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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin 2024;74:12-49. Review/Other-Dx N/A Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes using incidence data collected by central cancer registries (through 2020) and mortality data collected by the National Center for Health Statistics (through 2021). In 2024, 2,001,140 new cancer cases and 611,720 cancer deaths are projected to occur in the United States. Cancer mortality continued to decline through 2021, averting over 4 million deaths since 1991 because of reductions in smoking, earlier detection for some cancers, and improved treatment options in both the adjuvant and metastatic settings. However, these gains are threatened by increasing incidence for 6 of the top 10 cancers. Incidence rates increased during 2015-2019 by 0.6%-1% annually for breast, pancreas, and uterine corpus cancers and by 2%-3% annually for prostate, liver (female), kidney, and human papillomavirus-associated oral cancers and for melanoma. Incidence rates also increased by 1%-2% annually for cervical (ages 30-44 years) and colorectal cancers (ages <55 years) in young adults. Colorectal cancer was the fourth-leading cause of cancer death in both men and women younger than 50 years in the late-1990s but is now first in men and second in women. Progress is also hampered by wide persistent cancer disparities; compared to White people, mortality rates are two-fold higher for prostate, stomach and uterine corpus cancers in Black people and for liver, stomach, and kidney cancers in Native American people. Continued national progress will require increased investment in cancer prevention and access to equitable treatment, especially among American Indian and Alaska Native and Black individuals. No results stated in abstract. 4
2. NCCN Clinical Practice Guidelines in Oncology. Ovarian Cancer, Including Fallopian Tube Cancer and Primary Peritoneal Cancer. Version 2.2024.  Available at: https://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf. Review/Other-Dx N/A Practice guideline for ovarian cancer. No abstract available. 4
3. Kurman RJ, Shih Ie M. The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory. Am J Surg Pathol. 2010;34(3):433-443. Review/Other-Dx N/A To discuss the origin and pathogenesis of epithelial ovarian cancer - a proposed unifying theory. No results stated in abstract. 4
4. Gadducci A, Fuso L, Cosio S, et al. Are surveillance procedures of clinical benefit for patients treated for ovarian cancer?: A retrospective Italian multicentric study. Int J Gynecol Cancer. 2009; 19(3):367-374. Review/Other-Dx 412 patients Retrospective study to assess the pattern of failures of patients with recurrent ovarian cancer followed up with different surveillance protocols. Symptoms at relapse were referred by 81 women (19.7%). Among the 331 asymptomatic patients, the surveillance procedure that raised the suspect of recurrent disease was clinical examination in 49 (14.8%), imaging technique in 90 (27.2%), serum CA-125 in 77 (23.3%), and both serum CA-125 and imaging technique in 115 (34.7%). At univariate analysis, survival from initial diagnosis was related to stage (P=0.004), residual disease after initial surgery (P<0.0001), time to recurrence (P<0.0001), site of relapse (P=0.04), and treatment at recurrence (P<0.0001), and survival after recurrence was related to stage (P=0.01), residual disease (P<0.0001), time to recurrence (P<0.0001), and treatment at recurrence (P<0.0001). Conversely, symptoms at recurrence had no prognostic relevance. Cox proportional hazards model showed that residual disease and time to recurrence were the only independent prognostic variables for both survival from initial diagnosis (P<0.0001) and survival after recurrence (P<0.0001). There was no survival difference between asymptomatic and symptomatic patients at the time of relapse, and therefore, the diagnostic anticipation allowed by a scheduled follow-up protocol did not seem to improve the clinical outcome of patients who ultimately developed recurrent disease. 4
5. Lutz AM, Willmann JK, Drescher CW, et al. Early diagnosis of ovarian carcinoma: is a solution in sight? Radiology. 2011; 259(2):329-345. Review/Other-Dx N/A To review serum biomarkers and imaging tests for the early detection of ovarian cancer and provide an outlook on the potential improvements in these noninvasive diagnostic tools that may lead to successful implementation in a screening program. TVUS is an already established first-line imaging modality in the diagnostic work-up of ovarian lesions and is therefore widely available. TVUS costs less than other imaging modalities, has reasonable diagnostic performance, and has the potential for improving sensitivity and specificity with the application of molecularly targeted microbubbles. These facts render US the most likely imaging tool to be successful for screening purposes. 4
