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Ultrasound and Clinical Preoperative Characteristics for Discrimination Between Ovarian Metastatic Colorectal Cancer and Primary Ovarian Cancer: A Case-Control Study

  • Stukan, Maciej1
  • Alcazar, Juan Luis2
  • Gębicki, Jacek3
  • Epstein, Elizabeth4
  • Liro, Marcin5
  • Sufliarska, Alexandra6
  • Szubert, Sebastian7, 8
  • Guerriero, Stefano9
  • Braicu, Elena Ioana10
  • Szajewski, Mariusz11, 12
  • Pietrzak-Stukan, Małgorzata13
  • Fischerova, Daniela6
  • 1 Department of Gynecologic Oncology, Gdynia Oncology Center, Pomeranian Hospitals, 81519 Gdynia, Poland
  • 2 Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, 31008 Pamplona, Spain
  • 3 Department of Process Engineering and Chemical Technology, Faculty of Chemistry, Gdańsk University of Technology, 80233 Gdańsk, Poland
  • 4 Department of Clinical Science and Education, Karolinska Institutet and Department of Obstetrics and Gynecology Södersjukhuset, 11883 Stockholm, Sweden
  • 5 Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University, 80210 Gdańsk, Poland
  • 6 Gynecologic Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, 12851 Prague, Czech Republic
  • 7 Clinical Department of Gynecological Oncology, The Franciszek Lukaszczyk Oncological Center, 85796 Bydgoszcz, Poland
  • 8 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01809 Warsaw, Poland
  • 9 Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, 09124 Cagliari, Italy
  • 10 Department of Gynecology, Campus Virchow, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany
  • 11 Department of Oncological Surgery, Gdynia Oncology Centre, 81519 Gdynia, Poland
  • 12 Division of Propedeutics of Oncology, Medical University of Gdańsk, 80210 Gdańsk, Poland
  • 13 Medicover, 80309 Gdansk, Poland
Published Article
Publication Date
Dec 01, 2019
DOI: 10.3390/diagnostics9040210
PMID: 31805677
PMCID: PMC6963303
PubMed Central


The aim of this study was to describe the clinical and sonographic features of ovarian metastases originating from colorectal cancer (mCRC), and to discriminate mCRC from primary ovarian cancer (OC). We conducted a multi-institutional, retrospective study of consecutive patients with ovarian mCRC who had undergone ultrasound examination using the International Ovarian Tumor Analysis (IOTA) terminology, with the addition of evaluating signs of necrosis and abdominal staging. A control group included patients with primary OC. Clinical and ultrasound data, subjective assessment (SA), and an assessment of different neoplasias in the adnexa (ADNEX) model were evaluated. Fisher’s exact and Student’s t -tests, the area under the receiver–operating characteristic curve (AUC), and classification and regression trees (CART) were used to conduct statistical analyses. In total, 162 patients (81 with OC and 81 with ovarian mCRC) were included. None of the patients with OC had undergone chemotherapy for CRC in the past, compared with 40% of patients with ovarian mCRC ( p < 0.001). The ovarian mCRC tumors were significantly larger, a necrosis sign was more frequently present, and tumors had an irregular wall or were fixed less frequently; ascites, omental cake, and carcinomatosis were less common in mCRC than in primary OC. In a subgroup of patients with ovarian mCRC who had not undergone treatment for CRC in anamnesis, tumors were larger, and had fewer papillations and more locules compared with primary OC. The highest AUC for the discrimination of ovarian mCRC from primary OC was for CART (0.768), followed by SA (0.735) and ADNEX calculated with CA-125 (0.680). Ovarian mCRC and primary OC can be distinguished based on patient anamnesis, ultrasound pattern recognition, a proposed decision tree model, and an ADNEX model with CA-125 levels.

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