## Investigation of Choice for Ovarian Cancer Diagnosis and Staging ### Rationale for CT Abdomen and Pelvis **Key Point:** Contrast-enhanced CT (CECT) abdomen and pelvis is the gold standard imaging modality for diagnosis, staging, and assessment of resectability in suspected ovarian cancer. **High-Yield:** CT provides: - Characterization of the ovarian mass (cystic, solid, mixed) - Assessment of peritoneal involvement and omental caking - Detection of ascites and lymphadenopathy - Evaluation of distant metastases (liver, lungs, peritoneum) - Critical for surgical planning and determining operability ### Why CT Over Other Modalities | Investigation | Role | Limitation in This Context | |---|---|---| | **CECT abdomen/pelvis** | Gold standard for staging and resectability | — | | Transvaginal ultrasound | Characterizes ovarian mass, guides biopsy | Cannot assess peritoneal/distant spread | | MRI pelvis | Better soft tissue contrast, local extent | Not superior for staging; reserved for specific indications | | Diagnostic laparoscopy | Tissue diagnosis and staging | Invasive; not first-line; risks tumor spillage | **Clinical Pearl:** The patient already has imaging (TVS) showing a complex mass and elevated CA-125. The next step is staging imaging to determine extent of disease and surgical candidacy, NOT tissue diagnosis (which follows imaging). ### Staging and Resectability Assessment CT findings guide: 1. **TNM staging** — extent of tumor, nodal involvement, metastases 2. **Operability** — presence of unresectable disease (extensive peritoneal involvement, distant metastases) 3. **Neoadjuvant chemotherapy decision** — if unresectable at presentation, NACT may be given first **High-Yield:** In ovarian cancer, imaging precedes biopsy. Tissue confirmation is obtained during surgery (exploratory laparotomy with debulking) or via image-guided biopsy if surgery is deferred.
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