6. Chandrashekhara SH, Thulkar S, Srivastava DN, et al. Pre-operative evaluation of peritoneal deposits using multidetector computed tomography in ovarian cancer. Br J Radiol. 2011; 84(997):38-43. Observational-Dx 38 patients Prospective study to evaluate the role of MDCT in identifying peritoneal deposits pre-operatively. Sensitivity, specificity, positive and negative predictive values and accuracy of CT in the detection of peritoneal deposits were similar to those reported in the literature. The most common anatomical sites to have peritoneal deposits were the pouch of Douglas (18 cases) and the right subdiaphragmatic region (18 cases). Despite the improved scanning technology, image reconstruction and viewing ability of MDCT, its overall accuracy for the detection of peritoneal deposits is not significantly improved when compared with conventional CT; however, MDCT is useful in the assessment of disease at specific locations in the abdomen and pelvis. 3
7. Jeong YY, Outwater EK, Kang HK. Imaging evaluation of ovarian masses. [Review] [175 refs]. Radiographics. 20(5):1445-70, 2000 Sep-Oct. Review/Other-Dx N/A Review values of US, CT, and MRI in the evaluation of suspected ovarian neoplasms in various clinical settings. CT, US, and MRI have similar accuracy for staging ovarian cancer, but CT is used before and after cytoreductive surgery. 4
8. Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST. CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Radiographics. 2002; 22(6):1305-1325. Review/Other-Dx N/A Review typical and atypical CT and MRI findings in ovarian tumors with emphasis on differential diagnosis. Imaging features can distinguish specific types of ovarian tumors. 4
9. Liu J, Xu Y, Wang J. Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis of ovarian carcinoma. Eur J Radiol. 2007; 62(3):328-334. Meta-analysis 69 studies with 6,364 patients; 2 observers Meta-analysis was performed to compare US, CT, and MRI in differentiation of malignant from benign ovarian tumors. Results suggest that US techniques seems to be similar with CT and MRI in differentiation of malignant from benign ovarian tumors. The results also revealed that color Doppler flow imaging alone is significantly inferior to combined US techniques, morphologic assessment alone and contrast enhanced US in diagnosis of ovarian cancer. US morphologic assessment still is the most important and common modality in detecting ovarian cancer. Inadequate
10. Rettenmaier NB, Rettenmaier CR, Wojciechowski T, et al. The utility and cost of routine follow-up procedures in the surveillance of ovarian and primary peritoneal carcinoma: a 16-year institutional review. Br J Cancer. 2010; 103(11):1657-1662. Observational-Dx 287 patients Retrospective study to evaluate the number of ovarian cancer and primary peritoneal cancer progressive disease cases identified via routine follow-up procedures and the corresponding cost throughout a 16-year period at a single medical institution. In the group of 287 patients, there were 151 cases of disease progression. Serial imaging detected the highest number of progressive disease cases (66 initial and 45 confirmatory diagnoses), but the cost was high ($13,454 per patient recurrence), whereas CA-125 testing (74 initial and 20 corroborative diagnoses) was the least expensive ($3,924) per recurrent diagnosis. The total cost of surveillance during the 16-year period was nearly $2,400,000. Ultimately, serial imaging and the CA-125 assay detected the highest number of ovarian cancer and peritoneal carcinomatosis progressive disease cases in comparison to physical examination and vaginal cytology, but nevertheless, all of the procedures were conducted at a considerable financial expense. 3
11. Son H, Khan SM, Rahaman J, et al. Role of FDG PET/CT in staging of recurrent ovarian cancer. Radiographics. 2011; 31(2):569-583. Review/Other-Dx N/A Review role of FDG-PET combine with CT in staging of recurrent ovarian cancer. FDG-PET combined with CT is useful for detection of recurrent or residual ovarian cancer and for monitoring response to therapy. However, PET/CT may yield false-negative results in patients with small, necrotic, mucinous, cystic, or low-grade tumors. In addition, in the post-therapy setting, inflammatory and infectious processes may lead to false-positive PET/CT results. Despite these drawbacks, PET/CT is superior to CT and MRI for depiction of recurrent disease. 4
12. Castellani F, Nganga EC, Dumas L, Banerjee S, Rockall AG. Imaging in the pre-operative staging of ovarian cancer. [Review]. Abdominal Radiology. 44(2):685-696, 2019 02. Review/Other-Dx N/A The main prognostic factor in ovarian cancer is the stage of disease at diagnosis. No results stated in abstract. 4
