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Cancers
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The Role of Medical Imaging in Gynecological Cancer
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The Role of Medical Imaging in Gynecological Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: 1 June 2025 | Viewed by 6227

Special Issue Editors

Dr. Emma R. Allanson

E-Mail Website
Guest Editor
UWA Medical School, Obstetrics and Gynaecology, The University of Western Australia (M550), 35 Stirling Highway, Perth 6009, Australia
Interests: cervical cancer
Special Issues, Collections and Topics in MDPI journals
Dr. Ming Yin Lin

E-Mail Website
Guest Editor
Peter Maccallum Cancer Centre, Melbourne, Australia
Interests: cervical cancer; MRI; PET
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The recent tremendous technological advances in cancer imaging have been of the utmost importance in the accurate diagnosis, staging, and treatment of Gynaecological Cancer. The judicious application of the various modalities of 3D imaging in conjuction with clinical assessment have provided significant insights into various prognostic and predictive factors in the management of gynecological malignancies. This could guide appropriate patient selection for various treatment modalities and subsequent restaging following therapy in order to guide further management. Furthermore, the recent revisions of FIGO staging in Cervical Cancer have incorporated the use medical imaging in recognition of the prognostic significance of nodal involvement and tumour size, which can be obtained via medical imaging.

To this end, we would like to invite you to contribute to this Special Issue, entitled “The Role of Medical Imaging in Gynecological Cancer”, and look forward to receiving your valued submissions.

Prof. Emma R. Allanson
Dr. Ming Yin Lin
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cervical cancer
  • endometrial cancer
  • ovarian cancer
  • staging
  • ultrasound
  • MRI, PET-CT, radiotherapy
  • image-guided brachytherapy

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Published Papers (5 papers)

