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Staging and Follow-up of Ovarian Cancer
Variant: 1
Adult. Ovarian cancer. Pretreatment staging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| CT abdomen and pelvis with IV contrast | Usually Appropriate | ☢☢☢ |
| CT chest with IV contrast | Usually Appropriate | ☢☢☢ |
| MRI abdomen and pelvis without and with IV contrast | May Be Appropriate | O |
| MRI abdomen and pelvis without IV contrast | May Be Appropriate | O |
| CT abdomen and pelvis without IV contrast | May Be Appropriate | ☢☢☢ |
| CT chest without IV contrast | May Be Appropriate | ☢☢☢ |
| FDG-PET/MRI skull base to mid-thigh | May Be Appropriate | ☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | May Be Appropriate | ☢☢☢☢ |
| US abdomen and pelvis transabdominal | Usually Not Appropriate | O |
| US pelvis transvaginal | Usually Not Appropriate | O |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 2
Adult. Ovarian cancer. Posttreatment response evaluation.
| Procedure | Appropriateness Category | Relative Radiation Level |
| CT abdomen and pelvis with IV contrast | Usually Appropriate | ☢☢☢ |
| CT chest with IV contrast | Usually Appropriate | ☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | Usually Appropriate | ☢☢☢☢ |
| MRI abdomen and pelvis without and with IV contrast | May Be Appropriate | O |
| MRI abdomen and pelvis without IV contrast | May Be Appropriate | O |
| CT abdomen and pelvis without IV contrast | May Be Appropriate | ☢☢☢ |
| CT chest without IV contrast | May Be Appropriate | ☢☢☢ |
| FDG-PET/MRI skull base to mid-thigh | May Be Appropriate | ☢☢☢ |
| US abdomen and pelvis transabdominal | Usually Not Appropriate | O |
| US pelvis transvaginal | Usually Not Appropriate | O |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 3
Adult. Ovarian cancer. Posttreatment routine surveillance. Asymptomatic patient, no suspected recurrence.
| Procedure | Appropriateness Category | Relative Radiation Level |
| MRI abdomen and pelvis without and with IV contrast | May Be Appropriate | O |
| MRI abdomen and pelvis without IV contrast | May Be Appropriate | O |
| CT abdomen and pelvis with IV contrast | May Be Appropriate | ☢☢☢ |
| CT abdomen and pelvis without IV contrast | May Be Appropriate | ☢☢☢ |
| CT chest with IV contrast | May Be Appropriate | ☢☢☢ |
| CT chest without IV contrast | May Be Appropriate | ☢☢☢ |
| FDG-PET/MRI skull base to mid-thigh | May Be Appropriate | ☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | May Be Appropriate | ☢☢☢☢ |
| US abdomen and pelvis transabdominal | Usually Not Appropriate | O |
| US pelvis transvaginal | Usually Not Appropriate | O |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 4
Adult. Ovarian cancer. Posttreatment evaluation. Suspected or known recurrence.
| Procedure | Appropriateness Category | Relative Radiation Level |
| CT abdomen and pelvis with IV contrast | Usually Appropriate | ☢☢☢ |
| CT chest with IV contrast | Usually Appropriate | ☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | Usually Appropriate | ☢☢☢☢ |
| MRI abdomen and pelvis without and with IV contrast | May Be Appropriate | O |
| MRI abdomen and pelvis without IV contrast | May Be Appropriate | O |
| CT abdomen and pelvis without IV contrast | May Be Appropriate | ☢☢☢ |
| CT chest without IV contrast | May Be Appropriate | ☢☢☢ |
| FDG-PET/MRI skull base to mid-thigh | May Be Appropriate | ☢☢☢ |
| US abdomen and pelvis transabdominal | Usually Not Appropriate | O |
| US pelvis transvaginal | Usually Not Appropriate | O |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Panel Members
Erica B. Stein, MDa; Aradhana M. Venkatesan, MDb; Esma A. Akin, MDc; Emily Barrows, MDd; Parul Barry, MDe; Nicole M. Hindman, MDf; Chenchan Huang, MDg; Gaiane M. Rauch, MD, PhDh; Madeleine Sertic, MB, BChi; Krista Suarez-Weiss, MDj; Jason D. Wright, MDk; Ashish P. Wasnik, MDl.