13. Schmidt S, Meuli RA, Achtari C, Prior JO. Peritoneal carcinomatosis in primary ovarian cancer staging: comparison between MDCT, MRI, and 18F-FDG PET/CT. Clinical nuclear medicine 2015;40:371-7. Observational-Dx 15 women To compare multidetector CT (MDCT), MRI, and FDG PET/CT imaging for the detection of peritoneal carcinomatosis (PC) in ovarian cancer. Ten women had PC (67%). Altogether, 135 abdominopelvic sites were compared. Multidetector CT, MRI, and FDG PET/CT had a sensitivity of 96%, 98%, and 95%, and specificity was 92%, 84%, and 96%, respectively. Corresponding receiver operating characteristics area was 0.94, 0.90, and 0.96, respectively, without any significant differences between them (P = 0.12). FDG PET/CT detected supradiaphragmatic disease in 3 women (20%) not seen by MDCT or MRI. 2
14. Forstner R, Hricak H, Occhipinti KA, Powell CB, Frankel SD, Stern JL. Ovarian cancer: staging with CT and MR imaging. Radiology. 1995; 197(3):619-626. Observational-Dx 82 women underwent CT (n=43) or MRI (n=50); 11 of these 82 underwent both Prospective, comparative study to evaluate ovarian cancer staging and tumor resectability with CT or MRI. Staging accuracy was similar for CT and MRI: (77% [33/43] vs 78% [39/50]). For CT, the PPV for cancer nonresectability was 100%; the NPV was 92% (37 of 40 patients). The PPV and NPV for MRI were 91% (10/11 patients) and 97% (38/39 patients). Prediction of tumor resectability is excellent for both CT and MRI. 3
15. Ghossain MA, Buy JN, Ligneres C, et al. Epithelial tumors of the ovary: comparison of MR and CT findings. Radiology. 1991; 181(3):863-870. Observational-Dx 40 patients with 50 ovarian epithelial tumors of the ovary Retrospective study to compare CT with MR in ovarian epithelial tumors. Accuracy for overall characterization of benign vs malignant tumors was 86% with MRI and 92% with CT. There was no difference in sensitivity (P=1) or specificity (P=.5). 3
16. 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;131:389-94. Observational-Dx 41 women To compare (18)F-fluorodeoxyglucose (FDG) positron emission tomography/contrast-enhanced computed tomography (PET/CT) to contrast-enhanced CT for the detection of dissemination into the abdominal cavity preventing successful primary debulking surgery. FDG-PET/CT was superior to conventional CT for the detection of carcinomatosis in subdiaphragmatic peritoneal surfaces (p=0.020) and in the bowel mesentery (p=0.001). Patient-based analysis of upper abdominal areas requiring extensive surgical procedures showed no significant differences between the two imaging methods. The sensitivity of PET/CT and CT was poor in certain areas of the peritoneal cavity (64% vs. 27% in the small bowel mesentery and 65% vs. 55% in the right upper abdomen). Extra-abdominal disease spread was detected by PET/CT in 32 patients and by CT in 25 patients. 2
17. Pannu HK, Horton KM, Fishman EK. Thin section dual-phase multidetector-row computed tomography detection of peritoneal metastases in gynecologic cancers. J Comput Assist Tomogr. 2003; 27(3):333-340. Observational-Dx 17 women; 2 observers Retrospectively review CT scans to determine the sensitivity, specificity, and accuracy of MDCT in detection of peritoneal implants from ovarian cancer. Sensitivity, specificity, and accuracy are improved using MDCT compared to axial CT imaging. Specificities nearly 100% for most sites of disease. Accuracy >80% for all sites except diaphragm and pelvis. 2
18. Griffin N, Grant LA, Freeman SJ, et al. Image-guided biopsy in patients with suspected ovarian carcinoma: a safe and effective technique? Eur Radiol. 2009; 19(1):230-235. Observational-Dx 60 consecutive image-guided percutaneous biopsies To determine the diagnostic accuracy and complication rate of percutaneous biopsies performed under US or CT guidance. 47 patients had omental biopsies, 12 pelvic mass biopsies, and 1 para-aortic lymph node biopsy. 35 biopsies were performed under US, 25 under CT guidance. Biopsy needle gauges ranged from 14-20 swg with two to five passes for each patient. There were no complications. Histology was obtained in 52 (87%) patients. Percutaneous image-guided biopsy of peritoneal disease or pelvic mass is safe with high diagnostic accuracy. The large-gauge biopsy needle is as safe as the small gauge needle, but has the added value of obtaining tissue samples for immunohistochemistry and genomic studies. 3
19. Hewitt MJ, Anderson K, Hall GD, et al. Women with peritoneal carcinomatosis of unknown origin: Efficacy of image-guided biopsy to determine site-specific diagnosis. BJOG. 2007; 114(1):46-50. Observational-Dx 149 consecutive women Retrospective study to evaluate the use of image-guided biopsy in routine clinical practice to obtain site-specific diagnoses in women presenting with peritoneal carcinomatosis. In 138 (93%) women, a site-specific cancer diagnosis was made on the image-guided biopsy (including 111 müllerian tract, 8 gastrointestinal tract, 4 breast and 3 lymphoma); in ten women, a repeat biopsy was necessary, giving an overall failure rate of 7%. In a further 6 women, malignancy was confirmed but a site-specific diagnosis could not be made, and in four women, biopsy showed benign tissue. A site-specific diagnosis was obtained in 29 of the 32 women (94%) with previous malignancy, of which 18/32 (56%) showed a new primary cancer. Image-guided biopsy is a safe and accurate technique for providing site-specific diagnoses in women with peritoneal carcinomatosis in routine clinical practice, including those with a previous relevant malignancy. Image-guided biopsy can replace laparoscopic or open biopsy in defining primary therapeutic options. 3
