Diagnostic performance of MR imaging findings and quantitative values in the differentiation of seromucinous borderline tumour from endometriosis-related malignant ovarian tumour

Objectives To evaluate the diagnostic performance of quantitative values and MRI findings for differentiating seromucinous borderline tumours (SMBTs) from endometriosis-related malignant ovarian tumours (MT).

This retrospective study examined 19 lesions from SMBT and 84 lesions from MT. The following quantitative values were evaluated using receiver-operating characteristic analysis: overall and solid portion sizes, fluid signal intensity (SI), degree of contrast-enhancement, and mean and minimum apparent diffusion coefficient (ADC) values of the solid portion. Two radiologists independently evaluated four MRI findings characteristic of SMBT, fluid SI on the T1-weighted image and SI of the solid portion on diffusion-weighted image. The diagnostic values of these findings and interobserver agreement were assessed.

For diagnosing SMBT, the mean ADC value of the solid portion showed the greatest area under the curve (0.860) (cut-off value: 1.31 × 10-3 mm2/s, sensitivity: 1.00, specificity: 0.61). The T2-weighted image (T2WI) high SI solid portion was the most useful finding, with high specificity and interobserver agreement (sensitivity, 0.58; specificity, 0.95–0.96, kappa = 0.96), followed by T2WI low SI core (sensitivity, 0.48–0.63; specificity, 0.98, kappa = 0.68).

Mean ADC values of the solid portion, T2WI high SI solid portion, and T2WI low SI core were useful for differentiating SMBT from MT. Key Points • SMBT is a newly categorised ovarian tumour often associated with endometriosis. • Differentiation of SMBT from endometriosis-related malignant ovarian tumour is clinically important. • Diagnostic performances of quantitative values and MRI findings were evaluated. • Mean ADC value of the solid portion was the most useful value. • “T2WI high SI solid portion” was the most useful MRI finding. Similar content being viewed by others Abbreviations - MMBT: - Müllerian mucinous borderline tumour - MEBT: - Müllerian mixed epithelial borderline tumour - SMBT: - Seromucinous borderline tumour - CCC: - Clear cell carcinoma - EC: - Endometrioid carcinoma - DWI: - Diffusion-weighted image - ADC: - Apparent diffusion coefficient - SI: - Signal intensity

