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Radiologic-Histopathologic Correlation of Transvaginal US and Risk-reducing Salpingo-oophorectomy for Women at High
Michelle D Sakala1, Nicole E Curci1, William R Masch1
1Departments of Radiology (M.D.S., N.E.C., W.R.M., M.M.L., E.B.S., A.P.W., K.E.M.), Pathology (A.P.S.), and Obstetrics/Gynecology (S.U., M.D.P., K.E.M.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5326.
Transvaginal ultrasound has low sensitivity for detecting tubo-ovarian carcinoma (TOC) in high-risk women. Early cancers and precursors are often too small for detection, underscoring the need for improved screening methods.
Area of Science:
- Gynecologic Oncology
- Radiology
- Medical Imaging
Background:
- Women with BRCA mutations, Lynch syndrome, or family history of tubo-ovarian carcinoma (TOC) are at high risk.
- Risk-reducing salpingo-oophorectomy (RRSO) is a key management strategy for these individuals.
- Accurate preoperative imaging is crucial for identifying occult malignancies before RRSO.
Purpose of the Study:
- To evaluate the diagnostic performance of transvaginal ultrasound (US) in detecting TOC before RRSO.
- To correlate radiologic findings with histopathologic results in high-risk women.
- To assess the sensitivity and specificity of transvaginal US for TOC detection.
Main Methods:
- Retrospective analysis of 147 high-risk women undergoing transvaginal US within six months of RRSO.
- Histopathologic review of surgical specimens.
- Reinterpretation of transvaginal US findings by fellowship-trained radiologists using standardized descriptors.
- Statistical analysis including logistic regression.
Main Results:
- Of 147 women, 136 had genetic mutations and 11 had a family history of TOC.
- Histopathology revealed 5 malignant neoplasms (3.4%) and 2 p53 signature lesions (1.4%).
- Transvaginal US showed low sensitivity (20%) and positive predictive value (9%) for TOC, but high specificity (93%) and negative predictive value (97%).
- Three of five false-negative TOC cases involved microscopic or very small lesions.
Conclusions:
- Preoperative transvaginal US demonstrates limited sensitivity for detecting TOC in high-risk populations.
- Clinically significant precursors and early-stage TOC are frequently below the detection threshold of transvaginal US.
- These findings highlight challenges in preoperative screening for TOC using current ultrasound technology.