20. Souza FF, Mortele KJ, Cibas ES, Erturk SM, Silverman SG. Predictive value of percutaneous imaging-guided biopsy of peritoneal and omental masses: results in 111 patients. AJR. 2009; 192(1):131-136. Observational-Dx 111 patients Retrospective study to determine the predictive value of percutaneous imaging-guided biopsy of peritoneal and omental masses. Overall diagnostic rate was 89% (99/111); there were 86 true-positive, one false-positive, six true-negative, and six false-negative results (sensitivity, 93% [86/92]; specificity, 86% [6/7]; NPV, 50% [6/12]). There were no statistically significant differences between patients with and without known cancer. Among 79 patients with known cancer, 52 (66%) had metastatic disease from the known cancer; in eight (10%) patients, the biopsy result yielded new primary cancers. Of 32 patients with no known cancer, 23 (72%) had malignant results. Biopsy test characteristics did not differ with respect to mass or needle size. Minor complications were seen in three (3%) patients. Percutaneous imaging-guided biopsy of peritoneal and omental masses is a safe, effective procedure that is useful in clinical practice. A second malignancy was revealed in a substantial number of patients with a known primary cancer. A new malignancy was diagnosed in most patients without a history of cancer. 3
21. Spencer JA, Weston MJ, Saidi SA, Wilkinson N, Hall GD. Clinical utility of image-guided peritoneal and omental biopsy. Nat Rev Clin Oncol. 2010; 7(11):623-631. Review/Other-Dx N/A Review clinical applications of image-guided core biopsy and omental biopsy and examine the currently available alternative options. With current clinical trials for ovarian cancer directed to specific morphological subtypes of the disease, image-guided core biopsy offers a rapid and well tolerated nonsurgical means of providing this information. 4
22. Mironov O, Ishill NM, Mironov S, et al. Pleural effusion detected at CT prior to primary cytoreduction for stage III or IV ovarian carcinoma: effect on survival. Radiology. 258(3):776-84, 2011 Mar. Observational-Dx 203 patients stage III (n=172) or IV (n=31) Retrospective study to determine the prognostic importance of pleural effusions on preoperative CT images in patients with advanced epithelial ovarian cancer. Median survival was 50 months (95% CI: 45, 55 months) for patients with stage III disease and 41 months (95% CI: 27, 58 months) for patients with stage IV disease. Readers 1 and 2 found pleural effusions in 40 and 41 stage III and 20 and 21 stage IV patients, respectively. At multivariate analysis, after controlling for stage, age at surgery, preoperative serum CA-125 level, debulking status, and ascites, moderate-to-large pleural effusion on CT images was significantly associated with worse overall survival (reader 1: HR = 2.27 [95% CI: 1.31, 3.92], P<.01; reader 2: HR = 2.25 [95% CI: 1.26, 4.01], P=.02). Preoperative CA-125 level, debulking status, and ascites were also significant survival predictors (P=.03 for all for both readers). Readers agreed substantially in distinguishing small from moderate-to-large effusions (? = 0.764). Moderate-to-large pleural effusion on preoperative CT images in patients with stage III or IV epithelial ovarian cancer was independently associated with poorer overall survival after controlling for age, preoperative CA-125 level, surgical stage, ascites, and cytoreductive status. 2
23. Wilson MP, Sorour S, Bao B, et al. Diagnostic accuracy of contrast-enhanced CT versus PET/CT for advanced ovarian cancer staging: a comparative systematic review and meta-analysis. Abdom Radiol (NY) 2024. Meta-analysis 3701 citations, 15 studies (918 patients with mean age ranging from 51 to 65 years) Accurate staging of ovarian cancer is critical to guide optimal management pathways. From 3701 citations, 15 studies (918 patients with mean age ranging from 51 to 65 years) were included in the systematic review. Twelve studies evaluated contrast-enhanced CT (6 using a per-patient assessment and 6 using a per-region assessment) and 11 studies evaluated PET/CT (7 using a per-patient assessment and 4 using a per-region assessment). All but one reporting study used consensus reading. Respective sensitivity and specificity values on a per-patient basis were 82% (67-91%, 95% CI) and 72% (59-82%) for contrast-enhanced CT and 87% (75-94%) and 90% (82-95%) for PET/CT. There was no significant difference in sensitivities between modalities (p = 0.29), but PET/CT was significantly more specific than CT (p < 0.01). Presumed variability could not be assessed in any single category due to limited studies using per-patient assessment. Studies were almost entirely low risk for bias and applicability concerns using QUADAS-2. Not Assessed
