What are the ACR appropriateness criteria for imaging evaluation of suspected malignant ovarian tumors?

Updated: Feb 27, 2019
  • Author: Arthur C Fleischer, MD; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

American College of Radiology (ACR)

The ACR appropriateness criteria does not recommend that women at average risk for ovarian cancer receive screening imaging. Women at a high risk of ovarian cancer may benefit from screening. Pre- and postmenopausal women are considered to have a high risk of ovarian cancer if they have a personal or family history of ovarian cancer, have or are suspected to have BRCA1 or BRCA2 genetic mutations, or have an elevated CA-125 level (antigen 125—a protein elevated in cancer tumor cells) as measured by a blood test. The recommended imaging test to screen for ovarian cancer is ultrasound (US) to visualize the ovaries. These tests include transvaginal US (preferred), transabdominal US (in women who are not good candidates for transvaginal US), and US color Doppler (allows for visualization of blood flow). CT and MRI are usually not appropriate for screening women with either average or high risk of ovarian cancer. [12]

ACR appropriateness recommendations for evaluation of adnexal mass include the following [13] :

  • US duplex Doppler pelvis, US pelvis transvaginal, and US pelvis transabdominal are usually appropriate for the initial imaging of both premenopausal and postmenopausal women with a clinically suspected or likely adnexal mass and no acute symptoms. These examinations are complementary and should be performed together.
  • US pelvis transvaginal, US duplex Doppler pelvis, US pelvis transabdominal, and pelvic MRI without and with IV contrast are usually appropriate for the initial follow-up of premenopausal and postmenopausal women with indeterminate adnexal mass and no acute symptoms. These examinations are complementary and should be performed together.
  • The panel did not agree on recommending pelvic CT without and with IV contrast in postmenopausal patients with indeterminate adnexal mass and no acute symptoms. There is insufficient medical literature to conclude whether or not these patients would benefit from this procedure but it may be appropriate.
  • CT of the abdomen and pelvis with IV contrast and pelvic MRI without and with IV contrast are usually appropriate for the initial follow-up of patients with an adnexal mass, highly suspicious for malignancy, and no acute symptoms. These examinations are complementary and should be performed together.
  • The panel did not agree on recommending pelvic CT with IV contrast, pelvic CT without and with IV contrast, and US duplex Doppler of the pelvis in patients with an adnexal mass that is highly suspicious for malignancy and no acute symptoms. There is insufficient medical literature to conclude whether or not these patients would benefit from these procedures but they may be appropriate.
  • US duplex Doppler pelvis, US pelvis transabdominal, and US pelvis transvaginal are usually appropriate in the initial imaging and follow-up of pregnant patients with a clinically suspected adnexal mass and no acute symptoms. These examinations are complementary and should be performed together.

ACR appropriateness criteria for the initial staging of ovarian cancer recommends contrast-enhanced CT (with oral contrast) of the abdomen and pelvis as the imaging modality of choice, with inclusion of the chest where indicated. These examinations are complementary and should be performed together. Contrast-enhanced CT of the abdomen and pelvis (with oral contrast) or CT of the chest, abdomen, and pelvis are the modalities of choice for the extent of disease in suspected recurrence, and FDG-PET/CT is also usually appropriate, as it can provide management-changing information about unresectable sites of tumor or small lymph nodes. CT and FDG-PET/CT are considered equivalent alternatives. [14]


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