Thomassin-Naggara I, Daraï E, Lécuru F, Fournier L
Service de radiologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; Équipe medecine- Jussieu, institut des sciences du calcul et de données (ISCD), Sorbonne université 4, place Jussieu, 75006 Paris, France.
Service de gynécologie et obstétrique, hôpital Tenon, Assistance publique-Hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France.
Gynecol Obstet Fertil Senol. 2019 Feb;47(2):123-133. doi: 10.1016/j.gofs.2018.12.012. Epub 2019 Jan 25.
Transvaginal ultrasound is the first-line examination allowing characterizing 80 to 90% of adnexal masses (LP1). If performed by an expert, a subjective analysis is optimal. If performed by a non-expert, combining the use of Simple Rules with subjective analysis can achieve the diagnostic performance of an expert (LP1). Whichever the chosen model (subjective analysis by an expert or combination of the Simple Rules with a subjective analysis by a non-expert), a second-line examination will have to be proposed in the complex or indeterminate cases (about 20% of the masses) (grade A). The best-performing second-line test for characterization is pelvic MRI (LP1). If read by an expert, a pathological hypothesis can or should be suggested (grade D). In case of non-expert reading, the use of the ADNEXMR score allows a reliable assessment of the positive predictive value of malignancy to guide the patient towards the best management (gradeC). For preoperative assessment and evaluation of resectability of ovarian, fallopian tube or primary peritoneal cancer, it is recommended to perform a chest abdomen and pelvis CT with contrast agent injection (LP2, grade B). In the event of a contraindication to the injection of iodinated contrast agent (severe renal insufficiency, GFR <30mL/min), an abdomen and pelvis MRI completed with a non-injected chest CT may be proposed (LP3, grade C). By analogy, the same examinations are recommended to evaluate the disease after neo-adjuvant chemotherapy (LP3, Recommendation grade C). Further studies will be required to determine whether PET-CT provides better lymph node assessment before retroperitoneal and pelvic lymphadenectomy. PET-CT may be used to eliminate lymph node involvement in the absence of suspicious lymph nodes on morphological examination (LP3, grade C). The report should specify the localizations leading to a risk of incomplete cytoreductive surgery and lesions outside the field explored during surgery.
经阴道超声是一线检查方法，可对80%至90%的附件包块进行特征性诊断（低推荐级别1）。如果由专家进行操作，主观分析是最佳选择。如果由非专家进行操作，将简单规则与主观分析相结合可达到专家的诊断水平（低推荐级别1）。无论选择哪种模式（专家的主观分析或非专家将简单规则与主观分析相结合），对于复杂或不确定的病例（约20%的包块）都必须进行二线检查（A级）。用于特征性诊断的最佳二线检查是盆腔磁共振成像（MRI）（低推荐级别1）。如果由专家解读，可提出或应提出病理假设（D级）。在非专家解读的情况下，使用ADNEXMR评分可可靠评估恶性肿瘤的阳性预测值，以指导患者进行最佳管理（C级）。对于卵巢癌、输卵管癌或原发性腹膜癌的术前评估和可切除性评估，建议进行注射造影剂的胸部、腹部和盆腔CT检查（低推荐级别2，B级）。如果存在碘造影剂注射禁忌证（严重肾功能不全，肾小球滤过率<30mL/min），可建议进行未注射造影剂的胸部CT检查补充的腹部和盆腔MRI检查（低推荐级别3，C级）。同理，建议进行相同检查以评估新辅助化疗后的疾病情况（低推荐级别3，推荐等级C）。需要进一步研究以确定正电子发射断层扫描-计算机断层扫描（PET-CT）在腹膜后和盆腔淋巴结清扫术前是否能提供更好的淋巴结评估。在形态学检查未发现可疑淋巴结的情况下，PET-CT可用于排除淋巴结受累情况（低推荐级别3，C级）。报告应明确指出导致细胞减灭术不完全风险的部位以及手术探查范围外的病变。