24. Queiroz MA, Kubik-Huch RA, Hauser N, et al. PET/MRI and PET/CT in advanced gynaecological tumours: initial experience and comparison. European Radiology. 25(8):2222-30, 2015 Aug. Observational-Dx 26 patients To compare the diagnostic accuracy of PET/MRI and PET/CT for staging and re-staging advanced gynaecological cancer patients as well as identify the potential benefits of each method in such a population. Eighteen (69.2 %) patients underwent PET/MRI for primary staging and eight patients (30.8 %) for re-staging their gynaecological malignancies. For primary tumour delineation, PET/MRI accuracy was statistically superior to PET/CT (p?<?0.001). Among the different types of cancer, PET/MRI presented better tumour delineation mainly for cervical (6/7) and endometrial (2/3) cancers. PET/MRI for local evaluation as well as PET/CT for extra-abdominal metastases had therapeutic consequences in three and one patients, respectively. PET/CT detected 12 extra-abdominal distant metastases in 26 patients. 3
25. Tsuyoshi H, Tsujikawa T, Yamada S, Okazawa H, Yoshida Y. Diagnostic value of [18F]FDG PET/MRI for staging in patients with ovarian cancer. EJNMMI Research. 10(1):117, 2020 Oct 02. Observational-Dx 103 patients To evaluate the diagnostic potential of PET/MRI with 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) in ovarian cancer. Accuracy for the characterization of suspected ovarian cancer was significantly better for [18F]FDG PET/MRI (92.5%) [95% confidence interval (CI) 0.84-0.95] than for ceMRI (80.6%) (95% CI 0.72-0.83) (p < 0.05). Accuracy for T status was 96.4% (95% CI 0.96-0.96) and 92.9% (95% CI 0.93-0.93) for [18F]FDG PET/MRI and ceMRI/ceCT, respectively. Patient-based accuracies for N and M status were 100% (95% CI 0.88-1.00) and 100% (95% CI 0.88-1.00) for [18F]FDG PET/MRI and 85.2% (95% CI 0.76-0.85) and 30.8% (95% CI 0.19-0.31) for ceCT and M staging representing significant differences (p < 0.01). Lesion-based sensitivity, specificity and accuracy for N status were 78.6% (95% CI 0.57-0.91), 95.7% (95% CI 0.93-0.97) and 93.9% (95% CI 0.89-0.97) for [18F]FDG PET/MRI and 42.9% (95% CI 0.24-0.58), 96.6% (95% CI 0.94-0.98) and 90.8% (95% CI 0.87-0.94) for ceCT. 3
26. Zheng M, Xie D, Pan C, Xu Y, Yu W. Diagnostic value of 18F-FDG PET/MRI in recurrent pelvis malignancies of female patients: a systematic review and meta-analysis. [Review]. Nuclear Medicine Communications. 39(6):479-485, 2018 Jun. Meta-analysis 7 studies; 256 patients To assess the diagnostic performance of fluorine-18-fluorodeoxyglucose (F-FDG) PET/MRI for suspected recurrence of pelvis malignancies of female patients using a meta-analysis. On patient-based analysis, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of F-FDG PET/MRI in detecting recurrence of pelvis malignancies were 0.96 [95% confidence interval (CI): 0.93-0.99], 0.95 (95% CI: 0.87-0.99), 9.85 (95% CI: 4.62-21.00), 0.07 (95% CI: 0.04-0.13), and 201.41 (95% CI: 62.89-645.03), respectively. On lesion-based analysis, the corresponding estimates were 0.99 (95% CI: 0.97-1.00), 0.94 (95% CI: 0.89-0.97), 17.11 (95% CI: 4.46-65.60), 0.02 (95% CI: 0.01-0.05), and 1125.24 (95% CI: 211.46-5987.79), respectively. Good
27. Tarcha Z, Konstantinoff KS, Ince S, et al. Added Value of FDG PET/MRI in Gynecologic Oncology: A Pictorial Review. [Review]. Radiographics. 43(8):e230006, 2023 08. Review/Other-Dx N/A To discuss the added value of FDG PET/MRI in imaging gynecologic malignancies of the pelvis, with a focus on the role of FDG PET/MRI in diagnosis, staging, assessing treatment response, and characterizing complications. No results stated in abstract. 4
28. Mironov S, Akin O, Pandit-Taskar N, Hann LE. Ovarian cancer. Radiol Clin North Am. 2007; 45(1):149-166. Review/Other-Dx N/A Review imaging findings of patients with ovarian cancer. Multimodality approach is useful in patients with ovarian cancer, but success is dependent on available resources and on the skills of the physicians involved. 4
29. Woodward PJ, Hosseinzadeh K, Saenger JS. From the archives of the AFIP: radiologic staging of ovarian carcinoma with pathologic correlation. Radiographics. 2004; 24(1):225-246. Review/Other-Dx N/A Review the use of CT and MRI for preoperative staging of ovarian cancer. Imaging can affect choice of treatment and enable optimal debulking of ovarian cancer, but no imaging modality can demonstrate clinically important microscopic disease. 4
