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Liu D, Lyu G, Lai H, Li L, Gan Y, Yang S. Can the ultrasound microcystic pattern accurately predict borderline ovarian tumors? J Ovarian Res 2023; 16:162. [PMID: 37563718 PMCID: PMC10416400 DOI: 10.1186/s13048-023-01253-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE To investigate whether the ultrasound microcystic pattern (MCP) can accurately predict borderline ovarian tumors (BOTs). METHODS A retrospective collection of 393 patients who met the inclusion criteria was used as the study population. Indicators that could well identify BOT in different pathological types of tumors were derived by multivariate unordered logistic regression analysis. Finally, the correlation between ultrasound MCP and pathological features was analyzed. RESULTS (1) MCP was present in 55 of 393 ovarian tumors, including 34 BOTs (34/68, 50.0%), 16 malignant tumors (16/88, 18.2%), and 5 benign tumors (5/237, 2.1%). (2) Univariate screening showed significant differences (P < 0.05) in patient age, CA-125 level, ascites, > 10 cyst locules, a solid component, blood flow, and MCP among BOTs, benign ovarian tumors, and malignant ovarian tumors. (3) Multivariate unordered logistic regression analysis showed that the blood flow, > 10 cyst locules, and MCP were significant factors in identifying BOTs (P < 0.05). (4) The pathology of ovarian tumors with MCP showed "bubble"- or "fork"- like loose tissue structures. CONCLUSION MCP can be observed in different pathological types of ovarian tumors and can be used as a novel sonographic marker to differentiate between BOTs, benign tumors and malignant tumors. MCP may arise as a result of anechoic cystic fluid filling the loose tissue gap.
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Affiliation(s)
- Danyi Liu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Guorong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China.
- Department of Ultrasound, Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, No.2, Anji Road, Quanzhou, Fujian, China.
| | - Hongwei Lai
- Department of Ultrasound, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian, China
| | - Liya Li
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Yaduan Gan
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Shuping Yang
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
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2
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Xie L, Liu X, Li H, Huang L, Chen F, Wang X, Jiang L, Gan L. The Multimodal Ultrasound Features of Ovarian Serous Surface Papillary Borderline Tumor. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:523-532. [PMID: 35652002 PMCID: PMC9148660 DOI: 10.1089/whr.2021.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/25/2022]
Abstract
Aim: Ovarian serous surface papillary borderline tumor (OSSPBT) is very rare. Combined with clinical and pathological features, we aim to investigate the multimodal ultrasound features of OSSPBT. Patients and Methods: There were only 18 patients diagnosed with OSSPBT among the 142 patients who were diagnosed with borderline serous ovarian tumor by pathology from June 2008 to December 2020 in our hospital. Their clinical data, conventional ultrasound, two-dimensional contrast-enhanced ultrasound (2D-CEUS), three-dimensional contrast-enhanced ultrasound (3D-CEUS) characteristics, pathology, and prognosis were retrospectively analyzed. Results: The 18 patients had no specific clinical symptoms. Multiple implantable nodules were found in 8 patients (44.4%), ascites in 13 patients (72.2%), and elevated carbohydrate antigen 125 (CA125) in 15 patients (83.3%). After excluding 2 misdiagnosed patients from 18 patients, 26 tumors in 16 patients (6 unilateral and 10 bilateral) were studied. Conventional ultrasound findings of OSSPBT showed that large solid masses around normal ovary without capsule, and numerous small dense anechoic areas were observed in the parenchyma of the lesion, with strong speckle echo (“blizzard” sign) of varying degrees. The 2D-CEUS and 3D-CEUS showed a normal ovary in the center surrounded by a radial blood supply of OSSPBT with thick and irregular branches. Histopathologically, the papillary fibrous stalk of OSSPBT had a large number of sand bodies and tortuous dilated microvessels. All patients had no recurrence after surgery, and two of them delivered successfully through assisted reproductive technology. Conclusion: OSSPBT has a good prognosis. Its conventional ultrasound is characterized by irregular solid masses surrounding normal ovaries and a large number of “blizzard” signs. It showed low enhancement of eccentricity with irregular radial branches centered on the ovary by CEUS.
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Affiliation(s)
- Lijun Xie
- Department of Medical Ultrasound, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xinxiu Liu
- Department of Medical Ultrasound, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Haiying Li
- Department of Medical Ultrasound, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Liyan Huang
- Department of Medical Ultrasound, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Fang Chen
- Department of Medical Ultrasound, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xingfu Wang
- Department of Medical Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Lei Jiang
- Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fujian Medical University Cancer Center, Fuzhou, China
| | - Ling Gan
- Department of Medical Ultrasound, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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3
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Timor-Tritsch IE, Monteagudo A, Popiolek DA, Duncan KM, Goldstein SR. Reaffirming microcystic ultrasound appearance of borderline ovarian tumors using three-dimensional 'silhouette' rendering. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:700-704. [PMID: 35195307 DOI: 10.1002/uog.24883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/04/2022] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Affiliation(s)
- I E Timor-Tritsch
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| | - A Monteagudo
- Icahn School of Medicine, Carnegie Imaging for Women, New York, NY, USA
| | - D A Popiolek
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - K M Duncan
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| | - S R Goldstein
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
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4
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Budiana NG, Kurniawan PI. Characteristics Patients with Borderline Ovarian Tumor at Sanglah General Hospital: From Pre- to Post-operative Approach. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Specific epidemiology data of borderline ovarian tumor (BOT) might be beneficial for the early diagnosis of BOT. The scarcity of BOT epidemiological data in Indonesia urged the writer to study further.