Kurman RJ, Carcangiu ML, Herrington CS, Young RH (2014) WHO classification of tumours of female reproductive organs. International Agency for Research on Cancer, Lyon Taylor J, McCluggage WG (2015) Ovarian seromucinous carcinoma: report of a series of a newly categorized and uncommon neoplasm. Am J Surg Pathol 39:983–992 Rutgers JL, Scully RE (1988) Ovarian Mullerian mucinous papillary cystadenomas of borderline malignancy. A clinicopathologic analysis. Cancer 61:340–348 Kim KR, Choi J, Hwang JE et al (2010) Endocervical-like (Müllerian) mucinous borderline tumours of the ovary are frequently associated with the KRAS mutation. Histopathology 57:587–596 Yoshikawa H, Jimbo H, Okada S et al (2000) Prevalence of endometriosis in ovarian cancer. Gynecol Obstet Invest 50:11–17 Maeda D, Shih I-M (2013) Pathogenesis and the role of ARID1A mutation in endometriosis-related ovarian neoplasms. Adv Anat Pathol 20:45–52 Wu CH, Mao T-L, Vang R et al (2012) Endocervical-type mucinous borderline tumors are related to endometrioid tumors based on mutation and loss of expression of ARID1A. Int J Gynecol Pathol 31:297–303 Shappell HW, Riopel MA, Smith Sehdev AE et al (2002) Diagnostic criteria and behavior of ovarian seromucinous (endocervical-type mucinous and mixed cell-type) tumors: atypical proliferative (borderline) tumors, intraepithelial, microinvasive, and invasive carcinomas. Am J Surg Pathol 26:1529–1541 Rodriguez IM, Irving JA, Prat J (2004) Endocervical-like mucinous borderline tumors of the ovary: a clinicopathologic analysis of 31 cases. Am J Surg Pathol 28:1311–1318 Coumbos A, Sehouli J, Chekerov R et al (2009) Clinical management of borderline tumours of the ovary: results of a multicentre survey of 323 clinics in Germany. Br J Cancer 100:1731–1738 Fischerova D, Zikan M, Dundr P, Cibula D (2012) Diagnosis, treatment, and follow-up of borderline ovarian tumors. Oncologist 17:1515–1533 Lalwani N, Shanbhogue AKP, Vikram R et al (2010) Current update on borderline ovarian neoplasms. Am J Roentgenol 194:330–336 Seidman JD, Cho KR, Ronnett BM, Kurman RJ (2011) Surface epithelial tumors of the ovary. In: Blaustein’s Pathol. Female Genit. Tract. Springer US, Boston, MA, pp 679–784 Sugiyama T, Kamura T, Kigawa J et al (2000) Clinical characteristics of clear cell carcinoma of the ovary: A distinct histologic type with poor prognosis and resistance to platinum-based chemotherapy. Cancer 88:2584–2589 Matsubayashi RN, Matsuo Y, Nakazono T et al (2015) Magnetic resonance imaging manifestations of ovarian Mullerian mixed epithelial borderline tumors: imaging and histologic features in comparison with Mullerian mucinous borderline tumors. J Comput Assist Tomogr 39:276–280 Kataoka M, Togashi K, Koyama T et al (2002) MR imaging of müllerian mucinous borderline tumors arising from endometriotic cysts. J Comput Assist Tomogr 26:532–537 Kanda Y (2013) Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 48:452–458 Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174 Namimoto T, Awai K, Nakaura T et al (2009) Role of diffusion-weighted imaging in the diagnosis of gynecological diseases. Eur Radiol 19:745–760 Punwani S (2011) Diffusion weighted imaging of female pelvic cancers: concepts and clinical applications. Eur J Radiol 78:21–29 Zhao SH, Qiang JW, Zhang GF et al (2014) Diffusion-weighted MR imaging for differentiating borderline from malignant epithelial tumours of the ovary: pathological correlation. Eur Radiol 24:2292–2299 Fujii S, Kakite S, Nishihara K et al (2008) Diagnostic accuracy of diffusion-weighted imaging in differentiating benign from malignant ovarian lesions. J Magn Reson Imaging 28:1149–1156 Thomassin-Naggara I, Daraï E, Cuenod CA et al (2009) Contribution of diffusion-weighted MR imaging for predicting benignity of complex adnexal masses. Eur Radiol 19:1544–1552 Takeuchi M, Matsuzaki K, Nishitani H (2010) Diffusion-weighted magnetic resonance imaging of ovarian tumors: differentiation of benign and malignant solid components of ovarian masses. J Comput Assist Tomogr 34:173–176 Li W, Chu C, Cui Y et al (2012) Diffusion-Weighted MRI: a useful technique to discriminate benign versus malignant ovarian surface epithelial tumors with solid and cystic components. Abdom Imaging 37:897–903 Siegelman ES, Oliver ER (2012) MR Imaging of endometriosis: ten imaging pearls. Radiographics 32:1675–1691 Tanaka YO, Okada S, Yagi T et al (2010) MRI of endometriotic cysts in association with ovarian carcinoma. Am J Roentgenol 194:355–361 Burdette JH, Elster AD, Ricci PE (1999) Acute cerebral infarction: quantification of spin-density and T2 shine-through phenomena on diffusion-weighted MR images. Radiology 212:333–339 Thomassin-Naggara I, Daraï E, Cuenod CA et al (2008) Dynamic contrast-enhanced magnetic resonance imaging: a useful tool for characterizing ovarian epithelial tumors. J Magn Reson Imaging 28:111–120

The scientific guarantor of this publication is Aki Kido. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Kurata, Y., Kido, A., Moribata, Y. et al. Diagnostic performance of MR imaging findings and quantitative values in the differentiation of seromucinous borderline tumour from endometriosis-related malignant ovarian tumour. Eur Radiol 27, 1695–1703 (2017). https://doi.org/10.1007/s00330-016-4533-x Received: Revised: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00330-016-4533-x