30. Low RN, Barone RM. Combined diffusion-weighted and gadolinium-enhanced MRI can accurately predict the peritoneal cancer index preoperatively in patients being considered for cytoreductive surgical procedures. Ann Surg Oncol 2012;19:1394-401. Observational-Dx 33 patients To determine whether abdominal and pelvic magnetic resonance imaging (MRI) with diffusion-weighted and dynamic gadolinium-enhanced imaging can be used to accurately calculate the peritoneal cancer index (PCI) before surgery compared to the PCI tabulated at surgery. There was no significant difference between the MRI PCI and surgical PCI for the 33 patients (P = 0.12). MRI correctly predicted the PCI category in 29 (0.88) of 33 patients. Compared to surgical findings, MRI correctly predicted small-volume tumor in 6 of 7 patients, moderate-volume tumor in 3 of 4 patients, and large-volume tumor in 20 of 22 patients. MRI and surgical PCI scores were identical in 8 patients (24%). A difference of <5 was noted in 16 patients (49%) and of 5-10 in 9 patients (27%). Compared to surgical-site findings, MRI depicted 258 truly positive sites of peritoneal tumor, 35 falsely negative sites, 35 falsely positive sites, and 101 truly negative sites, with a corresponding sensitivity of 0.88, specificity of 0.74, and accuracy of 0.84. 3
31. Tempany CM, Zou KH, Silverman SG, Brown DL, Kurtz AB, McNeil BJ. Staging of advanced ovarian cancer: comparison of imaging modalities--report from the Radiological Diagnostic Oncology Group. Radiology 2000;215:761-7. Observational-Dx 118 patients To compare ultrasonography (US), magnetic resonance (MR) imaging, and computed tomography (CT) for diagnosing and staging advanced ovarian cancer. There were 118 patients with malignant tumors; 73 (62%) had stage III or IV disease. Metastases were found in the peritoneum in 70 (59%), nodes in 20 (17%), and liver in seven (6%) cases. In the peritoneum, MR imaging and CT (A(z) = 0.96 for both) were more accurate than US (A(z) = 0.86), especially in the subdiaphragmatic spaces and hepatic surfaces. MR imaging and CT were more sensitive than US (95%, 92%, and 69%, respectively) for peritoneal metastases. MR imaging was more accurate than CT for detection of lymph node metastases (A(z) = 0.76 vs 0.57, P =.04). In the liver, the A(z) values for the three modalities were 0.77-0.94. 1
32. Luis Alcazar J, Ramon Perez-Vidal J, Tameish S, Chacon E, Manzour N, Angel Minguez J. Ultrasound for assessing tumor spread in ovarian cancer. A systematic review of the literature and meta-analysis. [Review]. European Journal of Obstetrics, Gynecology, & Reproductive Biology. 292:194-200, 2024 Jan. Observational-Dx 5 studies 822 women To assess the diagnostic performance of ultrasound for assessing the tumor spread in the abdomen in women with ovarian cancer. Quality of studies were considered as good, except for patient selection as all studies were considered as having high risk of bias. The pooled sensitivity and specificity could be calculated for three anatomical areas (recto-sigma, major omentum and root of mesentery) and the presence of ascites. The pooled sensitivity and specificity for detecting disease in the recto-sigma, major omentum and root of mesentery were 0.83 and 0.95, 0.87 and 0.87, and 0.29 and 0.99, respectively. The pooled sensitivity and specificity for detecting ascites was 0.95 and 0.91, respectively. There is evidence that ultrasound offers good diagnostic performance for evaluating the intra-abdominal extent of disease in women with suspected ovarian cancer. 3
33. Alcazar JL, Caparros M, Arraiza M, et al. Pre-operative assessment of intra-abdominal disease spread in epithelial ovarian cancer: a comparative study between ultrasound and computed tomography. International Journal of Gynecological Cancer. 29(2):227-233, 2019 Feb. Observational-Dx 93 patients To compare the diagnostic performance of ultrasound and computed tomography (CT) for detecting pelvic and abdominal tumor spread in women with epithelial ovarian cancer. The tumorous stage was International Federation of Gynecology and Obstetrics (FIGO) stage I in 26 cases, stage II in 11 cases, stage III in 47 cases, and stage IV in nine cases. Excluding stages I and IIA cases (n=30), R0 (no macroscopic residual disease) was achieved in 36 women (62.2%), R1 (macroscopic residual disease <1 cm) was achieved in 13 women (25.0%), and R2 (macroscopic residual disease >1 cm) debulking surgery occurred in three women (5.8%). Eleven patients (11.8%) were considered not suitable for optimal debulking surgery during laparoscopic assessment. Overall sensitivity of ultrasound and CT for detecting disease was 70.3% and 60.1%, respectively, and specificity was 97.8% and 93.7%, respectively. The agreement between radiological stage and surgical stage for ultrasound (kappa index 0.69) and CT (kappa index 0.70) was good for both techniques. Overall accuracy to determine tumor stage was 71% for ultrasound and 75% for CT. 3
34. Conway C, Zalud I, Dilena M, et al. Simple cyst in the postmenopausal patient: detection and management. J Ultrasound Med. 17(6):369-72; quiz 373-4, 1998 Jun. Review/Other-Dx 1769 postmenopausal women To determine the prevalence of simple ovarian cysts in asymptomatic postmenopausal women and natural history of these cysts on follow-up US. Simple ovarian cysts are more common in postmenopausal women than previously thought and can be followed conservatively; unlikely to be malignant. 4
