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. 2020 Nov 13;2(6):e190086.
doi: 10.1148/rycan.2020190086. eCollection 2020 Nov.

Radiologic-Histopathologic Correlation of Transvaginal US and Risk-reducing Salpingo-oophorectomy for Women at High Risk for Tubo-ovarian Carcinoma

Michelle D Sakala  1 , Nicole E Curci  1 , William R Masch  1 , Mishal Mendiratta-Lala  1 , Erica B Stein  1 , Ashish P Wasnik  1 , Andrew P Sciallis  1 , Shitanshu Uppal  1 , Mark D Pearlman  1 , Katherine E Maturen  1
Affiliations

Radiologic-Histopathologic Correlation of Transvaginal US and Risk-reducing Salpingo-oophorectomy for Women at High Risk for Tubo-ovarian Carcinoma

Michelle D Sakala et al. Radiol Imaging Cancer. .

Abstract

Purpose: To examine radiologic-histopathologic correlation and the diagnostic performance of transvaginal US prior to risk-reducing salpingo-oophorectomy (RRSO) in women at high risk for tubo-ovarian carcinoma (TOC).

Materials and methods: This retrospective study included 147 women (mean age, 49 years; age range, 28-75 years) at high risk for TOC who underwent transvaginal US within 6 months of planned RRSO between May 1, 2007, and March 14, 2018. Histopathologic results were reviewed. Fellowship-trained abdominal radiologists reinterpreted transvaginal US findings by using standardized descriptors. Descriptive statistical analysis and multiple logistic regression were performed.

Results: Of the 147 women, 136 had mutations in BRCA1, BRCA2, Lynch syndrome, BRIP1, and RAD51D genes, and 11 had a family history of TOC. Histopathologic reports showed 130 (88.4%) benign nonneoplastic results, 10 (6.8%) benign neoplasms, five (3.4%) malignant neoplasms, and two (1.4%) isolated p53 signature lesions. Transvaginal US results showed benign findings in 95 (64.6%) women and abnormal findings in 11 (7.5%) women; one or both ovaries were not visualized in 41 (27.9%) women. Hydrosalpinx was absent in all TOC and p53 signature lesions at transvaginal US. Transvaginal US had 20% sensitivity (one of five), 93% specificity (132 of 142), 9% positive predictive value (one of 11), and 97% negative predictive value (132 of 136) for TOC. Cancer was detected in one of five women at transvaginal US, and three of five false-negative lesions were microscopic or very small.

Conclusion: Preoperative transvaginal US had low sensitivity for detecting TOC in women at high risk for TOC. Clinically relevant precursors and early cancers were too small to be detected.Keywords: Genital/Reproductive, UltrasoundSupplemental material is available for this article.© RSNA, 2020.

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Conflict of interest statement

Disclosures of Conflicts of Interest: M.D.S. disclosed no relevant relationships. N.E.C. disclosed no relevant relationships. W.R.M. disclosed no relevant relationships. M.M.L. disclosed no relevant relationships. E.B.S. disclosed no relevant relationships. A.P.W. disclosed no relevant relationships. A.P.S. disclosed no relevant relationships. S.U. disclosed no relevant relationships. M.D.P. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: payment from Davies McFarland & Carroll for expert testimony in a trial. Other relationships: disclosed no relevant relationships. K.E.M. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: paid royalties from Elsevier and Wolters Kluwer for educational publishing. Other relationships: disclosed no relevant relationships.

Figures

Concordant radiologic-histopathologic correlation of high-grade serous carcinoma (HGSC) (stage IIIC) in a 36-year-old woman who had BRCA1 mutation with bilateral 9- and 8-cm vascular solid adnexal masses and ascites at preoperative transvaginal US. (a) Sagittal (SAG) transvaginal US image of the right (RT) adnexa (ADN) shows a hypoechoic circumscribed solid mass. (b) Coronal (COR) transvaginal color Doppler US image of the left (LT) adnexa (ADN) shows a contralateral solid mass with marked vascularity. (c) Photomicrograph of benign left fallopian tube (black arrow) compressed by an expansile ovarian mass comprising HGSC (white arrow). (Hematoxylin-eosin stain; original magnification, ×20.) (d) Photomicrograph of benign left fallopian tube (black arrow) adjacent to HGSC of the ovary (white arrow). (Hematoxylin-eosin stain; original magnification, ×40.)
Figure 1a:
Concordant radiologic-histopathologic correlation of high-grade serous carcinoma (HGSC) (stage IIIC) in a 36-year-old woman who had BRCA1 mutation with bilateral 9- and 8-cm vascular solid adnexal masses and ascites at preoperative transvaginal US. (a) Sagittal (SAG) transvaginal US image of the right (RT) adnexa (ADN) shows a hypoechoic circumscribed solid mass. (b) Coronal (COR) transvaginal color Doppler US image of the left (LT) adnexa (ADN) shows a contralateral solid mass with marked vascularity. (c) Photomicrograph of benign left fallopian tube (black arrow) compressed by an expansile ovarian mass comprising HGSC (white arrow). (Hematoxylin-eosin stain; original magnification, ×20.) (d) Photomicrograph of benign left fallopian tube (black arrow) adjacent to HGSC of the ovary (white arrow). (Hematoxylin-eosin stain; original magnification, ×40.)
Concordant radiologic-histopathologic correlation of high-grade serous carcinoma (HGSC) (stage IIIC) in a 36-year-old woman who had BRCA1 mutation with bilateral 9- and 8-cm vascular solid adnexal masses and ascites at preoperative transvaginal US. (a) Sagittal (SAG) transvaginal US image of the right (RT) adnexa (ADN) shows a hypoechoic circumscribed solid mass. (b) Coronal (COR) transvaginal color Doppler US image of the left (LT) adnexa (ADN) shows a contralateral solid mass with marked vascularity. (c) Photomicrograph of benign left fallopian tube (black arrow) compressed by an expansile ovarian mass comprising HGSC (white arrow). (Hematoxylin-eosin stain; original magnification, ×20.) (d) Photomicrograph of benign left fallopian tube (black arrow) adjacent to HGSC of the ovary (white arrow). (Hematoxylin-eosin stain; original magnification, ×40.)
Figure 1b:
Concordant radiologic-histopathologic correlation of high-grade serous carcinoma (HGSC) (stage IIIC) in a 36-year-old woman who had BRCA1 mutation with bilateral 9- and 8-cm vascular solid adnexal masses and ascites at preoperative transvaginal US. (a) Sagittal (SAG) transvaginal US image of the right (RT) adnexa (ADN) shows a hypoechoic circumscribed solid mass. (b) Coronal (COR) transvaginal color Doppler US image of the left (LT) adnexa (ADN) shows a contralateral solid mass with marked vascularity. (c) Photomicrograph of benign left fallopian tube (black arrow) compressed by an expansile ovarian mass comprising HGSC (white arrow). (Hematoxylin-eosin stain; original magnification, ×20.) (d) Photomicrograph of benign left fallopian tube (black arrow) adjacent to HGSC of the ovary (white arrow). (Hematoxylin-eosin stain; original magnification, ×40.)
Concordant radiologic-histopathologic correlation of high-grade serous carcinoma (HGSC) (stage IIIC) in a 36-year-old woman who had BRCA1 mutation with bilateral 9- and 8-cm vascular solid adnexal masses and ascites at preoperative transvaginal US. (a) Sagittal (SAG) transvaginal US image of the right (RT) adnexa (ADN) shows a hypoechoic circumscribed solid mass. (b) Coronal (COR) transvaginal color Doppler US image of the left (LT) adnexa (ADN) shows a contralateral solid mass with marked vascularity. (c) Photomicrograph of benign left fallopian tube (black arrow) compressed by an expansile ovarian mass comprising HGSC (white arrow). (Hematoxylin-eosin stain; original magnification, ×20.) (d) Photomicrograph of benign left fallopian tube (black arrow) adjacent to HGSC of the ovary (white arrow). (Hematoxylin-eosin stain; original magnification, ×40.)
Figure 1c:
Concordant radiologic-histopathologic correlation of high-grade serous carcinoma (HGSC) (stage IIIC) in a 36-year-old woman who had BRCA1 mutation with bilateral 9- and 8-cm vascular solid adnexal masses and ascites at preoperative transvaginal US. (a) Sagittal (SAG) transvaginal US image of the right (RT) adnexa (ADN) shows a hypoechoic circumscribed solid mass. (b) Coronal (COR) transvaginal color Doppler US image of the left (LT) adnexa (ADN) shows a contralateral solid mass with marked vascularity. (c) Photomicrograph of benign left fallopian tube (black arrow) compressed by an expansile ovarian mass comprising HGSC (white arrow). (Hematoxylin-eosin stain; original magnification, ×20.) (d) Photomicrograph of benign left fallopian tube (black arrow) adjacent to HGSC of the ovary (white arrow). (Hematoxylin-eosin stain; original magnification, ×40.)
Concordant radiologic-histopathologic correlation of high-grade serous carcinoma (HGSC) (stage IIIC) in a 36-year-old woman who had BRCA1 mutation with bilateral 9- and 8-cm vascular solid adnexal masses and ascites at preoperative transvaginal US. (a) Sagittal (SAG) transvaginal US image of the right (RT) adnexa (ADN) shows a hypoechoic circumscribed solid mass. (b) Coronal (COR) transvaginal color Doppler US image of the left (LT) adnexa (ADN) shows a contralateral solid mass with marked vascularity. (c) Photomicrograph of benign left fallopian tube (black arrow) compressed by an expansile ovarian mass comprising HGSC (white arrow). (Hematoxylin-eosin stain; original magnification, ×20.) (d) Photomicrograph of benign left fallopian tube (black arrow) adjacent to HGSC of the ovary (white arrow). (Hematoxylin-eosin stain; original magnification, ×40.)
Figure 1d:
Concordant radiologic-histopathologic correlation of high-grade serous carcinoma (HGSC) (stage IIIC) in a 36-year-old woman who had BRCA1 mutation with bilateral 9- and 8-cm vascular solid adnexal masses and ascites at preoperative transvaginal US. (a) Sagittal (SAG) transvaginal US image of the right (RT) adnexa (ADN) shows a hypoechoic circumscribed solid mass. (b) Coronal (COR) transvaginal color Doppler US image of the left (LT) adnexa (ADN) shows a contralateral solid mass with marked vascularity. (c) Photomicrograph of benign left fallopian tube (black arrow) compressed by an expansile ovarian mass comprising HGSC (white arrow). (Hematoxylin-eosin stain; original magnification, ×20.) (d) Photomicrograph of benign left fallopian tube (black arrow) adjacent to HGSC of the ovary (white arrow). (Hematoxylin-eosin stain; original magnification, ×40.)
Discordant radiologic-histopathologic correlation of high-grade serous carcinoma (HGSC) (stage IA) in a 53-year-old woman with BRIP1 mutation. (a) Sagittal (SAG) transvaginal US image of the right (RT) adnexa demonstrates a large unilocular simple cyst. OV = ovary. (b) Transverse color Doppler US image of the right adnexa does not demonstrate vascularized soft-tissue components; however, histopathologic analysis revealed a 0.6-cm malignant mural nodule. (c) Photomicrograph of the same simple ovarian cyst (white arrow denotes outer serosal surface of cyst) colonized on the inner surface by HGSC (black arrow). (Hematoxylin-eosin stain; original magnification, ×40.) (d) Photomicrograph of the inner surface of the same ovarian cyst (black arrow denotes benign serosal mesothelial cells) colonized by HGSC (white arrow). (Hematoxylin-eosin stain; original magnification, ×200.)
Figure 2a:
Discordant radiologic-histopathologic correlation of high-grade serous carcinoma (HGSC) (stage IA) in a 53-year-old woman with BRIP1 mutation. (a) Sagittal (SAG) transvaginal US image of the right (RT) adnexa demonstrates a large unilocular simple cyst. OV = ovary. (b) Transverse color Doppler US image of the right adnexa does not demonstrate vascularized soft-tissue components; however, histopathologic analysis revealed a 0.6-cm malignant mural nodule. (c) Photomicrograph of the same simple ovarian cyst (white arrow denotes outer serosal surface of cyst) colonized on the inner surface by HGSC (black arrow). (Hematoxylin-eosin stain; original magnification, ×40.) (d) Photomicrograph of the inner surface of the same ovarian cyst (black arrow denotes benign serosal mesothelial cells) colonized by HGSC (white arrow). (Hematoxylin-eosin stain; original magnification, ×200.)
Discordant radiologic-histopathologic correlation of high-grade serous carcinoma (HGSC) (stage IA) in a 53-year-old woman with BRIP1 mutation. (a) Sagittal (SAG) transvaginal US image of the right (RT) adnexa demonstrates a large unilocular simple cyst. OV = ovary. (b) Transverse color Doppler US image of the right adnexa does not demonstrate vascularized soft-tissue components; however, histopathologic analysis revealed a 0.6-cm malignant mural nodule. (c) Photomicrograph of the same simple ovarian cyst (white arrow denotes outer serosal surface of cyst) colonized on the inner surface by HGSC (black arrow). (Hematoxylin-eosin stain; original magnification, ×40.) (d) Photomicrograph of the inner surface of the same ovarian cyst (black arrow denotes benign serosal mesothelial cells) colonized by HGSC (white arrow). (Hematoxylin-eosin stain; original magnification, ×200.)
Figure 2b:
Discordant radiologic-histopathologic correlation of high-grade serous carcinoma (HGSC) (stage IA) in a 53-year-old woman with BRIP1 mutation. (a) Sagittal (SAG) transvaginal US image of the right (RT) adnexa demonstrates a large unilocular simple cyst. OV = ovary. (b) Transverse color Doppler US image of the right adnexa does not demonstrate vascularized soft-tissue components; however, histopathologic analysis revealed a 0.6-cm malignant mural nodule. (c) Photomicrograph of the same simple ovarian cyst (white arrow denotes outer serosal surface of cyst) colonized on the inner surface by HGSC (black arrow). (Hematoxylin-eosin stain; original magnification, ×40.) (d) Photomicrograph of the inner surface of the same ovarian cyst (black arrow denotes benign serosal mesothelial cells) colonized by HGSC (white arrow). (Hematoxylin-eosin stain; original magnification, ×200.)
Discordant radiologic-histopathologic correlation of high-grade serous carcinoma (HGSC) (stage IA) in a 53-year-old woman with BRIP1 mutation. (a) Sagittal (SAG) transvaginal US image of the right (RT) adnexa demonstrates a large unilocular simple cyst. OV = ovary. (b) Transverse color Doppler US image of the right adnexa does not demonstrate vascularized soft-tissue components; however, histopathologic analysis revealed a 0.6-cm malignant mural nodule. (c) Photomicrograph of the same simple ovarian cyst (white arrow denotes outer serosal surface of cyst) colonized on the inner surface by HGSC (black arrow). (Hematoxylin-eosin stain; original magnification, ×40.) (d) Photomicrograph of the inner surface of the same ovarian cyst (black arrow denotes benign serosal mesothelial cells) colonized by HGSC (white arrow). (Hematoxylin-eosin stain; original magnification, ×200.)
Figure 2c:
Discordant radiologic-histopathologic correlation of high-grade serous carcinoma (HGSC) (stage IA) in a 53-year-old woman with BRIP1 mutation. (a) Sagittal (SAG) transvaginal US image of the right (RT) adnexa demonstrates a large unilocular simple cyst. OV = ovary. (b) Transverse color Doppler US image of the right adnexa does not demonstrate vascularized soft-tissue components; however, histopathologic analysis revealed a 0.6-cm malignant mural nodule. (c) Photomicrograph of the same simple ovarian cyst (white arrow denotes outer serosal surface of cyst) colonized on the inner surface by HGSC (black arrow). (Hematoxylin-eosin stain; original magnification, ×40.) (d) Photomicrograph of the inner surface of the same ovarian cyst (black arrow denotes benign serosal mesothelial cells) colonized by HGSC (white arrow). (Hematoxylin-eosin stain; original magnification, ×200.)
Discordant radiologic-histopathologic correlation of high-grade serous carcinoma (HGSC) (stage IA) in a 53-year-old woman with BRIP1 mutation. (a) Sagittal (SAG) transvaginal US image of the right (RT) adnexa demonstrates a large unilocular simple cyst. OV = ovary. (b) Transverse color Doppler US image of the right adnexa does not demonstrate vascularized soft-tissue components; however, histopathologic analysis revealed a 0.6-cm malignant mural nodule. (c) Photomicrograph of the same simple ovarian cyst (white arrow denotes outer serosal surface of cyst) colonized on the inner surface by HGSC (black arrow). (Hematoxylin-eosin stain; original magnification, ×40.) (d) Photomicrograph of the inner surface of the same ovarian cyst (black arrow denotes benign serosal mesothelial cells) colonized by HGSC (white arrow). (Hematoxylin-eosin stain; original magnification, ×200.)
Figure 2d:
Discordant radiologic-histopathologic correlation of high-grade serous carcinoma (HGSC) (stage IA) in a 53-year-old woman with BRIP1 mutation. (a) Sagittal (SAG) transvaginal US image of the right (RT) adnexa demonstrates a large unilocular simple cyst. OV = ovary. (b) Transverse color Doppler US image of the right adnexa does not demonstrate vascularized soft-tissue components; however, histopathologic analysis revealed a 0.6-cm malignant mural nodule. (c) Photomicrograph of the same simple ovarian cyst (white arrow denotes outer serosal surface of cyst) colonized on the inner surface by HGSC (black arrow). (Hematoxylin-eosin stain; original magnification, ×40.) (d) Photomicrograph of the inner surface of the same ovarian cyst (black arrow denotes benign serosal mesothelial cells) colonized by HGSC (white arrow). (Hematoxylin-eosin stain; original magnification, ×200.)
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