepe University Hospital. A total of 45 consecutive women with a mean age of 47.3 years (range 25–76) were analysed retrospectively.

Results

Of 45 cases reviewed, benign ovarian pathology was found in 35 cases (77.8%) and malignant ovarian neoplasms were found in 10 cases (22.2%). A simple ovarian cyst was observed in 25 cases (71.4%) as the most common type of benign pathology. Of the 10 cases with malignancy, 5 (50%) had primary ovarian carcinoma, while the remaining five women had breast carcinoma metastases to the ovary. Complex mass at ultrasonography, increased CA 125 level and oestrogen receptor–negative tumour were found to be the significant predictors of ovarian malignancy.

Conclusions

Although an adnexal mass in a woman with breast cancer is most commonly a benign ovarian cyst, the overall risk of ovarian malignancy is increased with breast cancer. An adnexal mass with complex architecture detected by ultrasonography and high CA 125 level were the strongest risk factors associated with increased risk of malignancy.

Vignette-Based Study of Ovarian Cancer Screening: Do U.S. Physicians Report Adhering to Evidence-Based Recommendations?

Abstract

"Background: No professional society or group recommends routine ovarian cancer screening, yet physicians' enthusiasm for several cancer screening tests before benefit has been proven suggests that some women may be exposed to potential harms.

Objective: To provide nationally representative estimates of physicians' reported nonadherence to recommendations against ovarian cancer screening.

Design: Cross-sectional survey of physicians offering women's primary care. The 12-page questionnaire contained a woman's annual examination vignette and questions about offers or orders for transvaginal ultrasonography (TVU) and cancer antigen 125 (CA-125).........."

open access: Integrated optical coherence tomography, ultrasound and photoacoustic imaging for ovarian tissue characterizationIntegrated optical coherence tomography, ultrasound and photoacoustic imaging for ovarian tissue characterization

"....Detection before the malignancy spreads or at the early stage would greatly improve the survival and benefit patient health. In this report, we present an integrated optical coherence tomography (OCT), ultrasound (US) and photoacoustic imaging (PAI) prototype endoscopy system for ovarian tissue characterization."

"Combining OCT, US and PAI would further provide complementary tissue optical absorption, scattering information, and deep tissue structures. Previously, Yang et al. developed a photoacoustic endoscopy [24]; Yin et al. reported an integrated intravascular OCT and ultrasound imaging probe [25,26]; Wang et al. demonstrated an ultrasound guided spectroscopic intravascular photoacoustic imaging system [27]; Li et al. [28] and Jiao et al. [29] both introduced the integrated OCT and photoacoustic microscopy. For the above referenced studies, either one or two imaging modalities were investigated, although some were not suitable for endoscopy applications. This study, to the best of our knowledge, reports the first prototype system that integrates OCT, US and PAI modalities for endoscopy applications. The performance of the system in ovarian tissue characterization has been demonstrated using ex vivo porcine and human ovaries."

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Summary

"We have developed the first integrated OCT, US and PAI endoscopy imaging system prototype and explored its application in ovarian tissue characterization. The absorption information provided by PAI, the high-resolution subsurface morphological image provided by OCT and the deeper tissue structures imaged by US demonstrate the great synergy of the combined endoscopy over each modality alone. The initial results have shown that the hybrid device has a potential in ovarian cancer detection and characterization."

Women's Health - Full Text - Imaging in gynecologic surgery (Release date: 16 March 2011; Expiration date: 16 March 2012)

"Primary peritoneal" high-grade serous carcinoma is very likely metastatic from serous tubal intraepithelial carcinoma: Assessing the new paradigm of ovarian and pelvic serous carcinogenesis and its implications for screening for ovarian cancer.

CONCLUSIONS: At least half the cases of primary peritoneal high-grade serous carcinoma are associated with intraepithelial carcinoma of the fallopian tube, usually involving the fimbriae. These findings support the view that, like "primary ovarian carcinoma," what has been traditionally classified as "primary peritoneal carcinoma" is probably derived from occult high-grade serous carcinoma in the fallopian tube. These findings have important implications for ultrasound screening trials for ovarian cancer which are based on the assumption that an enlarged ovary is a very early manifestation of disease.

Risk of malignancy in sonographically confirmed septated cystic ovarian tumors

CONCLUSIONS: Septated cystic ovarian tumors without solid areas or papillary projections have a low risk of malignancy and can be followed sonographically without surgery

Contrast-enhanced ultrasound in the detection and characterization of liver tumors

"Contrast-enhanced ultrasound (CEUS) has unique advantages over contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) in the characterization of hepatic tumors."

Ultrasound and Assessment of Ovarian Cancer Risk