35. Forstner R, Sala E, Kinkel K, Spencer JA. ESUR guidelines: ovarian cancer staging and follow-up. [Review]. European Radiology. 20(12):2773-80, 2010 Dec. Review/Other-Dx N/A To design clear guidelines for the staging and follow-up of patients with ovarian cancer, and to provide the radiologist with a framework for use in multidisciplinary conferences. No results stated in abstract. 4
36. Ponisio MR, Fowler KJ, Dehdashti F. The Emerging Role of PET/MR Imaging in Gynecologic Cancers. [Review]. Pet Clinics. 11(4):425-40, 2016 Oct. Review/Other-Dx N/A To summarizes recent advances in PET/MR imaging in gynecologic cancers. No results stated in abstract. 4
37. Gadducci A, Cosio S. Surveillance of patients after initial treatment of ovarian cancer. Crit Rev Oncol Hematol 2009;71:43-52. Review/Other-Dx N/A The surveillance of ovarian cancer patients after initial treatment is a challenging question in clinical practice. No results stated in abstract. 4
38. Salani R, Khanna N, Frimer M, Bristow RE, Chen LM. An update on post-treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology (SGO) recommendations. Gynecologic Oncology. 146(1):3-10, 2017 07. Review/Other-Dx N/A To provide an update on surveillance for gynecologic cancer recurrence in women who have had a complete response to primary cancer therapy. No results stated in abstract. 4
39. Sala E, Mannelli L, Yamamoto K, et al. The value of postoperative/preadjuvant chemotherapy computed tomography in the management of patients with ovarian cancer. Int J Gynecol Cancer. 2011;21(2):296-301. Observational-Tx 206 patients To compare the operative assessment of residual disease with the postoperative computed tomography (CT) findings in patients with ovarian cancer who underwent primary surgical cytoreduction or interval debulking surgery to residual disease 1 cm or less and to assess the effect of potential prognostic factors on patient survival. Between September 2005 and December 2008, 206 consecutive patients were enrolled; 51 were eligible. In 30 cases (59%), the postoperative CT findings correlated with the surgeon's assessment of residual disease. For the univariate analyses, the only significant prognostic factors associated with overall survival were no residual disease versus residual disease of less than 1 cm as assessed by the surgeon (hazard ratio [HR], 3.06; 95%confidence interval [CI], 1.29--7.27; P = 0.011) and no residual disease versus residual disease greater than 1 cm on CT (HR, 2.57; 95% CI, 1.02--6.48; P = 0.045). The interaction of surgical residual disease and stage 3 was significant (HR, 3.40; 95% CI, 1.42--8.16;P = 0.006) in the multivariate Cox model. 2
40. Tanner EJ, Chi DS, Eisenhauer EL, Diaz-Montes TP, Santillan A, Bristow RE. Surveillance for the detection of recurrent ovarian cancer: survival impact or lead-time bias? Gynecol Oncol 2010;117:336-40. Observational-Dx 121 patients To compare the survival impact of diagnosing recurrent disease by routine surveillance testing versus clinical symptomatology in patients with recurrent epithelial ovarian cancer (EOC) who have achieved a complete response following primary therapy. Of the 121 patients that met inclusion criteria, 22 (18.2%) were diagnosed with a symptomatic recurrence. Median primary PFS was similar for asymptomatic and symptomatic patients (24.8 versus 22.6 months, P = 0.36); however, post-recurrence survival was significantly greater in asymptomatic patients (45.0 versus 29.4 months, P = 0.006). Secondary cytoreductive surgery (SCRS) was attempted equally in both groups (41% versus 32%, P = NS); however, optimal residual disease (<or=5mm) was more often achieved in asymptomatic patients (90% versus 57%, P = 0.053). On multivariate analysis, detection of asymptomatic recurrence was a significant and independent predictor of improved overall survival (P = 0.001). Median OS was significantly greater for asymptomatic patients (71.9 versus 50.7 months, P = 0.004). 4
41. Kitajima K, Murakami K, Yamasaki E, et al. Performance of integrated FDG-PET/contrast-enhanced CT in the diagnosis of recurrent ovarian cancer: comparison with integrated FDG-PET/non-contrast-enhanced CT and enhanced CT. Eur J Nucl Med Mol Imaging. 2008;35(8):1439-1448. Observational-Dx 132 patients To evaluate the accuracy of integrated positron emission tomography and computed tomography (PET/CT) using (18)F-fluorodeoxyglucose with IV contrast for depiction of suspected recurrent ovarian cancer and to assess the impact of PET/contrast-enhanced CT findings on clinical management, compared with PET/non-contrast-enhanced CT and CT component. Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/contrast-enhanced CT were 78.8% (52 of 66), 90.9% (60 of 66), and 84.8% (112 of 132), respectively, whereas those of PET/non-contrast-enhanced CT were 74.2% (49 of 66), 90.9% (60 of 66), and 82.6% (109 of 132), respectively, and those of enhanced CT were 60.6% (40 of 66), 84.8% (56 of 66), and 72.7% (96 of 132), respectively. Sensitivity, specificity, and accuracy differed significantly among the three modalities (Cochran Q test: p = 0.0001, p = 0.018, and p < 0.0001, respectively). The findings of PET/contrast-enhanced CT resulted in a change of management for 51 of the 132 patients (39%) and had an effect on patient management in 16 patients (12%) diagnosed by enhanced CT alone and three patients (2%) diagnosed by PET/non-contrast-enhanced CT. 3
