Preoperative Ultrasound Assessment of Omental Spread in Ovarian Cancer

Abstract

The accuracy of high-resolution ultrasound in the detection of macroscopic omental metastases was evaluated in 50 consecutive patients undergoing surgery for ovarian cancer. Ultrasound provided an overall diagnostic accuracy of 83.7%, with a sensitivity of 76.6% and a specificity of 100%. The sensitivity in the diagnosis of diffuse omental involvement was 93.3%. Moreover, the overall diagnostic accuracy, sensitivity and positive predictive value of the method increased as the study progressed. In the last 25 cases examined, in fact, these values were 94.7, 90, and 90%, respectively.

Ultrasound and color power Doppler in the detection of metastatic omentum: a prospective study

“…These encouraging results can be explained partly by advances in the development of more sophisticated equipment, which likely improves not only the definition of specific sonographic features, but also the identification and characterization of novel sonographic findings. For instance, in the past, metastatic omentum has been described as hypoechoic thickened tissue ('omental cake') 11 , while it is now acknowledged that extensive infiltration by the tumor results in marked thickening that is usually echogenic 1 , as documented in our series.…”

“…Specifically, we obtained an NPV of 92.7% and a sensitivity of 95.0%. These values are quite high in comparison with previously published data11, especially taking into account the fact that we did not exclude from analysis microscopic and micronodular metastatic involvement, which represented the vast majority (4/5) of false negatives in our series. Considering that microscopic/micronodular disease is obviously below the resolution limits of the ultrasound procedure, our observations indicate that ultrasound performance in terms of sensitivity and NPV can theoretically approach 100%.…”

“…However, there is scanty data in the literature on the utility and accuracy of transabdominal and transvaginal sonography in the detection of metastatic omental involvement 1,11 . In particular, the study by Conte et al 11 , performed in a relatively small series of 50 ovarian carcinomas, reported that ultrasound examination was able to detect metastatic omental involvement with an overall accuracy of 83.7%.…”

Transvaginal sonographic features of peritoneal carcinomatosis

“…In this study, peritoneal carcinomatosis could be identified on TVS in 88% of the cases. However, the diagnosis can be reinforced by the detection, on TAS, of a grossly abnormal and thickened omentum, known as the 'omental cake', which is due to the metastatic colonization of the omentum by tumor cells 10 . As a consequence, the omentum appears rigid, thickened and floating in the ascites ( Figure 5).…”

“…Conventional radiology often fails to detect peritoneal carcinomatosis and supplies diagnostically relevant information only when there is extensive bowel involvement2. A more precise visualization of peritoneal and omental implants can be achieved by transabdominal ultrasound (TAS), computed tomography (CT) and magnetic resonance imaging (MRI) even if the reported diagnostic accuracy of such techniques is very variable and often unacceptably low1–13.…”