Stage III disease of ovarian, tubal and peritoneal cancers can be accurately diagnosed with pre-operative CT. Japan Clinical Oncology Group Study JCOG0602.

PURPOSE: Computed tomography of the abdomen and pelvis is a useful imaging modality for identifying origin and extent of ovarian cancer before primary debulking surgery. However, the International Federation of Gynecology and Obstetrics staging for ovarian cancer is determined based on surgico-pathological findings. The purpose of this study is to determine whether computed tomography staging can be the surrogate for surgico-pathological International Federation of Gynecology and Obstetrics staging in advanced ovarian cancer undergoing neoadjuvant chemotherapy. METHODS: Computed tomography staging was compared with surgico-pathological International Federation of Gynecology and Obstetrics staging in primary debulking surgery arm patients in a randomized controlled trial comparing primary debulking surgery and neoadjuvant chemotherapy (JCOG0602). The cancer of primary debulking surgery arm was identically diagnosed regarding the origin and extent with the cancer of neoadjuvant chemotherapy arm before accrual, using imaging studies (computed tomography and/or magnetic resonance imaging), cytological examination (ascites, pleural effusion or tumor contents fluid) and tumor marker (CA125 > 200 U/mL and CEA < 20 ng/mL). Institutional computed tomography staging was also compared with computed tomography staging by central review. RESULTS: Among 149 primary debulking surgery arm patients, 147 patients who underwent primary debulking surgery immediately were analyzed. Positive predictive values and sensitivity of computed tomography staging for surgical stage III disease (extra-pelvic peritoneal disease and/or retroperitoneal lymph node metastasis) were 99%. Meanwhile, positive predictive values for the presence of small (≤2 cm) extra-pelvic peritoneal disease were low; <20% in omentum. Accuracy of institutional computed tomography staging was comparable with computed tomography staging by central review. CONCLUSIONS: Preoperative computed tomography staging in each institution can be the surrogate for surgico-pathological diagnosis in stage III disease of ovarian cancer patients undergoing neoadjuvant chemotherapy without diagnostic surgery, but reliability of diagnosis of stage IIIB disease is inadequate.Clinical trial registration: UMIN000000523(UMIN-CTR).

Ability of preoperative 3.0-Tesla magnetic resonance imaging to predict the absence of side-specific extracapsular extension of prostate cancer.

OBJECTIVE: Recent studies have shown an improvement in prostate cancer diagnosis with the use of 3.0-Tesla magnetic resonance imaging. We retrospectively assessed the ability of this imaging technique to predict side-specific extracapsular extension of prostate cancer. METHODS: From October 2007 to August 2011, prostatectomy was carried out in 396 patients after preoperative 3.0-Tesla magnetic resonance imaging. Among these, 132 (primary sample) and 134 patients (validation sample) underwent 12-core prostate biopsy at the National Cancer Center Hospital of Tokyo, Japan, and at other institutions, respectively. In the primary dataset, univariate and multivariate analyses were carried out to predict side-specific extracapsular extension using variables determined preoperatively, including 3.0-Tesla magnetic resonance imaging findings (T2-weighted and diffusion-weighted imaging). A prediction model was then constructed and applied to the validation study sample. RESULTS: Multivariate analysis identified four significant independent predictors (P < 0.05), including a biopsy Gleason score of ≥8, positive 3.0-Tesla diffusion-weighted magnetic resonance imaging findings, ≥2 positive biopsy cores on each side and a maximum percentage of positive cores ≥31% on each side. The negative predictive value was 93.9% in the combination model with these four predictors, meanwhile the positive predictive value was 33.8%. Good reproducibility of these four significant predictors and the combination model was observed in the validation study sample. CONCLUSIONS: The side-specific extracapsular extension prediction by the biopsy Gleason score and factors associated with tumor location, including a positive 3.0-Tesla diffusion-weighted magnetic resonance imaging finding, have a high negative predictive value, but a low positive predictive value.

Magnetic resonance imaging of endometrial cancer and clear cell cancer.

OBJECTIVE: We attempt to clarify specific imaging findings useful for differential diagnosis between endometrioid cancer and clear cell cancer. METHODS: We examined magnetic resonance imaging features on 11 endometrioid cancer and 9 clear cell cancer patients. We compared them, focusing on the locularity, characteristic and growth pattern of solid components, and association with endometrial diseases. RESULTS: Endometrioid cancer had a predominantly multilocular appearance, but clear cell cancer showed almost equally multilocular and unilocular appearances. For the growth pattern, endometrioid cancer in 6 patients demonstrated a "centric pattern" and an "eccentric pattern" in 4, whereas clear cell cancer showed predominantly an eccentric pattern. An internal slit in the solid component was seen in 4 endometrioid cancer patients but not seen in any of the patients with clear cell cancer. CONCLUSIONS: The magnetic resonance imaging appearance of the internal slit in solid components and the presence of endometrial disease are key factors in differentiating endometrioid cancer from clear cell cancer, although lesion locularity and growth pattern are not specific in both.

Ovarian vessel dilatation with ovarian mass on MR images: influence of pelvic venous plexus dilatation.

PURPOSE: We assessed the value of analyzing visualization of the ovarian vessels in relation to the features of ovarian masses using MR images. MATERIALS AND METHODS: 74 patients with 91 masses (61 benign lesions and 30 malignant lesions) were evaluated. Ovarian masses were classified using the following features: 1) benignancy, 2) characterization, and 3) maximum diameter. We assessed the relationship between visualization and the diameter of the ipsilateral ovarian vessels and the features of ovarian masses. In addition, we assessed the relationship between visualization and the diameter of ovarian vessels and pelvic venous plexus (PVP) dilatation. RESULTS: Regardless of tumor laterality, 82% of ovarian vessels were visualized (121/148 vessels) on MR images. There was a significant relationship between the average diameter of ovarian vessels and dilatation of PVP (p<0.001). In patients without dilatation, there was a stronger relationship between ovarian vessel average diameter and benignancy (p=0.007), and the character of ovarian mass (solid versus cystic; p<0.05, mixed versus cystic; p<0.01). CONCLUSION: We confirmed a strong relationship between the diameter of ovarian vessels and dilatation of PVP. If ovarian vessels are dilated in patients without dilatation of PVP, we could suggest the possibility of malignant ovarian tumor.