Preoperative diagnosis of metastatic ovarian cancer is related to origin of primary tumor.

OBJECTIVE: To describe the gray-scale and color Doppler ultrasound features as well as some clinical and biochemical features of metastatic ovarian tumors according to the origin of the primary tumor in a large study population,

METHODS: This was a retrospective analysis of 116 masses in 92 patients (mean age, 51 years) evaluated and treated at three European university centers for a metastatic tumor in the ovary. All patients had undergone transvaginal color Doppler ultrasound according to a standardized protocol prior to surgery and tumor removal. Ultrasound features analyzed were bilaterality, tumor volume, morphologic gray-scale appearance and color score. CA 125 was also recorded.

RESULTS: Primary tumor histological diagnosis was as follows: colon-sigmoid (n = 32), stomach (n = 28), breast (n = 20), uterus (n = 17), lymphoma (n = 4), liver-pancreas-biliary tract (n = 4) and miscellaneous (n = 11). There were no differences in age, menopausal status or CA 125 values according to origin of primary tumor. Bilaterality was significantly more frequent in stomach metastases (56%) in comparison with colon-sigmoid and liver-pancreas-biliary tract metastases (18.5% and 0%, respectively, P < 0.05). Median tumor volume was significantly lower in breast metastases (33.5 mL) compared with other metastases (P < 0.05) except stomach metastases and metastatic tumors from the miscellaneous group. Ovarian metastases from breast cancers were significantly more frequently solid in comparison to stomach, colorectal and uterine cancer metastases (95.0% vs. 60.8%, 46.8% and 70.6%, respectively, P < 0.05), and tended to appear moderately or highly vascularized. There were no differences in color score among all groups, although the percentage of masses with abundant color was high (50-82%).

CONCLUSIONS: Ovarian metastases derived from breast cancers tend to be small, solid and vascularized; they seem to be the only ovarian metastases whose primary tumor origin can be suspected by ultrasonography preoperatively. Color score does not seem to help suspect the origin of the primary tumor.