The optimal imaging in gynecological oncology

Authors: D. Fischerová 1;  A. Burgetová 2
Authors‘ workplace: Gynekologicko-porodnická klinika 1. LF UK a VFN, Praha, přednosta prof. MUDr. A. Martan, DrSc. 1;  Radiologická klinika 1. LF UK a VFN, Praha, přednosta prof. MUDr. J. Daneš, CSc. 2
Published in: Ceska Gynekol 2014; 79(6): 425-435


In this review we discuss in detail the advantages and the limitations of the modern imaging techniques to assess the tumour spread in pelvis, abdomen and extraabdominally in patients with newly diagnosed or recurrent gynecological cancer. Transvaginal ultrasound and magnetic resonance imaging yield similar levels of accuracy when utilised for the diagnosis of gynecological cancer and the detection of pelvic spread. Ultrasound is, however, a commonly available, non-invasive, and inexpensive imaging method that can be carried out without any risk or discomfort to the patient. Although increasing evidence shows that transabdominal ultrasound is an accurate technique for the detection of intra- and retroperitoneal tumour spread, it requires experience, adequate equipment and suitable acoustic conditions. Contrast-enhanced computed abdominopelvic tomography remains the most commonly used preoperative imaging modality to assess abdominal cavity and retroperitoneum for extrapelvic tumour spread. Alternatively magnetic resonance imaging can be used in cases of contra-indication of computed tomography. If there is suspicion of extraabdominal tumour spread, contrast-enhanced computed tomography of thorax or positron emission tomography combined with computed tomography is used. Positron emission tomography combined with computed tomography detects more distant metastases than computed tomography alone. Positron emission tomography with computed tomography is, therefore, the optimal imaging technique for suspected recurrence, particularly if there is suspicion of recurrence but conventional imaging methods have yilded negative results or if salvage surgery is planned.

transvaginal ultrasound, transabdominal ultrasound, staging, gynecologic oncology, computed tomography, magnetic resonance, positron emission tomography


1. Bats, AS., Hugonnet, F., Huchon, C., et al. Prognostic significance of mediastinal 18F-FDG uptake in PET/CT in advanced ovarian cancer. Eur J Nucl Med Mol Imaging, 2012, 39, 3, p. 474–480.

2. Benedet, JL., Bender, H., Jones, H. 3rd, et al. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet, 2000, 70, 2, p. 209–262.

3. Bristow, RE., del Carmen, MG., Pannu, HK., et al. Clinically occult recurrent ovarian cancer: patient selection for secondary cytoreductive surgery using combined PET/CT. Gynecol Oncol, 2003, 90, 3, p. 519–528.

4. Colombo, N., Carinelli, S., Colombo, A., et al. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2012, 23, Suppl. 7, p. vii27–32.

5. Colombo, N., Preti, E., Landoni, F., et al. Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2013, 24, Suppl. 6, p. vi33–38.

6. Dauwen, H., Van Calster, B., Deroose, CM., et al. PET/CT in the staging of patients with a pelvic mass suspicious for ovarian cancer. Gynecol Oncol, 2013, 131, 3, p. 694–700.

7. Fischerova, D., Cibula, D., Dundr, P., et al. Ultrasound-guided tru-cut biopsy in the management of advanced abdomino-pelvic tumors. Int J Gynecol Cancer, 2008, 18, 4, p. 833–837.

8. Fischerova, D., Cibula, D., Zikan, M., et al. [Ultrasound-guided intervention in the treatment of abdomino-pelvic advanced tumors]. Ces Gynek, 2009, 74, 5, p. 329–334.

9. Fischerová, D. Doporučený diagnostický postup u ženy s ovariální cystou nebo nádorem. Čes Gynek, 2014, 79, 6, p. 477–486.

10. Fischerová, D. Zhoubný nádor děložního hrdla (předoperační stanovení rozsahu onemocnění – přehled výsledků nejnovějších ultrazvukových studií). Čes Gynek, 2014, 79, 6 p. 436–446.

11. Fischerova, D. Zhoubný nádor děložního těla – předoperační odlišení nádorů s nízkým a vysokým rizikem metastázování (přehled výsledků nejnovějších ultrazvukových studií). Ces Gynek, 2014, 79, 6, p. 456–465.

12. Fischerova, D., Burgetova, A. Imaging techniques for the evaluation of ovarian cancer. Best Pract Res Clin Obstet Gynaecol, 2014, 28, 5, p. 697–720.

13. Fischerová, D., Burgetová, A., Seidl, Z., Bělohlávek, O. Diagnostika. In Cibula, D., Petruželka, L. Onkogynekologie. Praha: Grada Publishing, 2009, s. 101–131.

14. Forstner, R., Hricak, H., Occhipinti, KA., et al. Ovarian cancer: staging with CT and MR imaging. Radiology, 1995, 197, 3, p. 619–626.

15. Forstner, R., Sala, E., Kinkel, K., et al. ESUR guidelines: ovarian cancer staging and follow-up. Eur Radiol, 2010, 20, 12, p. 2773–2780.

16. Fulham, MJ., Carter, J., Baldey, A., et al. The impact of PET-CT in suspected recurrent ovarian cancer: A prospective multi-centre study as part of the Australian PET Data Collection Project. Gynecol Oncol, 2009, 112, 3, p. 462–468.

17. Garcia-Velloso, MJ., Jurado, M., Ceamanos, C., et al. Diagnostic accuracy of FDG PET in the follow-up of platinum-sensitive epithelial ovarian carcinoma. Eur J Nucl Med Mol Imaging, 2007, 34, 9, p. 1396–1405.

18. Grueneisen, J., Beiderwellen, K., Heusch, P., et al. Simultaneous positron emission tomography/magnetic resonance imaging for whole-body staging in patients with recurrent gynecological malignancies of the pelvis: a comparison to whole-body magnetic resonance imaging alone. Invest Radiol, 2014.

19. Hynninen, J., Auranen, A., Carpen, O., et al. FDG PET/CT in staging of advanced epithelial ovarian cancer: frequency of supradiaphragmatic lymph node metastasis challenges the traditional pattern of disease spread. Gynecol Oncol, 2012, 126, 1, p. 64–68.

20. Hynninen, J., Kemppainen, J., Lavonius, M., et al. A prospective comparison of integrated FDG-PET/contrast-enhanced CT and contrast-enhanced CT for pretreatment imaging of advanced epithelial ovarian cancer. Gynecol Oncol, 2013, 131, 2, p. 389–394.

21. Iyer, VR., Lee, SI. MRI, CT, and PET/CT for ovarian cancer detection and adnexal lesion characterization. AJR Am J Roentgenol, 2010, 194, 2, p. 311–321.

22. Kitajima, K., Murakami, K., Yamasaki, E., et al. Diagnostic accuracy of integrated FDG-PET/contrast-enhanced CT in staging ovarian cancer: comparison with enhanced CT. Eur J Nucl Med Mol Imaging, 2008, 35, 10, p. 1912–1920.

23. Ledermann, JA., Raja, FA., Fotopoulou, C., et al. Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2013, 24, Suppl. 6, p. vi24–32.

24. Michielsen, K., Vergote, I., Op de Beeck, K., et al. Whole-body MRI with diffusion-weighted sequence for staging of patients with suspected ovarian cancer: a clinical feasibility study in comparison to CT and FDG-PET/CT. Eur Radiol, 2014, 24, 4, p. 889–901.

25. Mitchell, DG., Javitt, MC., Glanc, P., et al. ACR appropriateness criteria staging and follow-up of ovarian cancer. J Am Coll Radiol, 2013, 10, 11, p. 822–827.

26. Nogami, Y., Iida, M., Banno, K., et al. Application of FDG-PET in cervical cancer and endometrial cancer: utility and future prospects. Anticancer Res, 2014, 34, 2, p. 585–592.

27. Ovarian Cancer. In the National Comprehensive Cancer Network (NCCN) Guidelines, version 3. 2014.

28. Risum, S., Hogdall, C., Loft, A., et al. The diagnostic value of PET/CT for primary ovarian cancer – a prospective study. Gynecol Oncol, 2007, 105, 1, p. 145–149.

29. Risum, S., Hogdall, C., Markova, E., et al. Influence of 2-(18F) fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography on recurrent ovarian cancer diagnosis and on selection of patients for secondary cytoreductive surgery. Int J Gynecol Cancer, 2009, 19, 4, p. 600–604.

30. Simcock, B., Neesham, D., Quinn, M., et al. The impact of PET/CT in the management of recurrent ovarian cancer. Gynecol Oncol, 2006, 103, 1, p. 271–276.

31. Spencer, JA., Anderson, K., Weston, M., et al. Image guided biopsy in the management of cancer of the ovary. Cancer Imaging, 2006, 6, p. 144–147.

32. Tempany, CM., Zou, KH., Silverman, SG., et al. Staging of advanced ovarian cancer: comparison of imaging modalities – report from the Radiological Diagnostic Oncology Group. Radiology, 2000, 215, 3, p. 761–767.

33. Testa, AC., Van Holsbeke, C., Mascilini, F., Timmerman, D. Dynamic and interactive gynecological ultrasound examination. Ultrasound Obstet Gynecol, 2009, 34, 2, p. 225–229.

34. Testa, AC., Ludovisi, M., Mascilini, F., et al. Ultrasound evaluation of intra-abdominal sites of disease to predict likelihood of suboptimal cytoreduction in advanced ovarian cancer: a prospective study. Ultrasound Obstet Gynecol, 2012, 39, 1, p. 99–105.

35. Thrall, MM., DeLoia, JA., Gallion, H., Avril, N. Clinical use of combined positron emission tomography and computed tomography (FDG-PET/CT) in recurrent ovarian cancer. Gynecol Oncol, 2007, 105, 1, p. 17–22.

36. Woodward, PJ., Hosseinzadeh, K., Saenger, JS. From the archives of the AFIP: radiologic staging of ovarian carcinoma with pathologic correlation. Radiographics, 2004, 24, 1, p. 225–246.

37. Yoshida, Y., Kurokawa, T., Kawahara, K., et al. Incremental benefits of FDG positron emission tomography over CT alone for the preoperative staging of ovarian cancer. AJR Am J Roentgenol, 2004, 182, 1, p. 227–233.

38. Yoshida, Y., Kurokawa, T., Tsujikawa, T., et al. Positron emission tomography in ovarian cancer: 18F-deoxy-glucose and 16alpha-18F-fluoro-17beta-estradiol PET. J Ovarian Res, 2009, 2, 1, p. 7.

39. Zikan, M., Fischerova, D., Pinkavova, I., et al. Ultrasound-guided tru-cut biopsy of abdominal and pelvic tumors in gynecology. Ultrasound Obstet Gynecol, 2010, 36, 6, p. 767–772.

40. Zikan, M., Fischerova, D., Slama, J., et al. [Ultrasound-guided minimally invasive interventions in gynecologic oncology]. Ces Gynek, 2011, 76, 4, p. 257–261.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account