Sexcord/ stromal ovarian tumors diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Maneesha Nandimandalam, M.B.B.S.[2]

Overview

Biopsy is the gold standard test for the diagnosis of sexcord/ stromal ovarian tumors. There is no single diagnostic study of choice for the diagnosis of sexcord/ stromal ovarian tumors, but these can be diagnosed based on CT and MRI findings[1]

Diagnostic Study of Choice

Study of choice

Biopsy is the gold standard test for the diagnosis of sexcord/ stromal ovarian tumors. There is no single diagnostic study of choice for the diagnosis of sexcord/ stromal ovarian tumors, but these can be diagnosed based on CT and MRI findings[2][1][3][4][5]

Sequence of Diagnostic Studies

The various investigations must be performed in the following order:

  • CT
  • MRI
  • Biopsy

Name of Diagnostic Criteria

There are no established criteria for the diagnosis of sexcord/ stromal ovarian tumors

Staging

The TNM staging for sex cord/stromal ovarian tumors is mentioned in the following table:[6][7][8][9][10][11][12]

Primary tumor (T)
T category FIGO stage T criteria
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 I Tumor limited to ovaries (one or both) or fallopian tube(s)
T1a IA Tumor limited to one ovary (capsule intact) or fallopian tube,

no tumor on ovarian or fallopian tube surface; no malignant cells in ascites or peritoneal washings

T1b IB Tumor limited to both ovaries (capsules intact) or fallopian tubes;

no tumor on ovarian or fallopian tube surface; no malignant cells in ascites or peritoneal washings

T1c IC Tumor limited to one or both ovaries or fallopian tubes, with any of the following:
T1c1 IC1
  • Surgical spill
T1c2 IC2
  • Capsule ruptured before surgery or tumor on ovarian or fallopian tube surface
T1c3 IC3
  • Malignant cells in ascites or peritoneal washings
T2 II Tumor involves one or both ovaries or fallopian tubes with pelvic extension below pelvic brim or primary peritoneal cancer
T2a IIA Extension and/or implants on the uterus and/or fallopian tube(s) and/or ovaries
T2b IIB Extension to and/or implants on other pelvic tissues
T3 III Tumor involves one or both ovaries or fallopian tubes, or primary peritoneal cancer,

with microscopically confirmed peritoneal metastasis outside the pelvis

and/or metastasis to the retroperitoneal (pelvic and/or para-aortic) lymph nodes

T3a IIIA2 Microscopic extrapelvic (above the pelvic brim) peritoneal involvement with or

without positive retroperitoneal lymph nodes

T3b IIIB Macroscopic peritoneal metastasis beyond pelvis 2 cm or

less in greatest dimension with or without metastasis to the retroperitoneal lymph nodes

T3c IIIC Macroscopic peritoneal metastasis beyond the pelvis more than 2 cm in greatest dimension with or

without metastasis to the retroperitoneal lymph nodes (includes extension of tumor to capsule of liver and spleen without parenchymal involvement of either organ)

Regional lymph nodes (N)
N category FIGO stage N criteria
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N0(i+) Isolated tumor cells in regional lymph node(s) no greater than 0.2 mm
N1 IIIA1 Positive retroperitoneal lymph nodes only (histologically confirmed)
N1a IIIA1i Metastasis up to and including 10 mm in greatest dimension
N1b IIIA1ii Metastasis more than 10 mm in greatest dimension
Distant metastasis (M)
M category FIGO stage M criteria
M0 No distant metastasis
M1 IV Distant metastasis, including pleural effusion with positive cytology;

liver or splenic parenchymal metastasis;

metastasis to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside the abdominal cavity);

and transmural involvement of intestine

M1a IVA Pleural effusion with positive cytology
M1b IVB Liver or splenic parenchymal metastases;

metastases to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside the abdominal cavity);

