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Image guided biopsy in the management of cancer of the ovary

Abstract

When used in the context of multidisciplinary team discussion, image guided biopsy using ultrasound (US) or computed tomography (CT) guidance is of value in planning management of women with suspected ovarian cancer and peritoneal carcinomatosis (PC) of uncertain aetiology. It is essential in women believed to have ovarian cancer but with poor performance status or with advanced disease believed beyond the scope of primary cytoreductive surgery for whom staging surgical pathology will not be obtained. It provides a site-specific primary tumour diagnosis in 93% of cases and it should replace diagnostic laparoscopy or laparotomy for this purpose. It allows provision of primary (neoadjuvant) chemotherapy based on a firm histological diagnosis. It is mandatory in women with a history of cancer whose metastases may mimic ovarian cancer (e.g. breast, GI tract, melanoma). More women with prior breast cancer who re-present with peritoneal cancer will have a new gynaecological primary than recurrence of their original primary tumour; the two options require radically different therapies. Finally it is a valuable problem solving tool in situations of diagnostic uncertainty, e.g. unusual imaging patterns of disease such as PC with bilateral solid ovarian masses or non-enlarged ovaries and with an unusual tumour marker profiles suggesting primary tumours outwith the ovary. The technique is simple, safe and effective and can be combined with palliative drainage of ascites at the same procedure.

Author

John A Spencer, Kirsty Anderson, Michael Weston, Nafisa Wilkinson and Matt Hewitt

Contact Details

Corresponding address:
John A Spencer,
Department of Clinical Radiology,
Leeds Cancer Centre at St James's University Hospital,
Leeds LS9 7TF, UK

Reference

ICIS Cancer Imaging Volume 6 Issue 1
DOI: 10.1102/1470-7330.2006.0022

Date Posted

7 September 2006

Open Access is provided for this article.

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