Summary of Literature Review
Introduction/Background
Discussion of Procedures by Variant
Variant 1: Adult. Ovarian cancer. Pretreatment staging.
Variant 1: Adult. Ovarian cancer. Pretreatment staging.
A. CT abdomen and pelvis with IV contrast
A. CT abdomen and pelvis with IV contrast
Variant 1: Adult. Ovarian cancer. Pretreatment staging.
B. CT abdomen and pelvis without and with IV contrast
B. CT abdomen and pelvis without and with IV contrast
Variant 1: Adult. Ovarian cancer. Pretreatment staging.
C. CT abdomen and pelvis without IV contrast
C. CT abdomen and pelvis without IV contrast
Variant 1: Adult. Ovarian cancer. Pretreatment staging.
D. CT chest with IV contrast
D. CT chest with IV contrast
Variant 1: Adult. Ovarian cancer. Pretreatment staging.
E. CT chest without and with IV contrast
E. CT chest without and with IV contrast
Variant 1: Adult. Ovarian cancer. Pretreatment staging.
F. CT chest without IV contrast
F. CT chest without IV contrast
Variant 1: Adult. Ovarian cancer. Pretreatment staging.
G. FDG-PET/CT skull base to mid-thigh
G. FDG-PET/CT skull base to mid-thigh
Variant 1: Adult. Ovarian cancer. Pretreatment staging.
H. FDG-PET/MRI skull base to mid-thigh
H. FDG-PET/MRI skull base to mid-thigh
Variant 1: Adult. Ovarian cancer. Pretreatment staging.
I. MRI abdomen and pelvis without and with IV contrast
I. MRI abdomen and pelvis without and with IV contrast
Variant 1: Adult. Ovarian cancer. Pretreatment staging.
J. MRI abdomen and pelvis without IV contrast
J. MRI abdomen and pelvis without IV contrast
Variant 1: Adult. Ovarian cancer. Pretreatment staging.
K. US abdomen and pelvis transabdominal
K. US abdomen and pelvis transabdominal
Variant 1: Adult. Ovarian cancer. Pretreatment staging.
L. US pelvis transvaginal
L. US pelvis transvaginal
Variant 2: Adult. Ovarian cancer. Posttreatment response evaluation.
Variant 2: Adult. Ovarian cancer. Posttreatment response evaluation.
A. CT abdomen and pelvis with IV contrast
A. CT abdomen and pelvis with IV contrast
Variant 2: Adult. Ovarian cancer. Posttreatment response evaluation.
B. CT abdomen and pelvis without and with IV contrast
B. CT abdomen and pelvis without and with IV contrast
Variant 2: Adult. Ovarian cancer. Posttreatment response evaluation.
C. CT abdomen and pelvis without IV contrast
C. CT abdomen and pelvis without IV contrast
Variant 2: Adult. Ovarian cancer. Posttreatment response evaluation.
D. CT chest with IV contrast
D. CT chest with IV contrast
Variant 2: Adult. Ovarian cancer. Posttreatment response evaluation.
E. CT chest without and with IV contrast
E. CT chest without and with IV contrast
Variant 2: Adult. Ovarian cancer. Posttreatment response evaluation.
F. CT chest without IV contrast
F. CT chest without IV contrast
Variant 2: Adult. Ovarian cancer. Posttreatment response evaluation.
G. FDG-PET/CT skull base to mid-thigh
G. FDG-PET/CT skull base to mid-thigh
Variant 2: Adult. Ovarian cancer. Posttreatment response evaluation.
H. FDG-PET/MRI skull base to mid-thigh
H. FDG-PET/MRI skull base to mid-thigh
Variant 2: Adult. Ovarian cancer. Posttreatment response evaluation.
I. MRI abdomen and pelvis without and with IV contrast
I. MRI abdomen and pelvis without and with IV contrast
Variant 2: Adult. Ovarian cancer. Posttreatment response evaluation.
