## Investigation of Choice for Ovarian Cancer Staging **Key Point:** Contrast-enhanced CT (CECT) abdomen and pelvis is the gold standard imaging modality for staging epithelial ovarian cancer and assessing resectability. ### Why CECT is Superior | Feature | CECT | MRI | PET-CT | Diagnostic Laparoscopy | |---------|------|-----|--------|------------------------| | **Sensitivity for metastases** | 85–90% | 80–85% | 75–80% | Invasive; limited field | | **Assesses resectability** | Yes (peritoneal involvement, diaphragm) | Limited | No | Yes, but invasive | | **Detects ascites** | Excellent | Good | Poor | Invasive | | **Cost & availability** | Low; widely available | High; time-consuming | High; limited availability | Invasive; requires anesthesia | | **Standard of care** | Yes | No | Supplementary only | Reserved for select cases | **High-Yield:** CECT is used to: 1. Confirm diagnosis (mass characteristics) 2. Assess stage (peritoneal deposits, omental caking, ascites, nodal involvement) 3. Evaluate resectability (diaphragmatic involvement, bowel obstruction) 4. Detect distant metastases (liver, lungs) **Clinical Pearl:** In this patient, elevated CA-125 + complex ovarian mass + ascites on ultrasound = presumed epithelial ovarian cancer. CECT is needed BEFORE surgery to determine surgical approach (primary debulking vs. neoadjuvant chemotherapy). ### Why Other Options Are Not First-Line - **MRI pelvis:** Excellent for local staging but does NOT assess upper abdomen, diaphragm, or distant metastases as well as CECT. Time-consuming and not standard. - **PET-CT:** Useful for detecting distant metastases but NOT the primary staging tool; reserved for selected cases (e.g., suspected stage IV disease). - **Diagnostic laparoscopy:** Invasive, carries anesthetic risk, and limited field of view. Reserved for borderline resectable cases or when imaging is inconclusive. [cite:Park 26e Ch 11] 
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