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Research

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12 pages, 1647 KiB  
Article
Accuracy of O-RADS System in Differentiating Between Benign and Malignant Adnexal Masses Assessed via External Validation by Inexperienced Gynecologists
by Peeradech Buranaworathitikul, Veera Wisanumahimachai, Natthaphon Phoblap, Yosagorn Porngasemsart, Waranya Rugfoong, Nuttha Yotchana, Pakaporn Uthaichalanont, Thunthida Jiampochaman, Chayanid Kunanukulwatana, Atiphoom Thiamkaew, Suchaya Luewan, Charuwan Tantipalakorn and Theera Tongsong
Cancers 2024, 16(22), 3820; https://doi.org/10.3390/cancers16223820 - 13 Nov 2024
Viewed by 432
Abstract
Objective: To evaluate the accuracy of the O-RADS system in differentiating between benign and malignant adnexal masses, as assessed by inexperienced gynecologists. Methods: Ten gynecologic residents attended a 20 h training course on the O-RADS system conducted by experienced examiners. Following the training, [...] Read more.
Objective: To evaluate the accuracy of the O-RADS system in differentiating between benign and malignant adnexal masses, as assessed by inexperienced gynecologists. Methods: Ten gynecologic residents attended a 20 h training course on the O-RADS system conducted by experienced examiners. Following the training, the residents performed ultrasound examinations on patients admitted with adnexal masses under supervision, recording the data in a database that included videos and still images. The senior author later accessed this ultrasound database and presented the cases offline to ten residents for O-RADS rating, with the raters being blinded to the final diagnosis. The efficacy of the O-RADS system by the residents and inter-observer variability were assessed. Results: A total of 201 adnexal masses meeting the inclusion criteria were evaluated, consisting of 136 (67.7%) benign masses and 65 (32.3%) malignant masses. The diagnostic performance of the O-RADS system showed a sensitivity of 90.8% (95% CI: 82.2–96.2%) and a specificity of 86.8% (95% CI: 80.4–91.8%). Inter-observer variability in scoring was analyzed using multi-rater Fleiss Kappa analysis, yielding Kappa indices of 0.642 (95% CI: 0.641–0.643). The false positive rate was primarily due to the misclassification of solid components in classic benign masses as O-RADS-4 or O-RADS-5. Conclusions: The O-RADS system demonstrates high diagnostic performance in distinguishing benign from malignant adnexal masses, even when used by inexperienced examiners. However, the false positive rate remains relatively high, mainly due to the over-interpretation of solid-appearing components in classic benign lesions. Despite this, inter-observer variability among non-expert raters was substantial. Incorporating O-RADS system training into residency programs is beneficial for inexperienced practitioners. This study could be an educational model for gynecologic residency training for other systems of sonographic features. Full article
(This article belongs to the Special Issue The Role of Medical Imaging in Gynecological Cancer)
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20 pages, 6518 KiB  
Article
Evaluation of Selected MRI Parameters in the Differentiation of Mucinous Ovarian Carcinomas and Metastatic Ovarian Tumors
by Marta Halaburda-Rola, Laretta Grabowska-Derlatka, Leszek Kraj, Rafal Stec and Pawel Derlatka
Cancers 2024, 16(21), 3569; https://doi.org/10.3390/cancers16213569 - 23 Oct 2024
Cited by 1 | Viewed by 534
Abstract
Introduction: Analysis of selected MRI parameters in initial MRI for the characterization of ovarian masses enables differentiation between mucinous ovarian carcinoma and metastatic ovarian tumors. Material and Methods: A prospective analysis of contrast-enhanced MRI of patients with suspected ovarian masses diagnosed in ultrasound [...] Read more.
Introduction: Analysis of selected MRI parameters in initial MRI for the characterization of ovarian masses enables differentiation between mucinous ovarian carcinoma and metastatic ovarian tumors. Material and Methods: A prospective analysis of contrast-enhanced MRI of patients with suspected ovarian masses diagnosed in ultrasound and CT examination. Morphological criteria, such as the size of lesion, bilateral location, presence of “mille-feuille sign”, so-called Seidman criteria, as well as the diffusion weighted imaging and dynamic contrast enhancement of each lesion, were evaluated. Patients were allocated into two groups; the first group contained patients with mucinous ovarian cancer, and the second group contained patients with metastatic ovarian tumors. Results: A total of 35 patients were enrolled into the study. Median age was 49 in the first group and 59 in the second group of patients (p = 0.04). In the first group, all patients (100%) had unilateral lesions, and in the second group, 94% had bilateral tumors (p < 0.000001). In the first group, a tumor size equal or greater than 10 cm was present in 80% of patients, and the same was true for 21% of patients in the second group. The mille-feuille sign was present in 30% of patients from the first group and in 64% of patients from the second group. In the first group of patients, TTP was 410 and Perf.Max Enhancement was 141; in the second group, they were, respectively, 154 and 167 (p = 0.0001 and p = 0.5). Median ADC values in the first group were significantly higher in the first group than in the second group (p < 0.01). Conclusions: Significant differences in TTP and ADC values as well as in Seidman criteria enable reliable differentiation between the analyzed groups of tumors. Full article
(This article belongs to the Special Issue The Role of Medical Imaging in Gynecological Cancer)
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11 pages, 633 KiB  
Article
Reevaluating Axillary Lymph Node Dissection in Total Mastectomy for Low Axillary Burden Breast Cancer: Insights from a Meta-Analysis including the SINODAR-ONE Trial
by Munaser Alamoodi, Neill Patani, Kinan Mokbel, Umar Wazir and Kefah Mokbel
Cancers 2024, 16(4), 742; https://doi.org/10.3390/cancers16040742 - 10 Feb 2024
Viewed by 2546
Abstract
Complete axillary lymph node dissection (cALND) was previously the standard of care for breast cancer (BC) patients with axillary node disease or macro-metastases found via sentinel lymph node biopsy (SLNB). However, due to significant morbidity, contemporary management now considers a more selective approach, [...] Read more.
Complete axillary lymph node dissection (cALND) was previously the standard of care for breast cancer (BC) patients with axillary node disease or macro-metastases found via sentinel lymph node biopsy (SLNB). However, due to significant morbidity, contemporary management now considers a more selective approach, influenced by studies like ACOSOG Z0011. This trial showed that cALND could be omitted without compromising local control or survival in patients with low axillary nodal disease burden undergoing breast-conserving therapy, radiotherapy, and systemic therapy. The relevance of this approach for women with low axillary nodal burden undergoing total mastectomy (TM) remained unclear. A PubMed search up to September 2023 identified 147 relevant studies, with 6 meeting the inclusion criteria, involving 4184 patients with BC and low-volume axillary disease (1–3 positive lymph nodes) undergoing TM. Postmastectomy radiotherapy receipt was similar in both groups. After a mean 7.2-year follow-up, both the pooled results and the meta-analysis revealed no significant differences in overall survival. The combined analysis of the published studies, including the subgroup analysis of the SINODAR-One trial, indicates no survival advantage for cALND over SLNB in T1–T2 breast cancer patients with 1–3 positive sentinel lymph nodes (pN1) undergoing mastectomy. This suggests that, following a multidisciplinary evaluation, cALND can be safely omitted. However, the impact of other patient, tumor, and treatment factors on survival requires consideration and therefore further prospective trials are needed for conclusive validation. Full article
(This article belongs to the Special Issue The Role of Medical Imaging in Gynecological Cancer)
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Review

