Sung Il Hwang

Association of cul-de-sac seeding with intraperitoneal tumor burden in advanced ovarian cancer (CIEL, KGOG 4003)

To evaluate the relationship between tumor seeding in the cul-de-sac, assessed by transvaginal or transrectal ultrasound, and intraperitoneal tumor burden in advanced ovarian cancer. We prospectively enrolled 101 patients scheduled for surgery due to suspected or newly diagnosed ovarian, fallopian tube, or peritoneal cancer at three hospitals in Korea (Feb 2022-Dec 2023). Five were excluded for missing ultrasound or surgery, and eleven for benign or other malignancies. Preoperative ultrasound was used to assess cul-de-sac tumor seeding, categorized as no seeding, reticulonodular, serosal, or mass seeding. Intraperitoneal tumor burden was evaluated using the Peritoneal Cancer Index (PCI) and Fagotti score. Associations with bowel surgery and residual tumors >1 cm were also analyzed. Eighty-five patients were included; 28 received neoadjuvant chemotherapy. Cul-de-sac seeding was classified as no seeding (42 %), reticulonodular (14 %), serosal (18 %), or mass (26 %). Higher PCI and Fagotti scores correlated with more severe seeding. Intraoperative confirmation of seeding was seen in 69 % of cases. Bowel surgery was less frequent in patients without seeding. No significant differences were found in residual tumors >1 cm between groups. Cul-de-sac tumor seeding identified by transvaginal or transrectal ultrasound may reflect intraperitoneal tumor burden and could help predict surgical complexity in advanced ovarian cancer.

MR imaging findings of ovarian lymphoma: differentiation from other solid ovarian tumors

To evaluate magnetic resonance imaging (MRI) findings for distinguishing ovarian lymphomas from other solid ovarian tumors. This retrospective multicenter study included 14 women (median age, 46.5 years; range, 26-81 years) with surgically proven ovarian lymphoma and 28 women with solid ovarian tumors other than lymphoma. We conducted a subjective image analysis of factors including laterality, shape, composition, T2 signal intensity (SI), heterogeneity, diffusion restriction, enhancement, and presence of peripheral follicles. A generalized estimating equation was used to identify MRI findings that could be used to distinguish ovarian lymphomas from other solid ovarian tumors. Diagnostic performance of the identified MRI findings was assessed using the area under the receiver-operating characteristic curve (AUC). Ovarian lymphoma more frequently showed homogeneous high SI on T2-weighted imaging (81.8% vs. 19.4%, P 0.05 for all). Homogeneous high SI on T2-weighted imaging was the only independent MRI finding (OR = 15.19; 95% CI 3.15-73.33; P = 0.001) in the multivariable analysis. Homogeneous high SI on T2-weighted imaging yielded an AUC of 0.82 with a sensitivity of 81.8% and specificity of 80.6% in distinguishing ovarian lymphomas from other solid ovarian tumors. Homogeneous high signal intensity on T2-weighted imaging was helpful in distinguishing ovarian lymphomas from other solid ovarian tumors. Peripheral ovarian follicles might be an additional clue that suggests a diagnosis of ovarian lymphoma.