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114 Ultrasonography in Gynaecological Cancers

Ultrasound has the added advantages of being cheap, working group IOTA (the International Ovarian Tumour
commonly available and posing no risk or discomfort for Analysis) (8-13).
the patient (Table 1).
In many leading gynaecological oncology units,
Many recent prospective single-unit and multicenter ultrasound is already accepted as an obligatory imaging
studies, that were carried out under strictly defined method, significantly affecting the management of
protocols for ultrasound, clinical and histopathological gynaecological cancer treatment, and the cost of its
examinations, demonstrated high accuracy in regard implementation into routine care is considered a very
to preoperative ultrasound diagnostics and staging of good investment.
gynaecological cancers. For interested readers, a very
detailed collection of reviews adressing all these studies Cervical Cancer Imaging
was published last year (1-5). Furthermore, ultrasound
is an optimal technique to guide tru-cut biopsy for the Gynaecological oncologists require accurate information
collection of material for histology from inoperable, on tumour size and location (tumour topography within
metastatic or recurrent tumours in order to start the cervix), the presence of infiltrated parametria and
appropriate treatment without delay (6, 7). lymph node status in order to plan adequate treatment
(Figure 2). In 2009, the International Federation of
International unification of ultrasound terminology Gynaecology and Obstetrics (FIGO) undertook a
and methodology to create uniform diagnostic review of the clinical staging of cervical cancer, which
algorithms should ensure maximum objectivity of recommends the use of modern imaging methods in
examination and reproducibility of results, even in the determining these significant prognostic parameters
hands of a less experienced sonographer. A very good (14).
example is the effective, objective and reproducible
work-up of preoperative differentiation between Magnetic resonance imaging, due to the ability of
benign and malignant ovarian lesions presented by the high tissue resolution in the pelvis, is offered as a suitable
technique for determining the local stage of cervical

Table 1. Comparison of Different Imaging Methods for Application in Ovarian Cancer Patients

Ultrasound MRI CT PET/CT

Costs (approximate) 1x 4x 2x 6x

Availability Universal Specialized centres Most hospitals Specialized centres,
such as university
hospitals

Examination duration 15-20 30-45 1 30
(minutes)

Dynamic examination* Yes No No No

Preparation before None Antiperistaltic agents 4h fasting 4h fasting and 1h
imaging physical rest

Contrast agent None Gadolinium-based£ Iodine-based FDG-radiotracer and
iodine-based

Radiation exposure None None 10-20 mSv 20-30 mSv

Limitation for None Claustrophobia, Contraindication Contraindication
application metal components, for iodine based for iodine based
cochlear implants, contrast agent: contrast agent:
cardiac pacemaker renal insufficiency, renal insufficiency,
hyperthyreoidism, hyperthyreoidism,
iodine allergy iodine allergy

Dependence of Yes Yes Yes Yes

expertise

*Ultrasound can provide information on site-specific tenderness and information how pelvic structures move in relation to each other (sliding
effect) (23).
£In patients with renal insufficiency gadolinium-based contrast media must be used with caution (64).
CT-computed tomography, MRI-magnetic resonance imaging, PET/CT-positron emission tomography combined with CT, FDG-18F-fluoro-
deoxyglucose.