The role of imaging in detecting ovarian cancer recurrence
Number:28ESURABS0078
Type:Educational Electronic Presentation
Authors: Laura Cerón Nasarre, Laia Valls Masot, Victoria Garriga Farriol, Laura Cárdenas Puiggros, Anna Taltavull Pons, Albert Maroto Genover, Maria Pilar Barretina Ginesta, Nuria Ferran Sureda
Keywords:ovarian cancer, recurrence
SECTIONS
Educational objective

To describe the different imaging techniques useful for the detection of recurrence of ovarian cancer 

To review the limitations of each test to understand when it is better to use one or the other 

Topic Review

Ovarian cancer is the leading cause of death from gynecological cancer because usually presents at an advanced stage. Despite effective treatment and complete response, recurrence may occur in 50-80% of these patients within 18 months after treatment. 

Survival after the relapse is related to several factors including chemosensitivity, the time of progression-free interval after therapy and the number of recurrent lesions. 

Early detection of recurrence is important for patient management although there is no consensus in literature about the most appropriate follow-up strategy for these women.  

The gold-standard treatment for recurrent ovarian cancer is systemic platinum-based chemotherapy or subsequent line therapies. Secondary cytoreductive surgery is mostly performed in the localized disease at its first recurrence or after a long...

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Fig.1. Control CT scan shows an ovarian cancer recurrence. Nodular lesion depending on left vaginal vault wall (arrow). PET-CT showed a nodular area of FDG uptake at the same localization confirming the recurrence.
Fig.2. The most frequent sites of peritoneal dissemination are: the right (1) and left (2) subdiaphragmatic spaces, root of the small bowel mesentery, greater omentum (3), perihepatic (4) and perisplenic spaces, lesser peritoneal sac (5), right (6) and left paracolic gutter, hepatic (arrow) and splenic (curved arrow) capsules (with or without parenchymal involvement), gallbladder fossa and serosal layer of the gastrointestinal tract (circle).
Conclusions

Early detection of tumor recurrence is important in ovarian cancer patients due to its close relation with prognosis and the choice of appropriate treatment.  

The evaluation of recurrence should be done from a multimodal approach including clinical examination, serum tumor biomarkers combined with imaging techniques and has to be based upon a multidisciplinary conference decision. 

It is important for the radiologist to know the different relapse patterns to choose the most appropriate imaging techniques in every context. 

Although, CT is the most used imaging method to detect recurrent ovarian cancer, its contribution is limited in small-volume recurrent lesions or metastatic deposits on visceral surfaces.  

Diffusion weight MRI is showing promise in detecting small volume peritoneal disease and may be used to...

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