Deep learning-based segmentation of multisite disease in ovarian cancer

Thomas Buddenkotte, Leonardo Rundo, Ramona Woitek, Lorena Escudero Sanchez, Lucian Beer, Mireia Crispin-Ortuzar, Christian Etmann, Subhadip Mukherjee, Vlad Bura, Cathal McCague, Hilal Sahin, Roxana Pintican, Marta Zerunian, Iris Allajbeu, Naveena Singh, Anju Sahdev, Laura Havrilesky, David E. Cohn, Nicholas W. Bateman, Thomas P. ConradsKathleen M. Darcy, G. Larry Maxwell, John B. Freymann, Ozan Öktem, James D. Brenton, Evis Sala*, Carola Bibiane Schönlieb

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: To determine if pelvic/ovarian and omental lesions of ovarian cancer can be reliably segmented on computed tomography (CT) using fully automated deep learning-based methods. Methods: A deep learning model for the two most common disease sites of high-grade serous ovarian cancer lesions (pelvis/ovaries and omentum) was developed and compared against the well-established “no-new-Net” framework and unrevised trainee radiologist segmentations. A total of 451 CT scans collected from four different institutions were used for training (n = 276), evaluation (n = 104) and testing (n = 71) of the methods. The performance was evaluated using the Dice similarity coefficient (DSC) and compared using a Wilcoxon test. Results: Our model outperformed no-new-Net for the pelvic/ovarian lesions in cross-validation, on the evaluation and test set by a significant margin (p values being 4 × 10–7, 3 × 10–4, 4 × 10–2, respectively), and for the omental lesions on the evaluation set (p = 1 × 10–3). Our model did not perform significantly differently in segmenting pelvic/ovarian lesions (p = 0.371) compared to a trainee radiologist. On an independent test set, the model achieved a DSC performance of 71 ± 20 (mean ± standard deviation) for pelvic/ovarian and 61 ± 24 for omental lesions. Conclusion: Automated ovarian cancer segmentation on CT scans using deep neural networks is feasible and achieves performance close to a trainee-level radiologist for pelvic/ovarian lesions. Relevance statement: Automated segmentation of ovarian cancer may be used by clinicians for CT-based volumetric assessments and researchers for building complex analysis pipelines. Key points: • The first automated approach for pelvic/ovarian and omental ovarian cancer lesion segmentation on CT images has been presented. • Automated segmentation of ovarian cancer lesions can be comparable with manual segmentation of trainee radiologists. • Careful hyperparameter tuning can provide models significantly outperforming strong state-of-the-art baselines. Graphical Abstract: [Figure not available: see fulltext.]

Original languageEnglish
Article number77
JournalEuropean Radiology Experimental
Issue number1
StatePublished - Dec 2023
Externally publishedYes


  • Deep learning
  • Omentum
  • Ovarian Neoplasms
  • Pelvis
  • Tomography (x-ray computed)


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