16:45 CET
E³ 119 - Early detection of ovarian cancer
Oncologic Imaging Genitourinary Evidence-Based Imaging
Wednesday, February 27, 08:30 - 10:00
Room: M 4
Type of session: E³ - ECR Academies: Hot Topics in GU Cancer
Topic: Oncologic Imaging, Genitourinary, Evidence-Based Imaging
Moderator: R. Forstner (Salzburg/AT)

A-0069
08:30
Chairperson's introduction
R. Forstner; Salzburg/AT
Abstract

Ovarian cancer is still among the deadliest of cancers in females. Its prognosis depends on different factors including histologic subtype, stage at diagnosis, tumour burden after cytoreductive surgery and sensitivity to chemotherapy. However, it is early stage and detection of precursor lesions of ovarian cancer that are of utmost prognostic impact. New insights in biology and genetics in ovarian cancer hold promise in earlier detection and are pivotal in personalised treatment. Blood biomarkers and/or imaging have been widely used in screening programs of ovarian cancer. Currently, a screening test is widely recommended in patients at risk, e. g in familial history, BRCA1and 2 mutation carriers or HPCN families, which are estimated to account for approximately 5-15% of ovarian cancers. Imaging using US and MRI plays a central role in identifying early ovarian cancer and precursors of invasive cancer, e.g. cystadenomas or Borderline tumours. The “O RADS” working group has developed a lexicon for both US and MRI. Such standardised terminology will allow an unequivocal and generally applicable description of ovarian masses. It will also provide an essential tool for risk stratification of ovarian lesions.

A-0070
08:36
A. Current guidance on screening and familial ovarian cancer (part 1)
A. G. Rockall; London/GB
Learning Objectives

1. To be aware of the implications of results of recent screening trials.
2. To be aware of BRCA gene testing and treatment implications.
3. To know the guidance on screening high risk groups.

Abstract

Germline BRCA1/2 (gBRCA) mutations underlie 15-20% of epithelial ovarian cancer diagnoses and are associated with biologically distinct tumours. Those with a gBRCA mutation typically have a younger age of diagnosis, higher rates of visceral and nodal metastases and an improved prognosis compared to those with gBRCA wildtype tumours. Mutation carriers also have increased rates of synchronous/metachronous tumours, particularly breast and pancreatic cancers. As ovarian cancer is typically diagnosed at a late stage, with poor long-term survival, there has been interest in screening, to try and improve outcomes. A number of screening studies have investigated the role of transvaginal ultrasound +/- CA-125 testing in both those with a family history of ovarian cancer; and those at population risk. To date, no improvement in overall survival has been observed with screening, although studies assessing relative CA-125 levels are ongoing. The methods and results of the largest screening trials will be presented with a discussion of findings.

A-0071
08:50
A. Current guidance on screening and familial ovarian cancer (part 2)
A. George; London/GB
Learning Objectives

1. To be aware of the implications of results of recent screening trials.
2. To be aware of BRCA gene testing and treatment implications.
3. To know the guidance on screening high risk groups.

Abstract

Germline BRCA1/2 (gBRCA) mutations underlie 15-20% of epithelial ovarian cancer diagnoses and are associated with biologically distinct tumours. Those with a gBRCA mutation typically have a younger age of diagnosis, higher rates of visceral and nodal metastases and an improved prognosis compared to those with gBRCAwildtype tumours. Mutation carriers also have increased rates of synchronous/metachronous tumours, particularly breast and pancreatic cancers. As ovarian cancer is typically diagnosed at a late stage, with poor long-term survival, there has been interest in screening to try and improve outcomes. A number of screening studies have investigated the role of transvaginal ultrasound +/- CA-125 testing in both those with a family history of ovarian cancer; and those at population risk. To date, no improvement n overall survival has been observed with screening, although studies assessing relative CA-125 levels are ongoing. The methods and results of the largest screening trials will be presented with a discussion of findings.

A-0072
09:04
B. ORADS: ultrasound and International Ovarian Tumor Analysis (IOTA) group models
R. F. Andreotti; Nashville/US
Learning Objectives

1. To understand a new lexicon for ovarian/adnexal mass evaluation on ultrasound.
2. To understand the use of the lexicon in the development of a risk stratification and management system.
3. To apply O-RADS-US to case management.

Abstract

“O-RADS” is an acronym for an Ovarian-Adnexal Imaging-Reporting-Data System which is being developed by an international committee that is sponsored by the American College of Radiology (ACR) and will function as a quality assurance tool for the standardised ultrasound (US) and magnetic resonance imaging (MRI) description of ovarian/adnexal pathology. The O-RADS Committee has published a lexicon for describing US imaging characteristics of ovarian/adnexal masses. The terminology has been applied to a risk stratification classification for consistent follow up and management in clinical practice. The use of these internationally agreed upon standardised descriptors should result in consistent interpretations and decrease or eliminate ambiguity in reports resulting in a higher probability of accuracy in assigning the risk of malignancy and, subsequently, optimal patient management. The US lexicon is based upon supporting evidence for the performance of terms with regards to classification of the mass as benign or malignant and common usage of terms. A large part of the lexicon is based upon terms in use by the International Ovarian Tumor Analysis Group (IOTA). These terms demonstrate consistency regarding performance in the evaluation of malignancy risk and have been supplemented with other modifying, non-IOTA descriptors. Risk categories were developed using the most predictive descriptors in the lexicon that, in combination, include all possible lesions. The risk table is based on statistics collected by IOTA/ADNEX models. Cases that illustrate the O-RADS-US Lexicon and Risk Stratification System will be discussed.

A-0073
09:32
C. ORADS: MRI
I. Thomassin-Naggara; Paris/FR
Learning Objectives

1. To understand a new lexicon for ovarian/adnexal mass evaluation on MRI.
2. To understand the use of the lexicon in the development of a risk stratification and management system.
3. To apply O-RADS-MRI to case management.

Abstract

The O-RADS classification has been developed by the American College of Radiology in collaboration with ESR members. This classification helps the radiologist to evaluate the risk of malignancy of an adnexal mass and was built as a five categories steps. O-RADS needs the analysis of morphological and functional criteria including DCE MR images and DWI. This lecture will present the new lexicon.

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