Staging of advanced ovarian cancer: comparison of imaging modalities--report from the Radiological Diagnostic Oncology Group.
OBJECTIVE
To compare ultrasonography (US), magnetic resonance (MR) imaging, and computed tomography (CT) for diagnosing and staging advanced ovarian cancer.


METHODS
US, CT, and MR imaging were performed in 280 patients. Images were read by three radiologists from each of the five hospitals. Image analysis included determination of malignancy within the peritoneum (11 sites), lymph nodes (10 sites), and hepatic parenchyma. The standard of reference was based on surgical and histopathologic findings. Statistical methods used were receiver operating characteristic (ROC) curve analysis, pairwise comparison of areas under the ROC curves (A(z)), analysis of sensitivity and specificity pairs, and assessment of agreement between the degree of suspicion and standard of reference.


RESULTS
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.


CONCLUSIONS
CT and MR imaging are equally accurate, and either modality can be used to stage advanced ovarian cancer.
Tempany
C M
CM
Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA. ctempany@bwh.harvard.edu
Zou
K H
KH
Silverman
S G
SG
Brown
D L
DL
Kurtz
A B
AB
McNeil
B J
BJ
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D009367:Neoplasm Staging; D015588:Observer Variation; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D010053:Ovary / Q000000981:diagnostic imaging / Q000473:pathology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data; D018608:Ultrasonography, Doppler / Q000379:methods / Q000706:statistics & numerical data; D014481:United States