J. MRI abdomen and pelvis without IV contrast
J. MRI abdomen and pelvis without IV contrast
Variant 2: Adult. Ovarian cancer. Posttreatment response evaluation.
K. US abdomen and pelvis transabdominal
K. US abdomen and pelvis transabdominal
Variant 2: Adult. Ovarian cancer. Posttreatment response evaluation.
L. US pelvis transvaginal
L. US pelvis transvaginal
Variant 3: Adult. Ovarian cancer. Posttreatment routine surveillance. Asymptomatic patient, no suspected recurrence.
Variant 3: Adult. Ovarian cancer. Posttreatment routine surveillance. Asymptomatic patient, no suspected recurrence.
A. CT abdomen and pelvis with IV contrast
A. CT abdomen and pelvis with IV contrast
Variant 3: Adult. Ovarian cancer. Posttreatment routine surveillance. Asymptomatic patient, no suspected recurrence.
B. CT abdomen and pelvis without and with IV contrast
B. CT abdomen and pelvis without and with IV contrast
Variant 3: Adult. Ovarian cancer. Posttreatment routine surveillance. Asymptomatic patient, no suspected recurrence.
C. CT abdomen and pelvis without IV contrast
C. CT abdomen and pelvis without IV contrast
Variant 3: Adult. Ovarian cancer. Posttreatment routine surveillance. Asymptomatic patient, no suspected recurrence.
D. CT chest with IV contrast
D. CT chest with IV contrast
Variant 3: Adult. Ovarian cancer. Posttreatment routine surveillance. Asymptomatic patient, no suspected recurrence.
E. CT chest without and with IV contrast
E. CT chest without and with IV contrast
Variant 3: Adult. Ovarian cancer. Posttreatment routine surveillance. Asymptomatic patient, no suspected recurrence.
F. CT chest without IV contrast
F. CT chest without IV contrast
Variant 3: Adult. Ovarian cancer. Posttreatment routine surveillance. Asymptomatic patient, no suspected recurrence.
G. FDG-PET/CT skull base to mid-thigh
G. FDG-PET/CT skull base to mid-thigh
Variant 3: Adult. Ovarian cancer. Posttreatment routine surveillance. Asymptomatic patient, no suspected recurrence.
H. FDG-PET/MRI skull base to mid-thigh
H. FDG-PET/MRI skull base to mid-thigh
Variant 3: Adult. Ovarian cancer. Posttreatment routine surveillance. Asymptomatic patient, no suspected recurrence.
I. MRI abdomen and pelvis without and with IV contrast
I. MRI abdomen and pelvis without and with IV contrast
Variant 3: Adult. Ovarian cancer. Posttreatment routine surveillance. Asymptomatic patient, no suspected recurrence.
J. MRI abdomen and pelvis without IV contrast
J. MRI abdomen and pelvis without IV contrast
Variant 3: Adult. Ovarian cancer. Posttreatment routine surveillance. Asymptomatic patient, no suspected recurrence.
K. US abdomen and pelvis transabdominal
K. US abdomen and pelvis transabdominal
Variant 3: Adult. Ovarian cancer. Posttreatment routine surveillance. Asymptomatic patient, no suspected recurrence.
L. US pelvis transvaginal
L. US pelvis transvaginal
Variant 4: Adult. Ovarian cancer. Posttreatment evaluation. Suspected or known recurrence.
Variant 4: Adult. Ovarian cancer. Posttreatment evaluation. Suspected or known recurrence.
A. CT abdomen and pelvis with IV contrast
A. CT abdomen and pelvis with IV contrast
Variant 4: Adult. Ovarian cancer. Posttreatment evaluation. Suspected or known recurrence.
B. CT abdomen and pelvis without and with IV contrast
B. CT abdomen and pelvis without and with IV contrast
Variant 4: Adult. Ovarian cancer. Posttreatment evaluation. Suspected or known recurrence.
C. CT abdomen and pelvis without IV contrast
C. CT abdomen and pelvis without IV contrast
Variant 4: Adult. Ovarian cancer. Posttreatment evaluation. Suspected or known recurrence.
