Preliminary Diagnosis: Ovarian Cancer
I. What imaging technique is first-line for this diagnosis?
- Ultrasound (US) of the pelvis with transabdominal and endovaginal imaging
II. Describe the advantages and disadvantages of this technique for diagnosis of ovarian cancer.
Advantages
- Allows for evaluation of the ovaries, adnexa, and uterus
- Quick examination that does not expose patient to ionizing radiation
- Cost-effective
- Useful in determining cystic and solid components of ovarian lesions as well as vascularity
- If normal-appearing ovaries are seen, a diagnosis of ovarian cancer can be excluded
Disadvantages
- Operator dependent. Relies heavily on the skill of the sonographer or physician performing the exam
- Image quality can be degraded by patient body habitus and bowel gas content
- Endovaginal ultrasound, while more sensitive, may be uncomfortable to some patients
III. What are the contraindications for the first-line imaging technique?
- No significant contraindications to ultrasound
- Transvaginal ultrasound may be declined by a subset of patients
IV. What alternative imaging techniques are available?
- MRI with gadolinium IV contrast
- Note that CT should not be used for evaluation of female pelvic structures but is often used in staging and surveillance of known ovarian cancer
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of ovarian cancer.
MRI with gadolinium IV contrast
Advantages
- Allows for high-resolution evaluation of the ovaries and pelvic structures, local lymph nodes, and pelvic cul-de-sac.
- Does not use ionizing radiation.
- In a known diagnosis of ovarian cancer, MRI reliably allows for assessment of local staging
Disadvantages
- Expensive
- Time consuming
- Requires significant patient cooperation to minimize motion artifact
VI. What are the contraindications for the alternative imaging techniques?
MRI with gadolinium IV contrast
- Patients with embedded metallic devices not made of titanium such as cardiac pacers, stents, and other non–MR-approved metallic devices may not enter the magnet for imaging
- Patients with GFR less than 30 cannot receive gadolinium intravenous contrast
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