Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Imaging

• Published in: Gynécologie, obstétrique, fertilité & sénologie Vol. 48; no. 3; pp. 260 - 276
• Main Authors: Abdel Wahab, C, Rousset, P, Bolze, P-A, Thomassin-Naggara, I
• Format: Journal Article
• Language: French
• Published: France 01.03.2020
• Subjects: Carcinoma, Ovarian Epithelial - diagnostic imaging; Carcinoma, Ovarian Epithelial - pathology; Diagnosis, Differential; Female; France; Humans; Magnetic Resonance Imaging - methods; Ovarian Neoplasms - diagnostic imaging; Ovarian Neoplasms - pathology; Positron Emission Tomography Computed Tomography; Tomography, X-Ray Computed; Ultrasonography - methods; France; Frontière; Ovary; Papillary projection; Borderline; IRM; MRI; Échographie; Ultrasonography; Ovaire; Végétation
• ISSN: 2468-7189
• DOI: 10.1016/j.gofs.2020.01.014

To determine the place of imaging and the performance of different imaging techniques (transvaginal ultrasound with or without Doppler, scoring, CT, MRI) to differentiate benign tumour, borderline ovarian tumour (BOT) and malignant ovarian tumor. Differentiate the histological subtypes of BOT (serous, sero-mucinous, mucinous) and prediction in imaging of the possibility of conservative treatment. The research was carried out over the last 16 years using the terms "MeSH" based on the query of the Medline® database and supplemented by the review of references contained in the meta-analyzes, systematic reviews and original articles included. Endo-vaginal and suprapubic ultrasonography is recommended for analysis of an ovarian mass (grade A). In the case of ultrasound by a referent, subjective analysis is the recommended technique (grade A). In case of echography by a non-referent, the use of "Simple Rules" is recommended (grade A) and should be best combined with subjective analysis to rejoin the performance of a sonographer refer (grade A). In cases of undetermined ovarian lesions in endovaginal ultrasound and suprapubic ultrasound, it is recommended to perform a pelvic MRI (grade A). The MRI protocol should include T2, T1, T1 sequences with fat saturation, diffusion, injected dynamics, and after gadolinium injection (grade B). To characterize an MRI-adnexal image, it is recommended to include a risk score for malignancy (ADNEX-MR/O-RADS) (grade C) in the report and to formulate an anatomopathological hypothesis (Grade C). The predictive signs of benignity in front of a cyst with endocystic vegetations are the low number, the small size, the presence of calcifications and the absence of Doppler flow in case of size greater than 10mm in echography (LP 4) and a curve of type 1 MRI (LP4). MRI is recommended for suspicious lesions of BOT in ultrasound (grade B) or indeterminate lesions in ultrasound (grade A). There is no data to support the usefulness of CT or PET-CT for BOT. Morphological criteria in ultrasound and MRI exist to differentiate BOT from invasive tumors regardless of grade (NP 2). Pelvic MRI is recommended to characterize a tumor suggestive of ultrasound BOT (grade C). No recommendations can be made about the use of combined ultrasound, biological, and menopausal status scores for the diagnosis of BOT. The diagnostic performance of imaging to detect peritoneal implants of BOT is not known. The assessment of the invasiveness of peritoneal implants of imaging BOT has not been evaluated. The association of macroscopic signs in MRI makes it possible to differentiate the different subtypes - serous, sero-mucinous and mucinous (intestinal type) - of BOT, despite the overlap of certain presentations (LP3). The analysis of macroscopic MRI signs must be performed to differentiate the different subtypes of TFO (grade C). No recommendation can be made on imaging prediction of the possibility of conservative BOT treatment.