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Ultrasonography in Gynaecological Cancers 125

Figure 11. Malignant ovarian tumour. Thirty five years old woman with history of serous borderline tumour with microinvasion treated
with unilateral salpingoophorectomy on the right side. Three years later she is presenting with recurrent tumour of the left ovary.
Scheme of recurrent unilocular-solid tumour within the left ovary (A), transvaginal scan showing tumour solid papillary projection
with moderate perfusion and intracystic fluid of low-level echogenicity (B) and intraoperative finding of an ovarian tumour with intact
ovarian capsule (C). CL-corpus luteum in healthy residual ovarian stroma.

Figure 12. Protocol how to scan pelvis and abdomen for ovarian cancer staging. Schematic diagram showing pelvic involvement by
peritoneal carcinomatosis (A) with parietal carcinomatosis in pouch of Douglas (1), visceral carcinomatosis in vesicouterine pouch and
on sigmoid colon (2), mesenterial carcinomatosis in mesorectum and sigmoid mesocolon (3). Schematic diagram showing peritoneal
carcinomatosis in upper quadrant (B) with parietal carcinomatosis on diaphragm (4), visceral carcinomatosis on liver, stomach and
splenic surface (5) and greater omental infiltration (the border of supra- and infracolic omentum is marked with dot-and-dash code
according to the position of transverse colon) (6). Schematic diagram showing peritoneal involvement in middle abdomen (C) with
parietal carcinomatosis in left paracolic gutter (7), visceral carcinomatosis on cecum and ileal loops (8) and mesenterial involvement
of radix mesenterii of small intestine (9). Schematic diagram showing inguinal (1) and retroperitoneal (2-3) lymph node involvement
(D). Schematic diagram of visceral lymph nodes (E) containing celiac (4) and mesenteric lymph nodes (5). Schematic diagram of
hematogenous spread in liver and spleen (F). LNs-lymph nodes.

method is used particularly for primary inoperable oncological diseases benefit from biopsy, allowing us to
ovarian tumours, tumours suspected to be of extragenital reliably distinguish the type of recurrent cancer (6, 7). CT
origin (e.g. tumours of the stomach, pancreas, or guidance of tumour biopsy entails risks associated with
breast cancer may mimic primary advanced ovarian CT scans, and requires patient preparation (oral iodinated
carcinoma) and in the case of diagnostic uncertainty of contrast agent, fasting) (63). Therefore CT guidance of
tumour relapse. Also, patients with a history of multiple biopsy is only used in poorly accessible metastatic sites.