transmural involvement of intestine


References

  1. 1.0 1.1 Hashmi AA, Naz S, Edhi MM, Faridi N, Hussain SD, Mumtaz S, Khan M (March 2016). "Accuracy of intraoperative frozen section for the evaluation of ovarian neoplasms: an institutional experience". World J Surg Oncol. 14: 91. doi:10.1186/s12957-016-0849-x. PMC 4815136. PMID 27029917.
  2. Ratnavelu ND, Brown AP, Mallett S, Scholten RJ, Patel A, Founta C, Galaal K, Cross P, Naik R (March 2016). "Intraoperative frozen section analysis for the diagnosis of early stage ovarian cancer in suspicious pelvic masses". Cochrane Database Syst Rev. 3: CD010360. doi:10.1002/14651858.CD010360.pub2. PMC 6457848. PMID 26930463.
  3. Abudukadeer A, Azam S, Zunong B, Mutailipu AZ, Huijun B, Qun L (2016). "Accuracy of intra-operative frozen section and its role in the diagnostic evaluation of ovarian tumors". Eur. J. Gynaecol. Oncol. 37 (2): 216–20. PMID 27172748.
  4. Ivanov S, Ivanov S, Khadzhiolov N (2005). "[Ovarian tumours--accuracy of frozen section diagnosis]". Akush Ginekol (Sofiia) (in Bulgarian). 44 (1): 11–3. PMID 15853005.
  5. Huang Z, Li L, Li C, Ngaujah S, Yao S, Chu R, Xie L, Yang X, Zhang X, Liu P, Jiang J, Zhang Y, Cui B, Song K, Kong B (2018). "Diagnostic accuracy of frozen section analysis of borderline ovarian tumors: a meta-analysis with emphasis on misdiagnosis factors". J Cancer. 9 (16): 2817–2824. doi:10.7150/jca.25883. PMID 30123350.
  6. Meinhold-Heerlein I, Fotopoulou C, Harter P, Kurzeder C, Mustea A, Wimberger P, Hauptmann S, Sehouli J (October 2015). "Statement by the Kommission Ovar of the AGO: The New FIGO and WHO Classifications of Ovarian, Fallopian Tube and Primary Peritoneal Cancer". Geburtshilfe Frauenheilkd. 75 (10): 1021–1027. doi:10.1055/s-0035-1558079. PMC 4629993. PMID 26556905.
  7. Duska LR, Kohn EC (November 2017). "The new classifications of ovarian, fallopian tube, and primary peritoneal cancer and their clinical implications". Ann. Oncol. 28 (suppl_8): viii8–viii12. doi:10.1093/annonc/mdx445. PMID 29232468.
  8. Prat J (April 2015). "FIGO's staging classification for cancer of the ovary, fallopian tube, and peritoneum: abridged republication". J Gynecol Oncol. 26 (2): 87–9. doi:10.3802/jgo.2015.26.2.87. PMC 4397237. PMID 25872889.
  9. Saida T, Tanaka YO, Matsumoto K, Satoh T, Yoshikawa H, Minami M (February 2016). "Revised FIGO staging system for cancer of the ovary, fallopian tube, and peritoneum: important implications for radiologists". Jpn J Radiol. 34 (2): 117–24. doi:10.1007/s11604-015-0513-3. PMID 26696400.
  10. Prat J (July 2015). "Staging Classification for Cancer of the Ovary, Fallopian Tube, and Peritoneum: Abridged Republication of Guidelines From the International Federation of Gynecology and Obstetrics (FIGO)". Obstet Gynecol. 126 (1): 171–4. doi:10.1097/AOG.0000000000000917. PMID 26241270.
  11. Chen, Vivien W.; Ruiz, Bernardo; Killeen, Jeffrey L.; Cot�, Timothy R.; Wu, Xiao Cheng; Correa, Catherine N.; Howe, Holly L. (2003). "Pathology and classification of ovarian tumors". Cancer. 97 (S10): 2631–2642. doi:10.1002/cncr.11345. ISSN 0008-543X. replacement character in |last4= at position 4 (help)
  12. Wang J, Li J, Chen R, Lu X (July 2018). "Contribution of lymph node staging method and prognostic factors in malignant ovarian sex cord-stromal tumors: A world wide database analysis". Eur J Surg Oncol. 44 (7): 1054–1061. doi:10.1016/j.ejso.2018.03.027. PMID 29705285.

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