Introduction to Ultrasound in Gynecological Cancer Diagnosis
Imaging staging in gynecologic ultrasound has gained a pivotal role in the diagnosis and staging of gynecological cancers, becoming a valuable tool alongside pelvic MRI. Numerous prospective multicenter studies have highlighted the high accuracy of pre-operative locoregional ultrasound staging, leading to its widespread use in gynecological oncology units. Many centers now consider ultrasound a first-line imaging modality, particularly for assessing the local and regional spread of cancers.
Established Ultrasound Biomarkers and Risk Stratification
Imaging staging in gynecology is not only useful for cancer detection but also for predicting the risk of disease progression, determining therapeutic outcomes, and evaluating treatment responses. Clinicians have integrated various ultrasound biomarkers into practice, such as the Ovarian-Adnexal Reporting and Data System (O-RADS) for ovarian tumors and morphologic descriptors that help assess tumor characteristics. Additionally, the AJCC TNM staging system and RECIST criteria assist in evaluating the prognosis and response to treatment. Tumor size, echogenicity, and perfusion—using Doppler or contrast agents—are some of the morphological and functional biomarkers that ultrasound provides.
Technological Advancements in Ultrasound
Technological advancements have greatly enhanced the capabilities of ultrasound in gynecological oncology. The introduction of high-resolution endovaginal probes allows for detailed imaging of pelvic anatomy, comparable to MRI. Additionally, transabdominal ultrasound using a convex array probe provides comprehensive views of abdominal organs and retroperitoneal lymph nodes, aiding in the assessment of disease resectability. The use of linear probes has allowed for high-resolution
Current Guidelines and Future Directions
According to the European Society of Gynecological Oncology (ESGO) guidelines, ultrasound now serves as a first-line imaging modality, alongside pelvic MRI, for evaluating the locoregional stage of gynecologic cancers. As machine learning and precision ultrasound diagnostics evolve, they are expected to expand ultrasound’s role in gynecological oncology, enhancing diagnostic accuracy and improving patient outcomes.
