• D Fischerova, P Pinto, A Burgetova, M Masek, J Slama, R Kocian, F Frühauf, M Zikan, L Dusek, P Dundr, and D Cibula.
• Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague.
• Ultrasound Obstet Gynecol. 2021 Apr 19.

ObjectivesTo evaluate transvaginal and transabdominal ultrasound for assessment of sites of disease and prediction of non-resectability compared with the first-line staging method (CT, computed tomography) and a novel technique (WB-DWI/MRI, whole-body magnetic resonance imaging with diffusion-weighted sequence) in patients with suspected ovarian cancer.MethodsNew patients planned for ovarian cancer surgery at a Gynecologic oncology centre were enrolled. They underwent preoperative staging and prediction of non-resectability with ultrasound, CT, and WB-DWI/MRI, following a single predefined evaluation. Findings were compared to the reference standard (surgical and histopathological evaluation forms). The evaluation assessed peritoneal spread in 17 sites and metastatic lymph nodes in 7 sites. The prediction of non-resectability based on abdominal markers in ovarian cancer patients was based on the criteria defined by local guidelines.ResultsSixty-seven patients with ovarian cancer were enrolled between March 2016 and October 2017. In 67 patients, 51 (76%) had advanced and 16 (24%) had early stage ovarian cancer. Out of 67 patients, diagnostic laparoscopy was performed in 16% (11/67) and laparotomy in 84% (56/67) with R0 (68%, [38/56]; R≤1cm 16% [9/56]; R>1cm 16% [9/56]). Ultrasound and WB-DWI/MRI performed significantly better than the CT in the assessment of overall peritoneal carcinomatosis (AUC 0.86-0.87 vs 0.77)(p=0.002). For assessment of retroperitoneal lymph node staging (AUC 0.72-0.76) and prediction of non-resectability in abdomen (0.74-0.80) all three methods performed not different. Ultrasound showed equal or even better specificity than WB-DWI/MRI followed by CT in assessing all sites and prediction of non-resectability. To plan bowel resection, transvaginal ultrasound compared to WB-DWI/MRI and CT showed a higher accuracy (94 %, 91% and 85% respectively) and sensitivity (94%, 91% and 89% respectively) in the detection of pelvic carcinomatosis, particularly in the evaluation of deep rectosigmoid wall infiltration when compared to the other two modalities. On the contrary, for the bowel serosal and mesenterial assessment ultrasound showed the lowest accuracy (70 %, 78% and 79% respectively) and sensitivity (42%, 65% and 65% respectively).ConclusionsThis is the first prospective study to date documenting that in experienced hands ultrasound may be an alternative to WB-DWI/MRI and CT in the assessment of overall peritoneal assessment, retroperitoneal lymphadenopathy and prediction of tumor non-resectability based on abdominal markers in ovarian cancer patients This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.

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