Utility of functional and structural imaging in the multidisciplinary management of BRCA2-positive tubo-ovarian carcinoma. A clinical case report

Abstract

Introduction: Carcinoma of the fallopian tube linked to BRCA2 mutations presents a significant clinical challenge that has transformed its management through the implementation of targeted therapies and genomic-based precision medicine. In this framework, both functional and structural imaging are essential, serving not only to aid in staging and monitoring treatment efficacy, but also to critically assess atypical findings that could impact therapeutic decision-making. Case presentation: A 63-year-old woman with a history of metachronous bilateral breast cancer was diagnosed with high-grade serous tubo-ovarian carcinoma with a germline BRCA2 mutation. She received platinum-based neoadjuvant chemotherapy, underwent complete cytoreductive surgery, and was initiated on maintenance therapy with Olaparib. During follow-up, a PET-CT revealed a focal uptake in hepatic segment II, initially suggestive of recurrence. Further assessment
with hepatobiliary contrast-enhanced MRI and image-guided liver biopsy ruled out malignancy. The patient remains on active surveillance with no evidence of disease recurrence. Discussion: This case highlights the clinical utility of integrating functional and structural
imaging in the personalized oncologic approach. Multimodal interpretation avoided unnecessary interventions and enabled the continuation of targeted therapy. The case emphasizes the value of multidisciplinary collaboration among oncology, radiology, and interventional imaging in validating suspicious findings that may  otherwise lead to overtreatment. Conclusion: The correlation between PET-CT, liver MRI, and image-guided biopsy was essential in excluding tumor progression, underscoring the central role of radiology in clinical decision-making. This multidisciplinary strategy ensured optimal therapeutic continuity and reflects the impact of imaging in the era of precision oncology.