Staging of Advanced Ovarian Cancer: Comparison of Imaging Modalities—Report from the Radiological Diagnostic Oncology Group

Tempany, Clare M.; Zou, Kelly H.; Silverman, Stuart G.; Brown, Douglas L.; Kurtz, Alfred B.; McNeil, Barbara J.

doi:10.1148/radiology.215.3.r00jn25761

Cited by 338 publications

(194 citation statements)

References 24 publications

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“…Some studies have found MRI to be more accurate in this regard, especially for lymph node metastases and tumor resectability. 77,78 Contrast-enhanced MRI have been found to have a 92% sensitivity in detecting small peritoneal disease such as those that can be found in the omentum, in the mesentery of the small and large bowel, on the anterior abdominal peritoneal surface, under the diaphragm, and in the paracolic gutters. 77 Prolonged survival after ovarian cancer diagnosis and the success of chemotherapy depends on optimal debulking at the time of the initial surgery, yet less than 50% of ovarian cancer patients acquire a gynecologic oncologist to be involved in their care.…”

Section: Gynecologic Malignanciesmentioning

confidence: 99%

Imaging Modalities in Gynecology

Busse¹

2010

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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REVIEW ARTICLE DSJUOG ULTRASOUNDTransabdominal gynecologic ultrasound combined with transvaginal scanning is a technique that was initially introduced in the early 1980's and quickly became a "musthave" procedure for gynecologists and emergency room physicians for assistance in diagnosing many gynecologic conditions. Rapid advances in the quality of the equipment, techniques used to obtain best images, and research designed to help physicians interpret their findings have contributed to ultrasound's quick rise in use and popularity. It is ubiquitous that ultrasound is the imaging modality of choice for gynecologic conditions.The advantages of ultrasound are numerous. It is fast, easy to obtain, has a high patient tolerance and is relatively inexpensive when compared to CT and MRI. Many physicians' offices have ultrasound machines that are more than sufficient to make common diagnoses thereby alleviating patient anxiety and physician concerns if an abnormality is found during a physical exam. Appropriate referrals and treatments can be initiated in a timely manner at minimum expense. The ability to use the transvaginal ultrasound as an extension of a pelvic exam is extremely useful, particularly when the source of pain is uncertain during bimanual exam or if a mass is found of uterine or ovarian origin. An obvious advantage, especially when compared to CT, is that no radiation exposure occurs. As will be discussed in more detail, pelvic ultrasound has been shown, in numerous studies, to have a high negative predictive value and offers excellent resolution of the uterus and adnexal structures, especially when compared to CT and MRI.There are disadvantages; however, that should be addressed. Even with routine use of transabdominal scanning which utilizes the acoustic window of a full bladder, the field of view is very limited, especially, compared to CT and MRI. Transvaginal sonography limits the field; however, it is effective in obtaining excellent resolution of the uterus, endometrium and adnexal structures. Ultrasound visualizes the bowel poorly and it is well-known that bowel gas corrupts the ultrasound signal allowing for potential "missed" masses not visible under the bowel. An additional drawback is that poor contrast occurs between dissimilar tissues (i.e. blood and fat) making it difficult to characterize certain ovarian masses accurately.Ultrasound characterizes gynecologic pathology extremely well. Fibroids, endometriomas, dermoids, masses that are suspicious for malignancy, uterine anomalies, IUD complications, ectopic pregnancies, and endometrial pathology (with the help of transvaginal saline infusion sonography) are diagnoses that are detected with high accuracy. The following will give illustrations of the clinical utility of diagnostic gynecologic ultrasound for specific clinical conditions. AbstractAlthough ultrasound is the primary imaging modality for most gynecologic diagnoses and conditions, knowledge of other diagnostic imaging procedures is important to gynecologists, emergency room physici...

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Section: Gynecologic Malignanciesmentioning

confidence: 99%

Imaging Modalities in Gynecology

Busse¹

2010

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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“…The maximum likelihood estimates of the segmentation quality parameters are: (6) In our experience, typically only K <20 iterations were required to achieve convergence in several segmentation applications.…”

Section: The Maximization (M) Stepmentioning

confidence: 99%

“…For example, a five-point scale might be adopted for observer performance evaluations, where 1 = definitely normal, 2 = probably normal, 3 = probably abnormal, 4 = probably abnormal, and 5 = definitely abnormal. A discrete subjective rating method was used in a multi-modal (magnetic resonance [MR], computed tomography [CT], and ultrasound) comparative ovarian cancer technology assessment study (5,6), in one of a series of prospective multicenter Radiologic Diagnostic Oncology Group clinical trials sponsored by the funded by the National Institutes of Health in the 1990s. The advantages of the continuous diagnostic over ordinal scale are that detailed information is preserved, they are more natural with the advancements in measurement tools and computing methods, and enable more objective interpretations.…”

mentioning

confidence: 99%

Statistical validation based on parametric receiver operating characteristic analysis of continuous classification data1