AIM: The objectives of the study were to obtain the characteristics of BOT patients in Sanglah General Hospital between 2018 and 2019 according to sociodemographic, hormonal, clinical, and patient outcome factors.
METHODOLOGY: This is a descriptive retrospective study. Data were obtained from patient’s medical records at medical records installation Sanglah General Hospital between March 2020 and July 2020. Descriptive data collected from medical records were analyzed using Microsoft Excel 2010 and presented in tables and narrative form.
RESULTS: From sociodemographic factors, we found that majority of BOT patients were >40 years old, multiparous women, married, low educated, housewives, and had normal BMI. From hormonal factors, we found that experienced menarche between 11 and 15 years old, most of the patients were already menopause, did not use any contraception. From clinical factors, we found that many were referral cases, with abdominal pain as the main complaint, varied CA 125 and risk of malignancy index levels, unilateral mass, suspected with malignant ovarian cyst when being diagnosed earlier. From patient outcome factors, we found that the majority underwent definitive surgery with no post-operative CA 125 level, no malignant cells on cytology examination, borderline mucinous type in both frozen section and paraffin block examination, and followed up after surgery.
CONCLUSIONS: Clinicians could use these characteristics as a reference in diagnosing a patient who fits the profile.
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Sahin H, Akdogan AI, Smith J, Zawaideh JP, Addley H. Serous borderline ovarian tumours: an extensive review on MR imaging features. Br J Radiol 2021; 94:20210116. [PMID: 34111956 DOI: 10.1259/bjr.20210116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Serous borderline ovarian tumours (SBOTs) are an intermediate group of neoplasms, which have features between benign and malignant ovarian tumours and for which, fertility-sparing surgery can be offered. MRI in imaging of SBOTs is, therefore, crucial in raising the possibility of the diagnosis, in order to present the patient with the most appropriate treatment options. There are characteristic MRI features that SBOTs demonstrate. In addition, recent advanced techniques, and further classification into subtypes within the borderline group have been developed. The aim of this article is to review the MRI features of SBOT and provide the reporter with an awareness of the imaging tips and tricks in the differential diagnosis of SBOT.
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Affiliation(s)
- Hilal Sahin
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK.,Department of Radiology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Asli Irmak Akdogan
- Department of Radiology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Janette Smith
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jeries Paolo Zawaideh
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Helen Addley
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK.,Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Salvador S, Scott S, Glanc P, Eiriksson L, Jang JH, Sebastianelli A, Dean E. Guideline No. 403: Initial Investigation and Management of Adnexal Masses. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 42:1021-1029.e3. [PMID: 32736853 DOI: 10.1016/j.jogc.2019.08.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 08/30/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To aid primary care physicians, emergency medicine physicians, and gynaecologists in the initial investigation of adnexal masses, defined as lumps that appear near the uterus or in or around ovaries, fallopian tubes, or surrounding connective tissue, and to outline recommendations for identifying women who would benefit from a referral to a gynaecologic oncologist for further management. INTENDED USERS Gynaecologists, obstetricians, family physicians, general surgeons, emergency medicine specialists, radiologists, sonographers, nurses, medical learners, residents, and fellows. TARGET POPULATION Adult women 18 years of age and older presenting for the evaluation of an adnexal mass. OPTIONS Women with adnexal masses should be assessed for personal risk factors, history, and physical findings. Initial evaluation should also include imaging and laboratory testing to triage women for management of their care either by a gynaecologic oncologist or as per SOGC guideline no. 404 on the initial investigation and management of benign ovarian masses. EVIDENCE A search of PubMed, Cochrane Wiley, and the Cochrane systematic reviews was conducted in January 2018 for English-language materials involving human subjects published since 2000 using three sets of terms: (i) ovarian cancer, ovarian carcinoma, adnexal disease, ovarian neoplasm, adnexal mass, fallopian tube disease, fallopian tube neoplasm, ovarian cyst, and ovarian tumour; (ii) the above terms in combination with predict neoplasm staging, follow-up, and staging; and (iii) the above two sets of terms in combination with ultrasound, tumour marker, CA 125, CEA, CA19-9, HE4, multivariable-index-assay, risk-of-ovarian-malignancy-algorithm, risk-of-malignancy-index, diagnostic imaging, CT, MRI, and PET. Relevant evidence was selected for inclusion in descending order of quality of evidence as follows: meta-analyses, systematic reviews, guidelines, randomized controlled trials, prospective cohort studies, observational studies, non-systematic reviews, case series, and reports. Additional articles were identified through