Early detection of ovarian cancer with conventional and contrast-enhanced transvaginal sonography: recent advances and potential improvements

Abstract

Recently, there have been several major technical advances in the sonographic diagnosis of ovarian cancer in its early stages. These include improved assessment of tumor morphology with transvaginal sonography (TVS), and detection and characterization of tumor neovascularity with transvaginal color Doppler sonography (TV-CDS) and contrast-enhanced transvaginal sonography (CE-TVS). This paper will discuss and illustrate these improvements and describe how they enhance detection of early-stage ovarian cancer. Our initial experience with parametric mapping of CE-TVS will also be mentioned.

Figure 1

Morphologic signs of malignancy with histopathologic correlation on TVS in various histologic types of stage 1A ovarian cancer.

Figure 2

2D CDS of showing flow within papillary excrescence within a papillary cystadenofibroma.

Figure 3

3D TV-CDS of papillary excrescences within a papillary serous cystadenoma.

Figure 4

3D TV-CDS of papillary cystadenocarcinoma showing multiplanar reconstruction (MPR) images.

Figure 5

CE-TVS of a benign fibroma.

Figure 6

CE-TVS of serous cystadenoma with mural nodules.

Figure 7

CE-TVS of borderline mucinous (intestinal) cystadenocarcinoma.

Figure 8

CE-TVS of stage I papillary serous cystadenocarcinoma.

Figure 9

Box graph of contrast-enhanced parameters. While there is no difference in time of peak (T wash-in), there are significant differences in peak enhancement, wash-out time and vascularity ((b), (c); (d)) from [1].

Figure 10

Sensitivities and specificities of maximum enhancement, wash-in, wash-out and area under curve (AUC). Maximum enhancement, wash-out and AUC had greatest accuracy.

Figure 11

Receiver operator characteristerics for (a) wash-in, (b) maximum enhancement, (c) wash-out, and (d) area under curve.

Figure 12

Receiver operator characteristic of various parameters showing cutoff points for vascular index (VI), flow index (FI), and vascular flow index (VFI) (from [2]).

Figure 13

Relative accuracy (sensitivity and specificity of enhancement kinetic parameters) of various techniques using predetermined cutoff points of: 2D VFI (>0.4), 3D VFI (>0.5), CE-TVS (max >17.2 dB), CE-TVS ((1/2)T _wo > 41 sec), CE-TVS (AUC > 787 s⁻¹).