Camilla Panico

Unraveling Tumor Heterogeneity in Gynecological Cancer Using a Radiogenomics Approach

Abstract Ovarian cancer (OC) and endometrial cancer (EC) are highly heterogeneous gynecological malignancies with distinct molecular subtypes, therapeutic responses, and clinical outcomes. Traditional biopsy-based profiling often fails to capture the spatial and temporal complexity of these tumors. Radiogenomics, integrating imaging features with genomic and molecular data, has emerged as a promising approach to non-invasively analyze tumor heterogeneity. The purpose of this abstract is to critically examine and synthesize existing research on the application of radiogenomics in OC and EC, focusing on its ability to correlate imaging phenotypes with molecular biomarkers. This narrative review aims to demonstrate how radiogenomics can enhance tumor characterization, support biomarker prediction, and inform prognosis and therapeutic decision-making with non-invasive methods. This narrative review critically synthesizes current literature on radiogenomics applications in OC and EC. Studies using CT, MRI, and PET imaging were evaluated for their ability to correlate imaging phenotypes with molecular biomarkers, gene expression profiles, and clinical outcomes. The analysis emphasizes the role of radiogenomics in enhancing tumor characterization, predicting biomarker status, forecasting treatment response and prognosis. Radiogenomics has successfully identified associations between imaging features and key molecular alterations, such as BRCA mutations, homologous recombination deficiency (HRD), and immune-related biomarkers in OC, as well as POLE mutations, microsatellite instability (MSI), and tumor mutational burden (TMB) in EC. Predictive models incorporating radiomic features have demonstrated notable performance in estimating prognosis, treatment response, and recurrence risk across both cancer types. Radiogenomics has a strong potential to enhance personalized cancer care by analyzing tumor heterogeneity. However, clinical application requires methodological standardization, prospective validation, and integration into precision oncology workflows.

Thyroid hormones and epithelial ovarian cancer risk and survival: results from the European Prospective Investigation into Cancer and Nutrition study

Abstract Background Thyroid-stimulating hormone (TSH) and thyroid hormones (free triiodothyronine [fT3] and free thyroxine [fT4]) may influence cancer outcomes, but evidence for ovarian cancer is limited. Methods We conducted a nested case–control study comparing 578 epithelial ovarian cancer (EOC) cases with matched controls within the European Prospective Investigation into Cancer and Nutrition (EPIC). To examine associations between circulating TSH, fT3, and fT4 levels and EOC risk, we estimated risk ratios (RRs) and 95% confidence intervals (CIs) per SD using conditional logistic regression. Among cases, we evaluated all-cause and EOC-specific survival by prediagnostic hormone levels. Hazard ratios (HRs) and 95% confidence intervals were calculated using multivariable Cox regression. We also estimated covariate-adjusted restricted mean survival time (RMST) and survival probabilities at 5 and 10 years. Results Thyroid hormones were not associated with EOC risk (RR [95% CI] per SD increase: TSH = 0.99 [0.87 to 1.12], fT3 = 1.12 [0.70 to 1.79], and fT4 = 1.08 [0.56 to 2.07]) levels. However, higher TSH levels were associated with better survival (HR [95% CI] per SD: all-cause death = 0.90 [0.82 to 0.99], EOC-specific = 0.88 [0.79 to 0.97]), whereas higher fT4 levels were associated with worse survival (all-cause = 1.10 [1.00 to 1.22], EOC-specific = 1.17 [1.05 to 1.30]), but no association for fT3. RMST and survival probabilities showed similar patterns: for TSH, 10-year RMST and survival increased from 5.3 years and 42.2% in Quartile 1 (Q1) to 6.4 years and 50.7% in Q4. Conversely, for fT4, 10-year RMST declined from 5.6 years (Q1) to 5.1 years Q4, and survival from 46.3% to 37.8%. Conclusion TSH and thyroid hormones might not affect ovarian cancer risk. However, high fT4 and low TSH concentrations may be associated with poorer survival. Further evaluation is suggested in other populations.

Pearls and Potential Pitfalls for Correct Diagnosis of Ovarian Cystadenofibroma in MRI: A Pictorial Essay

Ovarian cystadenofibroma is a benign ovarian tumor that is characterized by a consistent percentage of masses, which remain indeterminate in ultrasonography and require magnetic resonance (MR) investigation; they may mimic borderline or malignant lesions. Three main morphologic patterns, resembling different ovarian neoplasms, can be identified in cystadenofibromas: multilocular solid lesions, unilocular cystic lesions with parietal thickening, and purely cystic masses. However, a cystoadenofibroma has typical features, such as T2-weighted hypointensity associated with no restrictions in diffusion-weighted imaging (the so-called "dark-dark appearance") and progressive post-contrast enhancement (type I perfusion curve). The purpose of this study was to review the features of ovarian cystadenofibromas in MR imaging and to suggest pearls and pitfalls regarding their correct diagnosis.