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13 pages, 235 KiB  
Review
Imaging in Vulval Cancer
by Minah Ha and Lois Eva
Cancers 2024, 16(12), 2269; https://doi.org/10.3390/cancers16122269 - 19 Jun 2024
Viewed by 876
Abstract
Vulval cancer is a rare gynaecological cancer, accounting for 3% of all gynaecological malignancies, with 47,000 cases in 2022 globally. Various imaging modalities are widely used in conjunction with clinical assessment in the diagnosis and staging of vulval cancers; however, there is significant [...] Read more.
Vulval cancer is a rare gynaecological cancer, accounting for 3% of all gynaecological malignancies, with 47,000 cases in 2022 globally. Various imaging modalities are widely used in conjunction with clinical assessment in the diagnosis and staging of vulval cancers; however, there is significant heterogeneity in which modalities are recommended in international guidelines, reflecting the paucity of evidence in this area. We reviewed the current evidence for the role of imaging in vulval cancer. A systematic search of the literature was performed on the PubMed database using the MeSH terms ‘vulval neoplasm’ and ‘diagnostic imaging’. We found that there is insufficient evidence to support the routine use of imaging for primary vulval tumours. For nodal assessment, there is no ideal imaging modality with sensitivity or specificity that is superior to other modalities. For distant metastases, CT CAP and FDG-PET/CT have the most evidence to support their use. In conclusion, the evidence for role of imaging in vulval cancer is limited by the heterogeneity of the study design and diagnostic criteria used in each study and the small sample size and retrospective nature of most studies. Full article
(This article belongs to the Special Issue The Role of Medical Imaging in Gynecological Cancer)
16 pages, 440 KiB  
Review
Current Preoperative Management of Vulvar Squamous Cell Carcinoma: An Overview
by Luigi Della Corte, Valeria Cafasso, Maria Chiara Guarino, Giuseppe Gullo, Gaspare Cucinella, Alessandra Lopez, Simona Zaami, Gaetano Riemma, Pierluigi Giampaolino and Giuseppe Bifulco
Cancers 2024, 16(10), 1846; https://doi.org/10.3390/cancers16101846 - 11 May 2024
Viewed by 1351
Abstract
Vulvar carcinoma is a rare cancer affecting the genital tract, constituting 4% of gynecological tumors. Vulvar squamous cell carcinoma (VSCC) is the most common type. Diagnosis relies on biopsy during vulvoscopy, plus imaging such as ultrasonography (USG), magnetic resonance imaging (MRI) and positron [...] Read more.
Vulvar carcinoma is a rare cancer affecting the genital tract, constituting 4% of gynecological tumors. Vulvar squamous cell carcinoma (VSCC) is the most common type. Diagnosis relies on biopsy during vulvoscopy, plus imaging such as ultrasonography (USG), magnetic resonance imaging (MRI) and positron emission tomography (PET). This review aims to lay out a thorough overview as to the current preoperative management of VSCC, both in case of vulvar and lymph node involvement. The data research was conducted using the following databases: MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID and Cochrane Library from 2010 to 2024. The selection criteria included only original articles. Seventeen studies were assessed for eligibility. A concordance rate of 62.3% for vHSIL and 65.2% for carcinoma at vulvoscopy, with a sensitivity of 98%, specificity of 40%, PPV (Positive Predictive Value) of 37% and NPV (Negative Predictive Value) of 98% in identifying malignant lesions was found. Regarding the reliability of PET for staging and assessing lymph node involvement, a mean SUV (Standardized Uptake Value) for malignant vulvar lesions of 8.4 (range 2.5–14.7) was reported. In the case of MRI, useful for the evaluation of loco-regional infiltration and lymph node involvement, the ratio of the short-to-long-axis diameter and the reader’s diagnostic confidence for the presence of lymph node metastasis yielded accuracy of 84.8% and 86.9%, sensitivity of 86.7% and 87.5%, specificity of 81.3% and 86.2%, PPV of 89.7% and 87.5% and NPV of 76.5% and 86.2%, respectively. A long lymph node axis >10 mm and a short diameter >5.8 mm were found to be predictors of malignancy. At USG, instead, the two main characteristics of potentially malignant lymph nodes are cortical thickness and short axis length; the combination of these ultrasound parameters yielded the highest accuracy in distinguishing between negative and positive lymph nodes. Despite the heterogeneity of the included studies and the lack of randomized clinical trials, this review provides a broad overview of the three imaging tools used for the presurgical management of VSCC. Nowadays, although MRI and PET represent the gold standard, ultrasound evaluation is taking on a growing role, as long as it is carried out by expert sonographer. The management of this rare disease should be always performed by a multidisciplinary team in order to precisely stage the tumor and determine the most suitable treatment approach. Full article
(This article belongs to the Special Issue The Role of Medical Imaging in Gynecological Cancer)
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