Maximal-effort upfront or interval debulking surgery is the recommended approach for advanced-stage ovarian cancer. The role of diagnostic imaging is to provide a systematic and structured report on tumour dissemination with emphasis on key sites for resectability. Imaging methods, such as pelvic and abdominal ultrasound, contrast-enhanced computed tomography, whole-body diffusion-weighted magnetic resonance imaging and positron emission tomography, yield high diagnostic performance for diagnosing bulky disease, but they are less accurate for depicting small-volume carcinomatosis, which may lead to unnecessary explorative laparotomies. Diagnostic laparoscopy, on the other hand, may directly visualize intraperitoneal involvement but has limitations in detecting tumours beyond the gastrosplenic ligament, in the lesser sac, mesenteric root or in the retroperitoneum. Laparoscopy has its place in combination with imaging in cases where ima-ging results regarding resectability are unclear. Different imaging models predicting tumour resectability have been developed as an adjunctional objective tool. Incorporating results from tumour quantitative analyses (e.g., radiomics), preoperative biopsies and biomarkers into predictive models may allow for more precise selection of patients eligible for extensive surgery. This review will discuss the ability of imaging and laparoscopy to predict non-resectable disease in patients with advanced ovarian cancer.

1st Faculty of Medicine Charles University and General University Hospital Prague 121 08 Prague Czech Republic

Department of Gynecology Portuguese Institute of Oncology Francisco Gentil 1099 023 Lisbon Portugal

Department of Obstetrics and Gynaecology Burton and Derby Hospitals NHS Trust Derby DE13 0RB UK

Department of Radiology 1st Faculty of Medicine Charles University and General University Hospital Prague 121 08 Prague Czech Republic

Gynecologic Oncology Center Department of Obstetrics and Gynecology 1st Faculty of Medicine Charles University and General University Hospital Prague 121 08 Prague Czech Republic

Mohn Medical Imaging and Visualization Centre Department of Radiology Haukeland University Hospital 5009 Bergen Norway

Section of Radiology Department of Clinical Medicine University of Bergen 5021 Bergen Norway

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