Useful preoperative examination findings to classify the grade of ovarian primary mucinous tumor.

Purpose: To evaluate various imaging features on magnetic resonance imaging (MRI) and tumor markers and their utility to assess various grades of ovarian primary mucinous tumors (OPMTs): benign, borderline, or malignant.
Methods: Ninety-five pathologically diagnosed OPMTs [53 benign, 24 borderline malignant (BM), and 18 malignant] were selected in this retrospective study. MRI features of the ovarian mass, namely the maximum diameter, honeycomb loculi, solid components (SC), stained-glass pattern, and signal intensity of the cyst on T1- (T1WI) and T2-weighted imaging (T2WI) with/without fat suppression, and preoperative STMs, namely carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, and CA125, were compared between the three tumor grades using univariate analysis. We also analyzed the findings to estimate the pathological diagnosis using classification tree (CT) analysis.
Results: Maximum diameter, honeycomb loculi, SC, stained-glass pattern, signal intensity of the cyst [hyperintensity on both T1WI and T2WI (T1-hyper/T2-hyper), and hyperintense on T1WI and hypointense on T2WI (T1-hyper/T2-hypo)], and CEA and CA 19-9 concentrations were significantly different between the three tumor grades (p < 0.05). The concordance rate with the pathological diagnosis was the highest with diagnosis by the CT comprising T1-hyper/T2-hypo, CEA, and CA 19-9 and by the CT comprising T1-hyper/T2-hypo, CEA, and SC.
Conclusion: Four types of findings were important for OPMT grading. Lesions negative for both T1-hyper/T2-hypo and CEA suggest benign; lesions positive for T1-hyper/T2-hypo and negative for CA 19-9 or SC suggest BM; and lesions negative for T1-hyper/T2-hypo and positive for CEA, or positive for both T1-hyper/T2-hypo and CA 19-9 or SC suggest malignancy.