Zou¹,

Warfield²,

Tempany³

et al. 2003

Academic Radiology

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Rationale and Objectives-The accuracy of diagnostic test and imaging segmentation is important in clinical practice because it has a direct impact on therapeutic planning. Statistical validations of classification accuracy was conducted based on parametric receiver operating characteristic analysis, illustrated on three radiologic examples.Materials and Methods-Two parametric models were developed for diagnostic or imaging data. Example 1: A semiautomated fractional segmentation algorithm was applied to magnetic resonance imaging of nine cases of brain tumors. The tumor and background pixel data were assumed to have bi-beta distributions. Fractional segmentation was validated against an estimated composite pixelwise gold standard based on multi-reader manual segmentations. Example 2: The predictive value of 100 cases of spiral computed tomography of ureteral stone sizes, distributed as bi-normal after a nonlinear transformation, under two treatment options received. Example 3: One hundred eighty cases had prostate-specific antigen levels measured in a prospective clinical trial. Radical prostatectomy was performed in all to provide a binary gold standard of local and advanced cancer stages. Prostate-specific antigen level was transformed and modeled by bi-normal distributions. In all examples, areas under the receiver operating characteristic curves were computed. Conclusion-All clinical examples yielded fair to excellent accuracy. The validation metric area under the receiver operating characteristic curves may be generalized to evaluating the performances of several continuous classifiers related to imaging. Results-The KeywordsBrain segmentation; magnetic resonance; prostate specific antigen (PSA); genitourinary system; computed tomography; receiver operating characteristic (ROC) analysisThe accuracy of diagnostic test and imaging segmentation is important in clinical practice because it has a direct impact on therapeutic planning. Recently, continuous classification tools In contrast, traditional diagnostic tests were often based on an ordinal rating scale. For example, a five-point scale might be adopted for observer performance evaluations, where 1 = definitely normal, 2 = probably normal, 3 = probably abnormal, 4 = probably abnormal, and 5 = definitely abnormal. A discrete subjective rating method was used in a multi-modal (magnetic resonance [MR], computed tomography [CT], and ultrasound) comparative ovarian cancer technology assessment study (5,6), in one of a series of prospective multicenter Radiologic Diagnostic Oncology Group clinical trials sponsored by the funded by the National Institutes of Health in the 1990s. The advantages of the continuous diagnostic over ordinal scale are that detailed information is preserved, they are more natural with the advancements in measurement tools and computing methods, and enable more objective interpretations. Ordinal rating data will not be the focus of this article. Instead, we will evaluate the performances of continuous classifiers only.To conduct a...

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“…Recurrent EOC, unlike other solid tumors, tends to present without accompanying symptoms and forms multiple small implantations, particularly in the small intestine and mesentery, which cannot be readily detected using conventional imaging techniques (13,14).…”

Section: Introductionmentioning

confidence: 99%

Serum HE4 levels combined with CE CT imaging improve the management of monitoring women affected by epithelial ovarian cancer

et al. 2013

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Abstract. The aim of the present study was to evaluate human epididymis protein 4 (HE4) as a marker of epithelial ovarian cancer (EOC) relapse and the combination of this biomarker with contrast-enhanced high-resolution multidetector row computed tomography CE CT imaging to impove the monitoring of EOC patients. Twenty-one patients with advanced EOC (FIGO III/IV) who underwent surgery and adjuvant chemotherapy were retrospectively selected. Each patient contributed 3 serum samples drawn at 3-month intervals: time interval I (1-3 months from surgery), time interval II (4-6 months from surgery) and time interval III (7-10 months from surgery). Serum HE4 and cancer antigen-125 (CA-125) levels were determined by EIA and IRMA assays, respectively. Nine out of the 21 (Group A) women had disease relapse while 12 out of the 21 (Group B) women had stable disease during the follow-up study. Twenty out of the 21 patients underwent at least two CE CT follow-ups with an interval time of ~6 months. One patient did not undergo a second CE CT. In patients with relapsed EOC, an increase in HE4 was noted in 22, 78 and 89% of patients within the time intervals I, II and III, respectively. Positivity for CA-125 was found later at time interval III and only in 44% of patients. Conversely, for EOC patients in remission, increase over the threshold level was observed only for marker CA-125 (4/12). The evaluation of imaging findings at interval time II showed a significant correlation with high levels of HE4 in 6 out of 9 patients with recurrent disease. This study supports the hypothesis that HE4 may serve as an early biomarker for recurrence of EOC.Moreover, HE4 serum levels combined with CE CT imaging may improve the monitoring management of women affected by ovarian cancer.

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Staging of Advanced Ovarian Cancer: Comparison of Imaging Modalities—Report from the Radiological Diagnostic Oncology Group

Abstract: CT and MR imaging are equally accurate, and either modality can be used to stage advanced ovarian cancer.

Cited by 338 publications

References 24 publications

Imaging Modalities in Gynecology

Imaging Modalities in Gynecology

Statistical validation based on parametric receiver operating characteristic analysis of continuous classification data1

Serum HE4 levels combined with CE CT imaging improve the management of monitoring women affected by epithelial ovarian cancer

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