Most cited article - PubMed ID 24846098
Imaging techniques for the evaluation of ovarian cancer
OBJECTIVES: To analyze the safety, adequacy and accuracy of ultrasound-guided tru-cut biopsy in the diagnosis of ovarian cancer. METHODS: A systematic search of PubMed, Web of Science, and Scopus was conducted through June 2024. Studies meeting predefined criteria were included in the review. The quality of diagnostic accuracy studies was assessed using QUADAS-2. A meta-analysis was performed on studies reporting complete 2 × 2 diagnostic data. RESULTS: A total of 2,250 articles were initially screened, and after the removal of duplicates, 54 articles were deemed eligible for full-text assessment. Ultimately, 18 studies, comprising 1,867 patients who underwent ultrasound-guided tru-cut biopsy, were included in the systematic review. A total of 16 complications were reported across 1,898 biopsies performed in the included studies, resulting in a mean complication rate of 0.58% (95% CI: 0.187- 0.964%). Adequacy for histological and immunohistochemical examination after one attempt was reported in 16 studies, with a mean adequacy rate of 95.1% (95% CI: 92.69- 97.50%) and a median rate of 95.97%. Diagnostic accuracy was assessed in 13 studies, revealing a mean diagnostic accuracy of 95.54% (95% CI: 93.19- 97.89%) and a median of 97.48%.In the meta-analysis of 10 studies, pooled sensitivity was 98.6%, specificity 41.9%, positive predictive value (PPV) 99.0%, and negative predictive value (NPV) 47.2%, with high heterogeneity observed in specificity and NPV estimates. CONCLUSIONS: Ultrasound guided tru-cut biopsy is a safe and effective diagnostic method, demonstrating a high adequacy rate for histological and immunohistochemical analysis. It shows excellent performance in confirming malignancy and supports preoperative decision making. To further define its role in the diagnostic pathway for ovarian cancer, additional prospective multicenter studies are needed-both to validate its reliability in negative cases and to ensure tissue adequacy for advanced molecular testing in the context of personalized medicine.
- Keywords
- Core needle biopsy, Ovarian cancer, Systematic review, Tru-cut biopsy, Ultrasound,
- MeSH
- Humans MeSH
- Ovarian Neoplasms * diagnosis pathology diagnostic imaging MeSH
- Ultrasonography methods MeSH
- Image-Guided Biopsy * methods adverse effects MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Review MeSH
- Systematic Review MeSH
In recent years the role of diagnostic imaging by pelvic ultrasound in the diagnosis and staging of gynecological cancers has been growing exponentially. Evidence from recent prospective multicenter studies has demonstrated high accuracy for pre-operative locoregional ultrasound staging in gynecological cancers. Therefore, in many leading gynecologic oncology units, ultrasound is implemented next to pelvic MRI as the first-line imaging modality for gynecological cancer. The work herein is a consensus statement on the role of pre-operative imaging by ultrasound and other imaging modalities in gynecological cancer, following European Society guidelines.
- Keywords
- cervical cancer, cross-sectional studies, ovarian cancer, uterine cancer, vulvar and vaginal cancer,
- MeSH
- Gynecology * MeSH
- Consensus MeSH
- Humans MeSH
- Genital Neoplasms, Female * diagnostic imaging MeSH
- Pelvis MeSH
- Ultrasonography MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
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.
