Atul Bhanudas Shinagare

This multicenter multinational study demonstrated that Bosniak classification version 2019 can be used to stratify the probability of cancer and cancer with unfavorable histologic features; nodule size was strongly associated with unfavorable histologic features.

Radiologists use CT, along with diffusion-weighted MRI and sometimes PET, to assess disease extent, including peritoneal carcinomatosis, in advanced ovarian cancer, preferably applying systematic image interpretation and disease-specific structured reporting to enhance communication and support decision-making.

Even among nine expert readers, CT diagnosis was not reproducible and was frequently incorrect for most adnexal lesion types, excluding dermoids, malignant ovarian lesions with metastases, and simple cysts.

The role of imaging in the diagnosis of gynecologic manifestations of hereditary syndromes is important and allows evaluation of key imaging features and associated conditions.

Purpose To assess the frequency and outcomes of follow-up MRI recommendations for adnexal lesions on pelvic US interpreted by US experts versus non-US expert abdominal radiologists. Methods In this IRB-approved, HIPAA-compliant retrospective cohort study, all pelvic US reports in adult women between 2018–2023 at a tertiary academic center were screened using a validated NLP algorithm for follow-up MRI recommendations for incidental adnexal lesions. MRI recommendation rates, compliance with the recommendation, and impact of MRI on management (malignancy risk upgrade/no change/downgrade and final outcomes) were compared between US expert and non-US expert abdominal radiologists. Results Of 19,335 pelvic US in 14,328 patients (15,609, 80.7% read by US experts, 3726, 19.3% by non-US expert abdominal radiologists), 458 (2.3%) had follow-up MRI recommendations. US experts made fewer recommendations (248, 1.5% vs 210, 5.6%; p < 0.001) and had higher compliance rate (157, 63.3% vs 108, 51.4%; p = 0.01). MRI caused risk downgrade, no change, and upgrade in 191 (72.1%), 62 (23.4%), and 12 (4.5%) respectively; without significant difference between US experts and non-US experts (113, 72%, 39, 24.8%, 5, 3.2% vs 78, 72.2%, 23, 21.3%, 7, 6.5%; p = 0.96). Of 191 lesions with risk-downgrade, 124 underwent surgery (n = 60) or follow-up (n = 64) without any cancers; 67 had no further follow-up. Of 12 lesions with risk-upgrade on MRI, 6 (50%) were malignant, 4 (33.3%) benign, 2 (16.7%) borderline. Of 193 cases where MRI was not performed, 60 were resected (53, 88.3% benign, 3, 5.0% borderline, 4, 6.7% malignant). Conclusion US experts made fewer follow-up MRI recommendations, with no difference in the impact of MRI on risk-assessment between US experts and non-US expert radiologists. MRI resulted in malignancy risk-downgrade in most lesions and can potentially avoid unnecessary surgeries.