Nav: Home

MRI tool can diagnose difficult cases of ovarian cancer

January 30, 2020

The tool has produced encouraging results in a clinical study and its impact on management and outcomes of women with ovarian cancer will now be evaluated in a major trial at 18 hospitals in the UK, including Imperial College Healthcare NHS Trust.

The tool is able to distinguish between malignant and benign ovarian cysts with 90 per cent accuracy, in cases that cannot be distinguished on ultrasound. It was developed by researchers led by Professor Isabelle Thomassin-Naggara at the APHP-Sorbonne Université, with Professor Andrea Rockall at Imperial College London.

Currently, to investigate potential cases of ovarian cancer doctors use ultrasound scanning and blood tests. However, in a quarter of cases these methods cannot identify with confidence whether a patient's cyst in benign or malignant. This leads to surgical investigations, which are invasive and carry risks, such as potential loss of fertility. In most cases women are then diagnosed as having benign cysts.

The team believes that the new tool can be used as a triage test to decide whether patients need further follow up or treatment. They also believe that the findings from the study, published in the JAMA Network Open, could help stratify patients who are high risk so they can be given treatment at a much earlier stage.

Professor Andrea Rockall, senior author of the study and Chair of Radiology at Imperial College London, said:

"Ovarian cancer is referred to as a 'silent killer' as cases are often diagnosed at an advanced stage of the disease. When it is diagnosed earlier the chance of survival is much improved.

There is a real unmet clinical need to find less invasive ways to identify women at risk of ovarian cancer. Our tool has the potential to help triage patients who are low risk so they can have less invasive treatment options, as well as identifying high risk patients so they can receive treatment at an earlier stage and have a better chance of long-term survival."

Ovarian cancer is the sixth most common cancer in women and usually affects women after the menopause or those with a family history of the disease. There are 6,000 new cases of ovarian cancer a year in the UK but the long-term survival rate is just 35-40 per cent as the disease is often diagnosed at a late stage once symptoms such as bloating are noticeable. Early detection of the disease could improve survival rates.

Currently, to investigate potential cases of ovarian cancer clinicians use an ultrasound of the pelvis which shows the ovaries, womb and surrounding structures. They look for cysts in the ovaries and if these look suspicious, women are referred for additional investigations. Clinicians also use a blood test to look for a substance called CA125 - an indication of cancer. These methods are effective at differentiating most benign cysts with those that are malignant. However, in 20-25 per cent of cases the ultrasound is unable to confidently characterise whether a cyst is malignant or benign.

When this occurs, patients may need to undergo surgery in order to confirm if the cyst is malignant or benign. This is invasive and the majority turn out to be benign. In some small cases, this can also lead to a loss of fertility in younger patients.

If the nature of the cysts could be known before surgery, patients would potentially benefit from a more limited surgical approach or follow-up, saving the patients from additional risks as well as cutting unnecessary costs for the NHS.

In the new study, researchers looked at the effectiveness of a tool called Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) in identifying the risk of malignancy in ovarian cysts that could not be categorised by ultrasound in 1340 women. The study took place from March 2013 to March 2016 at 15 centres across Europe, including Hammersmith Hospital, part of Imperial College Healthcare NHS Trust.

Each patient underwent a routine pelvic MRI examination which looked for particular features in cysts that could not be identified during an ultrasound examination such as changes to tissue structure. The researchers developed a risk stratification score which scored the cysts based on five categories. Radiologists then used this tool to score the cysts.

A score of one to three was identified as no mass or benign and a score between four and five was deemed high risk. The women then underwent appropriate standard care, such as surgery if they were identified as high risk or a two year follow-up if their cysts were benign.

A team of radiologists also analysed patients' medical records and ultrasound scans to compare the tool.

The team found that the system outperformed current methods and was 90 per cent accurate at identifying malignant and benign cysts.

The team also found that in patients who scored two or three the risk of a malignant tumour was very low. The researchers believe that these patients can make an informed decision, with the support of their physicians, to undergo a minimally invasive approach towards their treatment such as close monitoring and follow-up rather than surgery.
The research was funded Societé d'Imagerie de la Femme and supported by National Institute of Health Research Imperial Biomedical Research Centre (NIHR- Imperial BRC), the Cancer Research UK Imperial Centre.

Imperial College London

Related Cancer Articles:

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.
Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.
Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.
Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.
More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.
New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.
American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.
Oncotarget: Cancer pioneer employs physics to approach cancer in last research article
In the cover article of Tuesday's issue of Oncotarget, James Frost, MD, PhD, Kenneth Pienta, MD, and the late Donald Coffey, Ph.D., use a theory of physical and biophysical symmetry to derive a new conceptualization of cancer.
Health indicators for newborns of breast cancer survivors may vary by cancer type
In a study published in the International Journal of Cancer, researchers from the UNC Lineberger Comprehensive Cancer Center analyzed health indicators for children born to young breast cancer survivors in North Carolina.
Few women with history of breast cancer and ovarian cancer take a recommended genetic test
More than 80 percent of women living with a history of breast or ovarian cancer at high-risk of having a gene mutation have never taken the test that can detect it.
More Cancer News and Cancer Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Clint Smith
The killing of George Floyd by a police officer has sparked massive protests nationwide. This hour, writer and scholar Clint Smith reflects on this moment, through conversation, letters, and poetry.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at