Preoperative Imaging for Newly Diagnosed Ovarian Cancer

Primary Imaging Recommendation

The European Society for Medical Oncology (ESMO) recommends obtaining CT thorax, abdomen, and pelvis with IV contrast as the first-line staging study after diagnosis, as stated in the 2023 ESMO Clinical Practice Guidelines 1
The American College of Radiology (ACR) suggests that CT provides comprehensive staging of the entire disease extent, including peritoneal implants, lymph node involvement, pleural disease, and distant metastases 2, 3

CT is currently the modality of choice for staging ovarian cancer according to ACR Appropriateness Criteria, with CT and MRI having equivalent accuracy (82-84%) for staging ovarian cancer 2, 3, 4
MRI pelvis with IV contrast should be reserved for specific scenarios, such as borderline tumors, young patients requiring fertility preservation, CT findings that are inconclusive or indeterminate, and suspected endometriosis-associated malignancy 2, 3, 4

The American College of Radiology (ACR) does not recommend PET/CT for initial staging of newly diagnosed ovarian cancer due to low specificity (as low as 54%) and potential for false-negative and false-positive results 2, 3, 4
PET/CT may be useful as an adjunct when CT findings are indeterminate or for staging advanced disease, with fusion PET/CT showing higher accuracy than CT alone for detecting small peritoneal deposits and lymph nodes 2, 3, 4

The American College of Radiology (ACR) emphasizes the importance of not skipping chest imaging, as CT chest is essential for detecting pleural effusions and pulmonary metastases, which can upstage disease to Stage IV and alter surgical planning 2, 4
The ACR also recommends ensuring IV contrast is administered unless contraindicated, as contrast is essential for detecting and characterizing tumor deposits and assessing vascular involvement 2, 3, 4

The American College of Radiology (ACR) states that CT findings directly impact surgical decision-making by identifying inoperable tumor sites that would preclude optimal cytoreduction (residual tumor >1 cm) 4