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In contrast, the five-year combined survival rate for all stages of breast cancer has steadily improved, from around 75 percent in the s to over 90 percent now. Belcher's lab has been developing a novel type of medical imaging based on light in the near-infrared NIR spectrum. In a paper published in March, she reported that this imaging system could achieve an unprecedented combination of resolution and penetration-depth in living tissue.

In the new study, Belcher, Birrer, and their colleagues worked with researchers at MIT Lincoln Laboratory to adapt NIR imaging to help surgeons locate tumors during ovarian cancer surgery, by providing continuous, real-time imaging of the abdomen, with tumors highlighted by fluorescence. Previous analyses have shown that survival rates are strongly inversely correlated with the amount of residual tumor mass left behind in the patient during debulking surgery, but many ovarian tumors are so small or hidden that surgeons can't find them.

To make the tumors visible, the researchers designed chemical probes using single-walled carbon nanotubes that emit fluorescent light when illuminated by a laser. They coated these nanotubes with a peptide that binds to SPARC, a protein that is overexpressed by highly invasive ovarian cancer cells. This probe binds to the tumors and makes them fluoresce at NIR wavelengths, allowing surgeons to more easily find them with fluorescence imaging.

The researchers tested the image-guided system in mice that had ovarian tumors implanted in a region of the abdominal cavity known as the intraperitoneal space, and showed that surgeons were able to locate and remove tumors as small as 0. Ten days after surgery, these mice had no detectable tumors, while mice that had undergone the traditional, non-image-guided surgery, had many residual tumors missed by the surgeon. By three weeks after the surgery, many of the tumors had grown back in the mice that underwent image-guided surgery, but those mice still had a median survival rate that was 40 percent longer than that of mice that underwent traditional surgery.

No other imaging system would be able to locate tumors that small during a surgical procedure, the researchers say. This optics-based imaging system allows us to do that in a safe manner," Bardhan says. For most ovarian cancer patients, tumor debulking surgery is followed by chemotherapy, so the researchers now plan to do another study where they treat the mice with chemotherapy after image-guided surgery, in hopes of preventing the remaining tiny tumors from spreading.

Nandy, R. Chen, R. Rais, I. Gonzalez, Q. Zhou, D. Chatterjee, M. Mutch, and Q.

Key points

Hysi, L. Wirtzfeld, J. May, E. Undzys, S. Li, and M. Valluru, K. Wilson, and J. Salehi, H. Li, A.

Diagnosis and Management of Ovarian Cancer

Merkulov, P. Kumavor, H. Vavadi, M. Sanders, A. Kueck, M. Brewer, and Q. Li, P. Kumavor, U. Salman Alqasemi, and Q. Feng, J. Perosky, K. Kozloff, G. Xu, Q. Cheng, S.

Tests for Ovarian Cancer

Du, J. Yuan, C. Deng, and X. Xu, Z. Meng, J. Lin, J. Yuan, P. Carson, B. Joshi, and X. Cox, J. Laufer, S. Arridge, and P. Wang and S. Kumon, C. Shaaban and M. Nossov, M. Amneus, F. Su, J. Lang, J. Janco, S. Reddy, and R. Can we really do better than serum CA? Van Calster, D. Timmerman, T. Bourne, A. While if one or more B features were present in the absence of an M feature, the mass would be classified as benign.

However, if both M features and B features were present, or if none of the features was present, the simple rules were considered inconclusive [ 20 ]. Sonographic characteristics of ovarian lesions based on simple ultrasound rules [ 18 , 19 ]. Colour Doppler can identify the presence of colour flow, within the papillary or solid components of an ovarian tumour and has good PPV for detecting malignancy. Nevertheless, the absence of colour flow in smaller lesions potentially causes falsely negative observations.

False positive findings of flow can also occur in ovarian cysts in the luteal phase in premenopausal women [ 21 ]. Although the introduction of power 3D Doppler has been able to increase the PPV of detecting malignancy; the availability of instruments and necessary expertise for interpretation has limited the use of this technique [ 23 ]. Several scoring systems have been suggested based on USS morphology of ovarian lesions to calculate and determine scores for malignancy [ 15 , 24 ].

The PPV of these systems are small because the morphology of many benign lesions overlaps with that of malignant disease [ 21 ]. Recently, some experiments have been conducted to evaluate the role of contrast-enhanced USS to help further characterise ovarian tumours [ 26 ].

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The meta-analysis of 10 studies revealed a pooled sensitivity of 0. The limitation of ultrasound is the low sensitivity for detection of peritoneal metastasis [ 28 ]. Furthermore, screening low-risk population by transvaginal ultrasound may incidentally detect indeterminate lesions and lead to unnecessary biopsies [ 29 ]. Therefore, it should not be considered as a standalone investigation to be used to screen the general population for OC. Computed tomography CT scan utilises ionising radiation photon beams of X-ray to create cross sectional images of the internal organs. CT scans can give detailed information regarding tumour extent and metastatic disease Figure 3.

Figure 3 is a multiplanar CT scan of a patient in axial, coronal and sagittal views, demonstrating a large ovarian cancer with intra-abdominal extension white arrow as well as gross ascites black arrow and thickened peritoneum consistent with metastasis red arrow. Multiplanar computed tomography scan demonstrating an ovarian cancer. The red arrow shows thickened peritoneum, black arrow shows gross ascites and white arrow shows a large adnexal mass. It is the preferred modality for the staging of OC and detection of recurrence because it is more widely available and less costly compared to magnetic resonance imaging MRI [ 30 ].