D. CT chest with IV contrast
D. CT chest with IV contrast
Variant 4: Adult. Ovarian cancer. Posttreatment evaluation. Suspected or known recurrence.
E. CT chest without and with IV contrast
E. CT chest without and with IV contrast
Variant 4: Adult. Ovarian cancer. Posttreatment evaluation. Suspected or known recurrence.
F. CT chest without IV contrast
F. CT chest without IV contrast
Variant 4: Adult. Ovarian cancer. Posttreatment evaluation. Suspected or known recurrence.
G. FDG-PET/CT skull base to mid-thigh
G. FDG-PET/CT skull base to mid-thigh
Variant 4: Adult. Ovarian cancer. Posttreatment evaluation. Suspected or known recurrence.
H. FDG-PET/MRI skull base to mid-thigh
H. FDG-PET/MRI skull base to mid-thigh
Variant 4: Adult. Ovarian cancer. Posttreatment evaluation. Suspected or known recurrence.
I. MRI abdomen and pelvis without and with IV contrast
I. MRI abdomen and pelvis without and with IV contrast
Variant 4: Adult. Ovarian cancer. Posttreatment evaluation. Suspected or known recurrence.
J. MRI abdomen and pelvis without IV contrast
J. MRI abdomen and pelvis without IV contrast
Variant 4: Adult. Ovarian cancer. Posttreatment evaluation. Suspected or known recurrence.
K. US abdomen and pelvis transabdominal
K. US abdomen and pelvis transabdominal
Variant 4: Adult. Ovarian cancer. Posttreatment evaluation. Suspected or known recurrence.
L. US pelvis transvaginal
L. US pelvis transvaginal
Summary of Highlights
Supporting Documents
The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.
For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.
Gender Equality and Inclusivity Clause
The ACR acknowledges the limitations in applying inclusive language when citing research studies that predates the use of the current understanding of language inclusive of diversity in sex, intersex, gender, and gender-diverse people. The data variables regarding sex and gender used in the cited literature will not be changed. However, this guideline will use the terminology and definitions as proposed by the National Institutes of Health.
Appropriateness Category Names and Definitions
|
Appropriateness Category Name |
Appropriateness Rating |
Appropriateness Category Definition |
|
Usually Appropriate |
7, 8, or 9 |
The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients. |
|
May Be Appropriate |
4, 5, or 6 |
The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal. |
|
May Be Appropriate (Disagreement) |
5 |
The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned. |
|
Usually Not Appropriate |
1, 2, or 3 |
The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable. |
Relative Radiation Level Information
Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level (RRL) indication has been included for each imaging examination. The RRLs are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk associated with an imaging procedure. Patients in the pediatric age group are at inherently higher risk from exposure, because of both organ sensitivity and longer life expectancy (relevant to the long latency that appears to accompany radiation exposure). For these reasons, the RRL dose estimate ranges for pediatric examinations are lower as compared with those specified for adults (see Table below). Additional information regarding radiation dose assessment for imaging examinations can be found in the ACR Appropriateness Criteria® Radiation Dose Assessment Introduction document.
|
Relative Radiation Level Designations |
||
|
Relative Radiation Level* |
Adult Effective Dose Estimate Range |
Pediatric Effective Dose Estimate Range |
|
O |
0 mSv |
0 mSv |
|
☢ |
<0.1 mSv |
<0.03 mSv |
|
☢☢ |
0.1-1 mSv |
0.03-0.3 mSv |
|
☢☢☢ |
1-10 mSv |
0.3-3 mSv |
|
☢☢☢☢ |
10-30 mSv |
3-10 mSv |
|
☢☢☢☢☢ |
30-100 mSv |
10-30 mSv |
|
*RRL assignments for some of the examinations cannot be made, because the actual patient doses in these procedures vary as a function of a number of factors (e.g., region of the body exposed to ionizing radiation, the imaging guidance that is used). The RRLs for these examinations are designated as “Varies.” |
||
References
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Disclaimer
The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination