Elastography, a sensitive tool for the evaluation of neoadjuvant chemotherapy in patients with high-grade serous ovarian carcinoma

Abstract

The aim of the present study was to evaluate tumor stiffness by ultrasound elastography, which has the potential to provide additional information that is useful in predicting the response to neoadjuvant chemotherapy (NACT) in high-grade serous ovarian carcinoma (HGSC) patients. In total, 32 patients with International Federation of Gynecology and Obstetrics stage III and IV epithelial ovarian cancer treated with NACT underwent transvaginal and transabdominal sonography, followed by elastography and finally, by interval cytoreductive surgery. Histopathological analysis revealed 24 (75%) HGSCs. The mean elasticity score was statistically higher for the post-NACT lesions than for the pre-NACT lesions (3.13±0.57 vs. 2.04±0.51, respectively; P<0.001). The median elasticity score for the pre-NACT lesions on the four-point scale was 2, and the score for the post-NACT lesions was 4. Cases of post-NACT with scores of 3 and 4 had a higher optimal cytoreduction rate than cases with scores of 1 and 2 (93.8 vs. 25.0%, respectively; P<0.001). When the post-NACT elasticity scores of 3 and 4 were used for the prediction of optimal cytoreduction, elastography exhibited 88.2% sensitivity, 85.7% specificity, a 93.8% positive predictive value, a 75.0% negative predictive value and 87.5% accuracy. The results of the current study suggested that elastography is a sensitive tool for the evaluation of NACT in patients with HGSC and that it may aid gynecologists in choosing the optimal cytoreduction.

Evaluation of Tubal Pregnancy After Treatment With Methotrexate by Ultrasound Elastography

“…We considered that the lesions of tubal pregnancy became soft, since parts of lesions were necrotic after MTX therapy. In a previous study, we had similar results in the study of neoadjuvant chemotherapy with ovarian high‐grade serous cancer . The trophocytes showed necrosis after MTX therapy.…”

“…Although the colors indicating tissue elasticity in various studies were different, the principle of showing tissue stiffness was consistent. Our previous studies demonstrated it was effective and convenient …”

“…In recent years, we investigated the function of elastography in gynecology. We successfully applied elastography in the discrimination of high‐ and low‐grade serous ovarian cancer, the diagnosis of the extent of the large‐scar endometriosis, evaluation of neoadjuvant chemotherapy in patients with high‐grade serous ovarian carcinoma, and the levator ani with no defect on elastography in women with pelvic organ prolapse …”

Evaluation of the Cervix After Cervical Conization by Transvaginal Elastography

“…3 We reported several applications of elastography in gynecology in recent years, such as discrimination of high-and low-grade serous ovarian cancer, diagnosis of large-scar endometriosis, assessment of neoadjuvant chemotherapy in patients with high-grade serous ovarian carcinoma, and evaluation of the levator ani in women with pelvic organ prolapse. [4][5][6][7] However, to our knowledge, an evaluation of the regeneration process after cervical conization by transvaginal elastography in a clinical study has not been reported previously. In this study, we investigated the elastic properties of the cervix after cervical conization by elastography and its potential ability to predict future pregnancy.…”

Usefulness of transabdominal real-time sonoelastography in the evaluation of ovarian lesions: preliminary results

“…Also, another study which was performed with sonoelastography investigated the response of high- grade serous ovarian cancer to neoadjuvant chemotherapy revealed that tumour got stiffer after the treatment. 19 This also shows that malignant ovarian lesions are soft on elastogram but tissue stiffness increases after tumour treatment. Hence, benignity and/or response to treatment in an ovarian lesion is presented as hard elastogram pattern and increased strain index.…”