42. Meyer JI, Kennedy AW, Friedman R, Ayoub A, Zepp RC. Ovarian carcinoma: value of CT in predicting success of debulking surgery. AJR. 1995; 165(4):875-878. Observational-Dx 28 women Retrospective study to determine the value of CT in predicting the success of debulking surgery in ovarian cancer. 10-point preoperative CT scoring system, a score of =3 identified patients whose tumors were not successfully debulked with a sensitivity of 58% (7/12) and a specificity of 100% (16/16). Study shows CT can be used to predict the success of PDS in women with metastatic ovarian carcinoma. 3
43. Tawakol A, Abdelhafez YG, Osama A, Hamada E, El Refaei S. Diagnostic performance of 18F-FDG PET/contrast-enhanced CT versus contrast-enhanced CT alone for post-treatment detection of ovarian malignancy. Nuclear Medicine Communications. 37(5):453-60, 2016 May. Observational-Dx 111 patients To evaluate the diagnostic performance of combined fluorine-18 fluorodeoxyglucose (F-FDG) positron emission tomography (PET)/contrast-enhanced computed tomography (Ce-CT) in comparison with Ce-CT alone for the detection of residual/recurrent tumor after initial treatment of malignant ovarian tumors. Of the 136 studies evaluated, 97 (71%) studies had recurrent/residual disease and 39 (29%) studies were disease free on the basis of the final diagnosis. F-FDG PET/Ce-CT and Ce-CT had a sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of 96 versus 84%, 92 versus 59%, 90 versus 59%, 97 versus 84%, and 95 versus 76%, respectively. F-FDG PET/Ce-CT was significantly more sensitive, specific, and accurate compared with Ce-CT, with P-values of 0.002, 0.001, and less than 0.0001, respectively. Site-based analyses also showed significant differences. 3
44. Wang X, Yang L, Wang Y. Meta-analysis of the diagnostic value of 18F-FDG PET/CT in the recurrence of epithelial ovarian cancer. Frontiers in Oncology. 12:1003465, 2022. Meta-analysis 17 studies (639 patients) To summarize relevant studies and evaluate the accuracy and application value of 18F-FDG PET/CT in the diagnosis of recurrence of epithelial ovarian cancer. A total of 17 studies on 18F-FDG PET/CT for the diagnosis of epithelial ovarian cancer recurrence were included in this systematic review, involving 639 patients with epithelial ovarian cancer. Meta-analysis showed that the sensitivity, specificity and area under the curve of 18F-FDG PET/CT for the diagnosis of epithelial ovarian cancer recurrence were 0.88 (95% CI: 0.79 - 0.93), 0.89 (95% CI: 0.72 - 0.96) and 0.94 (95% CI: 0.91- 0.96), respectively. Subgroup analysis showed higher diagnostic efficacy in prospective studies than in retrospective studies, and no significant publication bias was observed in Deeks’ funnel plot, with sensitivity analysis revealing the stability of results. Meta regression shows that the heterogeneity of this study comes from study type. Good
45. Salani R, Backes FJ, Fung MF, et al. Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. [Review]. American Journal of Obstetrics & Gynecology. 204(6):466-78, 2011 Jun. Review/Other-Tx N/A To review the most recent data on surveillance for gynecologic cancer recurrence in women who have had a complete response to primary cancer therapy. Although gynecologic cancers account for only 10% of all new cancer cases in women, these cancers account for 20% of all female cancer survivors. Improvements in cancer care have resulted in almost 10 million cancer survivors, and this number is expected to grow. Therefore, determining the most cost-effective clinical surveillance for detection of recurrence is critical. Unfortunately, there has been a paucity of research in what are the most cost-effective strategies for surveillance once patients have achieved a complete response. Currently, most recommendations are based on retrospective studies and expert opinion. Taking a thorough history, performing a thorough examination, and educating cancer survivors about concerning symptoms is the most effective method for the detection of most gynecologic cancer recurrences. There is very little evidence that routine cytologic procedures or imaging improves the ability to detect gynecologic cancer recurrence at a stage that will impact cure or response rates to salvage therapy. 4
46. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022. Review/Other-Dx N/A Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. No abstract available. 4
47. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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