Contrast-enhanced CT CECT studies have an added advantage compared to low dose non-enhanced CT scans, as they enable improved delineation of anatomical structures, and increased sensitivity for detection of pathological lesions [ 32 ]. Spiral CT can improve the detection of peritoneal lesions and implants, in particular in those with concurrent ascites. Obtaining a CT before secondary debulking may aid in surgical planning and to assess the feasibility of achieving maximum resectability [ 34 ]. Contrast-enhanced CT scans CECT can detect the involvement of specific intra-abdominal sites recognised to reduce the chances of optimal debulking.

These sites include suprarenal aortic lymph nodes, disease in the root of the mesentery, portal triad disease, or bulky liver disease [ 35 ].

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Conversely, multidetector CECT scans often underestimates the extent of liver surface disease and infra-renal para-aortic lymph node involvement [ 36 ]. The reliability of CT assessment is also related to improvements in imaging techniques as well as scanner equipment and this can vary across different centres [ 37 ].

CECT provides improved contrast resolution in delineating suspicious adnexal masses [ 38 ]. CECT is helpful in characterising benign and malignant ovarian tumours by observation of certain characteristic features Table 2.

It can also help differentiate OC subtypes, albeit with some overlapping features, especially the commoner subtypes such as serous tumours. Serous tumours are usually unilocular but with multiple papillary projections and often present bilaterally [ 39 ]. Furthermore, peritoneal carcinomatosis is also seen more frequently in serous adenocarcinomas [ 40 ]. However, this can be solved by pre-surgical laparoscopic assessment. The detection of sub-diaphragmatic peritoneal deposits are also difficult, but can be aided by multiplanar reformatting of contrast-enhanced scans.

Magnetic resonance imaging MRI uses a high strength magnetic field and pulsed radiofrequency waves to generate images with excellent soft tissue detail. It does not utilise ionising radiation and is relatively safe to use. It commonly involves acquiring T1-weighted, T2-weighted, fat-saturation spin echo, and usually, includes post-gadolinium contrast-enhanced T1-weighted fat-saturation sequences for the pelvic region.

This protocol includes a full abdominal scan in three planes for the staging of ovarian cancer [ 41 ]. MRI and CT have been noted to be more sensitive than ultrasound for detection of peritoneal metastases. The improved soft tissue resolution achieved by MRI is able to better delineate the presence of pathological lymph nodes, both within the pelvic cavity as well as extra-pelvic spread.

However, its limitations are that it is rather costly, time-consuming and often difficult to interpret due to breathing and bowel movement artefacts. Therefore, the clinical utility of MRI is limited to evaluation of indeterminate pelvic lesions.

Ovarian Cancer Research | New Treatments for Ovarian Cancer

MRI can detect haemorrhagic lesions and enhancement in papillary projections, as well as identify the fatty tissue components within individual adnexal tumours. It can delineate ovarian lesions from uterine or urinary bladder involvement. MRI is also useful in cases where CECT is relatively contraindicated such as in the pregnant woman, in a patient with, a history of dye allergy or where giving iodinated contrast material is contraindicated, e. Hence, a non-contrast-enhanced MRI scan should be performed instead. MRI is able to differentiate simple ovarian cysts from malignant lesions with solid internal components.

Simple cysts return a low signal in the case of T1-weighted images and a high signal in T2-weighted images, whereas malignant lesions are often heterogeneous and show marked enhancement of its solid components.

  1. Epidemiology;
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  3. Diagnosis and Management of Ovarian Cancer - American Family Physician;
  4. MRI is best to delineate the local extent of the tumour as well as detect pelvic nodal metastases. Diffusion-weighted imaging measures the Brownian motion of extracellular water and thereby approximates tissue cellularity and fluid viscosity, hence malignant tumours that have increased cellularity will have restricted diffusion, thus giving lower apparent diffusion coefficient ADC values. It is considered by the European Society of Medical Oncology ESMO as an appropriate imaging modality to help in the selection of patients for secondary debulking surgery.

    Interestingly, elevated maximum standardised uptake values SUVmax are frequently detected in the ovaries in the luteal phase of the menstrual cycle. This is considered as normal physiological FDG metabolism and should not be mistaken for pathology.

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    It is recommended that the examination include a diagnostic contrast-enhanced computed tomography CECT scan by the administration of low osmolar iodinated contrast media. Apart from enabling attenuation correction, and anatomical localisation; CECT is essential for performing diagnostic clinical staging [ 1 ]. The combined images will be utilised for visual interpretation, tumour size and maximum standard uptake value SUVmax measurements.

    Regions commonly evaluated to detect nodal spread and distant metastases include the pelvic, abdominal and inguinal lymph nodes; the uterus, urinary bladder, peritoneum, omentum, bowel, liver, lungs and bones. Adnexal lesions frequently have a variable FDG uptake irrespective of their histopathological origin. For instance, mucinous carcinomas do not demonstrate avid FDG uptake compared to serous tumours [ 44 ]. It is postulated that indolent Type I and aggressive Type II ovarian cancers may arise from different cell lines [ 5 ]. Therefore, it can aid in the decision-making for primary debulking surgery followed by platinum-based chemotherapy as opposed to treatment using neoadjuvant chemotherapy.