Ovarian cancer staging and follow-up: updated guidelines from the European Society of Urogenital Radiology female pelvic imaging working group

Abstract

Objective: To provide up-to-date European Society of Urogenital Radiology (ESUR) guidelines for staging and follow-up of patients with ovarian cancer (OC).

Methods: Twenty-one experts, members of the female pelvis imaging ESUR subcommittee from 19 institutions, replied to 2 rounds of questionnaires regarding imaging techniques and structured reporting used for pre-treatment evaluation of OC patients. The results of the survey were presented to the other authors during the group's annual meeting. The lexicon was aligned with the Society of American Radiology (SAR)-ESUR lexicon; a first draft was circulated, and then comments and suggestions from the other authors were incorporated.

Results: Evaluation of disease extent at diagnosis should be performed by chest, abdominal, and pelvic CT. The radiological report should map the disease with specific mention of sites that may preclude optimal cytoreductive surgery. For suspected recurrence, CT and [¹⁸F]FDG PET-CT are both valid options. MRI can be considered in experienced centres, as an alternative to CT, considering the high costs and the need for higher expertise in reporting.

Conclusions: CT is the imaging modality of choice for preoperative evaluation and follow-up in OC patients. A structured radiological report, including specific mention of sites that may preclude optimal debulking, is of value for patient management.

Key points: Question Guidelines were last published for ovarian cancer (OC) imaging in 2010; here, guidance on imaging techniques and reporting, incorporating advances in the field, are provided. Findings Structured reports should map out sites of disease, highlighting sites that limit cytoreduction. For suspected recurrence, CT and 18FDG PET-CT are options, and MRI can be considered. Clinical relevance Imaging evaluation of OC patients at initial diagnosis (mainly based on CT), using a structured report that considers surgical needs is valuable in treatment selection and planning.

Keywords: Magnetic resonance imaging; Ovarian cancer; Photon emission computed tomography; Structured report; Tomography (x-ray computed).

Fig. 1

Sites of disease that may preclude optimal cytoreduction include: hepatic parenchyma metastases (red); metastases in the porta hepatis (pink); metastases in the lesser sac (blue) and lesser omentum (violet); metastases in the head of the pancreas (orange) and in the gastric wall (purple)

Fig. 2

Thoracic sites of disease that may preclude optimal debulking include right internal mammary lymphadenopathy (white arrow in (a); pleural lesions (white arrowhead in (b)); lung metastases (black arrow in (c))

Fig. 3

Axial (a) and coronal (b) CT images show infiltration of the lesser sac (white arrow) and of the hepatic hilum (black arrowhead)

Fig. 4

Small bowel mesentery Infiltration: axial (a, b) and sagittal (c) CT images of a diffuse deep infiltration (white arrows)

Fig. 5

Abdominal MR images showing infiltration of the small bowel mesentery as hypointense thickening of the mesenteric surface on T2w images (a) and as an area with restricted diffusion on DWI MRI images (b); subtle infiltration of the hepatic hilum on axial T2-weighted (c) and high b-Value DWI MRI images (d). MRI can be used as a complement to CT as a problem-solving tool, like evaluating the extent of serosal and mesenteric involvement or bowel involvement