Deepak G. Bedi MD, Abstract Co-Author: Consultant, Koninklijke Philips Electronics NV

Madhavi Patnana MD, Presenter: Nothing to Disclose

Randy Devereux Ernst MD, Abstract Co-Author: Nothing to Disclose

Karen H Lu MD, Abstract Co-Author: Nothing to Disclose

To describe the sonographic findings of early ovarian cancer in a screened population of women with increased risk for ovarian cancer.

 Over a 6 year period, biannual ultrasound studies were performed on 840 patients with one or both intact ovaries, derived from 1017 patients (177 with prior bilateral oophorectomy) with increased risk of ovarian cancer/peritoneal cancer (personal or family history of breast/ovarian cancer, BRCA+ gene status, history of related cancers, i.e. Lynch Groups) Six patients underwent surgery for abnormal sonography and 9 patients had prophylactic/elective oophorectomy for statistically high risk. The sonographic studies of the patients who underwent surgery were reviewed retrospectively.

Three patients with invasive serous cancer, Stage I, II and IIIB, demonstrated normal gray-scale appearance of the ovaries, but with distinctly increased central vascularity and minimal enlargement over 2-3 months. Central vascularity was absent in all other postmenopausal ovaries. While vascularity was common in premenopausal ovaries, it resolved on follow up with changing menstrual cycles. One patient with an incipient serous low malignant potential tumor (LMP) was demonstrated to show a slowly enlarging cyst over 4 years. Two patients. with LMP presented with cystic masses, minimal mural nodularity and no vascularity. Nine patients who underwent elective oophorectomy, [benign tubal hyperplasia (2 ), a 4 mm. granulosa cell ovarian tumor (1) and microscopic foci  carcinoma-in-situ in the fallopian tube (6)], had normal sonography.

Invasive ovarian cancer appears to first manifest itself as an area of increased vascularity in a solid ovary of normal gray-scale appearance. The appearance does not meet sensitivity/specificity parameters due to the small number of cases. However, when central ovarian vascularity is present on short term follow up in high risk patients, it should lead to serious consideration for surgery. Ovarian cysts under survellance did not develop high grade cancers, although benign or LMP lesions were documented.

Screening for early ovarian cancer should focus on the detection of increased vascularity in solid ovaries or solid areas of ovaries with cysts. Cysts do not appear to develop cancers.

Bedi, D, Patnana, M, Ernst, R, Lu, K, Sonographic Findings in Early Ovarian Cancer: Preliminary Experience in a Population of High Risk Women Screened with Biannual Ultrasound.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9001292.html