The International Federation of Gynecologists and Obstetricians revised the criteria for ovarian cancer staging in 2014 [46]. The updated system recognizes the morphologic and molecular similarities between fallopian tube, primary peritoneal carcinomas, and ovarian malignancy [47]. Stage I disease includes tumor limited to 1 or both ovaries or fallopian tubes, stage II disease has spread to the surface of other pelvic organs, stage III indicates spread to retroperitoneal lymph nodes (IIIA1) or abdominal peritoneal surfaces (IIIA2 if microscopic disease, IIIB or C with macroscopic nodules), and stage IV is advanced disease with distant metastases to solid organs or a malignant pleural effusion [5,6,46]. When there is a contraindication to administration of iodinated contrast, CT without intravenous contrast offers limited evaluation of extent of disease in initial evaluation or follow-up; for more information on the imaging of patients with end-stage renal failure, please see the ACR Manual on Contrast Media [48]. Discussion of Procedures by Variant Variant 1: Initial staging of pretreatment ovarian cancer. CT Abdomen and Pelvis Contrast-enhanced CT (with oral contrast) is the current imaging modality of choice in the preoperative evaluation of ovarian cancer and is an accurate method for identifying sites of abdominopelvic disease that predict successful surgical cytoreduction [57]. CT has been useful to detect local tumor involvement of the pelvic ureter and uterine serosa (although uterine serosal involvement is less important in ovarian cancer than it is for endometrial cancer), as well as metastases to the peritoneum, omentum, mesentery, liver, spleen, lymph nodes, and lung parenchyma [5,39,40,52]. CT has a reported accuracy for ovarian cancer staging of up to 94% [14].
Staging and Follow up of Ovarian Cancer. The International Federation of Gynecologists and Obstetricians revised the criteria for ovarian cancer staging in 2014 [46]. The updated system recognizes the morphologic and molecular similarities between fallopian tube, primary peritoneal carcinomas, and ovarian malignancy [47]. Stage I disease includes tumor limited to 1 or both ovaries or fallopian tubes, stage II disease has spread to the surface of other pelvic organs, stage III indicates spread to retroperitoneal lymph nodes (IIIA1) or abdominal peritoneal surfaces (IIIA2 if microscopic disease, IIIB or C with macroscopic nodules), and stage IV is advanced disease with distant metastases to solid organs or a malignant pleural effusion [5,6,46]. When there is a contraindication to administration of iodinated contrast, CT without intravenous contrast offers limited evaluation of extent of disease in initial evaluation or follow-up; for more information on the imaging of patients with end-stage renal failure, please see the ACR Manual on Contrast Media [48]. Discussion of Procedures by Variant Variant 1: Initial staging of pretreatment ovarian cancer. CT Abdomen and Pelvis Contrast-enhanced CT (with oral contrast) is the current imaging modality of choice in the preoperative evaluation of ovarian cancer and is an accurate method for identifying sites of abdominopelvic disease that predict successful surgical cytoreduction [57]. CT has been useful to detect local tumor involvement of the pelvic ureter and uterine serosa (although uterine serosal involvement is less important in ovarian cancer than it is for endometrial cancer), as well as metastases to the peritoneum, omentum, mesentery, liver, spleen, lymph nodes, and lung parenchyma [5,39,40,52]. CT has a reported accuracy for ovarian cancer staging of up to 94% [14].