ESGO/ISUOG/IOTA/ESGE Consensus Statement on pre-operative diagnosis of ovarian tumors

Abstract

The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group, and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence-based statements on the pre-operative diagnosis of ovarian tumors, including imaging techniques, biomarkers, and prediction models. ESGO/ISUOG/IOTA/ESGE nominated a multidisciplinary international group, including expert practising clinicians and researchers who have demonstrated leadership and expertise in the pre-operative diagnosis of ovarian tumors and management of patients with ovarian cancer (19 experts across Europe). A patient representative was also included in the group. To ensure that the statements were evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on the review of the relevant literature. During a conference call, the whole group discussed each preliminary statement and a first round of voting was carried out. Statements were removed when a consensus among group members was not obtained. The voters had the opportunity to provide comments/suggestions with their votes. The statements were then revised accordingly. Another round of voting was carried out according to the same rules to allow the whole group to evaluate the revised version of the statements. The group achieved consensus on 18 statements. This Consensus Statement presents these ESGO/ISUOG/IOTA/ESGE statements on the pre-operative diagnosis of ovarian tumors and the assessment of carcinomatosis, together with a summary of the evidence supporting each statement.

Keywords: ovarian neoplasms; ovary.

Figure 1

Eight-step process for development of the Consensus Statement on the pre-operative diagnosis of ovarian tumors and assessment of disease spread.

Figure 2

Flowchart of steps recommended to distinguish between benign and malignant tumors and to direct patients towards appropriate treatment pathway. CT, computed tomography; F/U, follow-up; IOTA ADNEX, International Ovarian Tumour Analysis Group Assessment of Different NEoplasias in the adneXa; MRI, magnetic resonance imaging; O-RADS, Ovarian-Adnexal Reporting and data system.

Figure 3

Flowchart of steps necessary to differentiate between subgroups of malignancy and extent of disease within gynecological oncology centers. *Early stage and advanced stage might differ according to different ADNEX models (stage I vs stages III–IV) and oncologically (stages I–II vs stages I–IV). αFP, alpha-fetoprotein; AMH, anti-Müllerian hormone; CA 125, cancer antigen 125; CA 15-3, cancer antigen 15-3; CA 19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; CT, computed tomography; hCG, human chorionic gonadoptropin; IOTA ADNEX, International Ovarian Tumor Analysis group Assessment of Different NEoplasias in the adneXa; LDH, lactate dehydrogenase; MRI, magnetic resonance imaging; PET-CT, positron emission tomography-computed tomography.