Ultrasound and Clinical Preoperative Characteristics for Discrimination Between Ovarian Metastatic Colorectal Cancer and Primary Ovarian Cancer: A Case-Control Study

Abstract

The aim of this study was to describe the clinical and sonographic features of ovarian metastases originating from colorectal cancer (mCRC), and to discriminate mCRC from primary ovarian cancer (OC). We conducted a multi-institutional, retrospective study of consecutive patients with ovarian mCRC who had undergone ultrasound examination using the International Ovarian Tumor Analysis (IOTA) terminology, with the addition of evaluating signs of necrosis and abdominal staging. A control group included patients with primary OC. Clinical and ultrasound data, subjective assessment (SA), and an assessment of different neoplasias in the adnexa (ADNEX) model were evaluated. Fisher's exact and Student's t-tests, the area under the receiver-operating characteristic curve (AUC), and classification and regression trees (CART) were used to conduct statistical analyses. In total, 162 patients (81 with OC and 81 with ovarian mCRC) were included. None of the patients with OC had undergone chemotherapy for CRC in the past, compared with 40% of patients with ovarian mCRC (p < 0.001). The ovarian mCRC tumors were significantly larger, a necrosis sign was more frequently present, and tumors had an irregular wall or were fixed less frequently; ascites, omental cake, and carcinomatosis were less common in mCRC than in primary OC. In a subgroup of patients with ovarian mCRC who had not undergone treatment for CRC in anamnesis, tumors were larger, and had fewer papillations and more locules compared with primary OC. The highest AUC for the discrimination of ovarian mCRC from primary OC was for CART (0.768), followed by SA (0.735) and ADNEX calculated with CA-125 (0.680). Ovarian mCRC and primary OC can be distinguished based on patient anamnesis, ultrasound pattern recognition, a proposed decision tree model, and an ADNEX model with CA-125 levels.

Effects of Laparoscopic Hyperthermic Perfusion Therapy Combined with Adjuvant Treatment of Compound Yew Capsule on Ovarian Blood Flow Parameters and Immune Function in Patients with Ovarian Cancer

“…e ovarian tumor's symptoms are vague, are not prominent in the early stage, and appear upon progression to the advanced stage. Symptoms include decreased appetite, lower abdominal discomfort, and bloating [3][4][5]. At present, the pathogenesis of OC has not been fully elucidated.…”

Accuracy of Pretreatment Ultrasonography Assessment of Intra-Abdominal Spread in Epithelial Ovarian Cancer: A Prospective Study

“…In the future, it would be worth conducting a study in a larger group of patients with suspected lesions in the liver parenchyma, which would allow for more objective results. In addition, such studies should comprise patients with recurrent EOC because, in primary diagnosis and treatment settings, parenchymal liver lesions are rather a marker for nonovarian malignancy, as described earlier [34].…”

The clinicopathological characteristics, prognosis, and CT features of ovary metastasis from colorectal carcinoma

“…Therefore, preoperative imaging diagnosis is crucial for the differentiation of OM-CRC, particularly for differentiation from primary ovarian cancer, which has a totally different therapeutic approach to secondary ovarian cancer. Differentiation is difficult to perform with imaging examinations such as ultrasound, CT and magnetic resonance imaging ( 2 , 13 , 15 , 16 , 32 , 33 ). CT is one of the most common preoperative imaging examinations for ovarian tumors.…”

“…Preoperative differentiation of OM-CRC from primary ovarian cancer using imaging examinations is quite difficult; a histological examination is usually required (2,(11)(12)(13). Different types of tumours are often treated by different specialists and using different therapeutic strategies.…”

“…Colorectal carcinoma (CRC) is one of the most commonly diagnosed malignant tumors in female patients worldwide ( 1 , 2 ). Over the past several decades, the incidence of CRC has increased in different degrees in various countries ( 3 , 4 ).…”