cross-referencing the identified reviews. The total number of studies identified was 2350, with 59 being included in this review. VALIDATION METHODS The content and recommendations were drafted and agreed upon by the authors. The Executive and Board of the Society of Gynecologic Oncology of Canada reviewed the content and submitted comments for consideration. The Board of Directors of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology framework (Table A1 of Online Appendix A). See Table A2 of Online Appendix A for the interpretation of strong and weak recommendations. The summary of findings is available upon request. BENEFITS, HARMS, COSTS Adnexal masses are common, and guidelines on how to triage them and manage the care of patients presenting with adnexal masses will continue to guide the practice of primary care providers and gynaecologists. Ovarian cancer outcomes are improved when initial surgery is performed by a gynaecologic oncologist, likely as a result of complete surgical staging and optimal cytoreduction. Given these superior outcomes, guidelines to assist in the triage of adnexal masses and the referral and management of the care of patients with an adnexal mass are critical. SUMMARY STATEMENTS (GRADE RATINGS IN PARENTHESES) RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
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7
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Management of Borderline Ovarian Tumors: Series of Case Report and Review of the Literature. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02455-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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8
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Abdel Wahab C, Rousset P, Milon A, Bazot M, Thomassin-Naggara I. Recommandations pour l’imagerie des tumeurs frontières de l’ovaire. IMAGERIE DE LA FEMME 2021. [DOI: 10.1016/j.femme.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Performance of the IOTA ADNEX Model on Selected Group of Patients with Borderline Ovarian Tumours. ACTA ACUST UNITED AC 2020; 56:medicina56120690. [PMID: 33322438 PMCID: PMC7763161 DOI: 10.3390/medicina56120690] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/29/2020] [Accepted: 12/03/2020] [Indexed: 12/15/2022]
Abstract
Background and objectives: ultrasound is considered to be the primary tool for preoperative assessment of ovarian masses; however, the discrimination of borderline ovarian tumours (BOTs) is challenging, and depends highly on the experience of the sonographer. The Assessment of Different NEoplasias in the adneXa (ADNEX) model is considered to be a valuable diagnostic tool for preoperative assessment of ovarian masses; however, its performance for BOTs has not been widely studied, due to the low prevalence of these tumours. The aim of this study was to evaluate the performance of ADNEX model for preoperative diagnosis of BOTs. Methods: retrospective analysis of preoperative ultrasound datasets of patients diagnosed with BOTs on the final histology after performed surgery was done at a tertiary oncogynaecology centre during the period of 2012–2018. Results: 85 patients were included in the study. The performance of ADNEX model based on absolute risk (AR) improved with the selection of a more inclusive cut-off value, varying from 47 (60.3%) correctly classified cases of BOTs, with the selected cut-off of 20%, up to 67 (85.9%) correctly classified cases of BOTs with the cut-off value of 3%. When relative risk (RR) was used to classify the tumours, 59 (75.6%) cases were identified correctly. Forty (70.2%) cases of serous and 16 (72.7%) cases of mucinous BOTs were identified when AR with a 10% cut-off value was applied, compared to 44 (77.2%) and 15 (68.2%) cases of serous and mucinous BOTs, correctly classified by RR. The addition of Ca125 improved the performance of ADNEX model for all BOTs in general, and for different subtypes of BOTs. However, the differences were insignificant. Conclusions: The International Ovarian Tumour Analysis (IOTA) ADNEX model performs well in discriminating BOTs from other ovarian tumours irrespective of the subtype. The calculation based on RR or AR with the cut-off value of at least 10% should be used when evaluating for BOTs.
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10
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Moro F, Verdecchia V, Romeo P, Ciccarone F, Zannoni GF, Valentin L, Timmerman D, Bourne T, Froyman W, Scambia G, Testa AC. Ultrasound, macroscopic and histological features of malignant ovarian tumors. Int J Gynecol Cancer 2020; 31:150-151. [PMID: 32820011 DOI: 10.1136/ijgc-2020-001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- Francesca Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Valeria Verdecchia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche, Università Politecnica delle Marche, Ancona, Italy
| | - Paola Romeo
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Francesca Ciccarone
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Gian Franco Zannoni
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Lil Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Dirk Timmerman
- Department of Obstetrics and Gynecology, Multidisciplinary Breast Centre and Leuven University Centre for Cancer Prevention (LUCK), University Hospitals Leuven, Leuven, Belgium
| | - Tom Bourne
- Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK.,Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - Wouter Froyman
- Department of Obstetrics and Gynecology, Multidisciplinary Breast Centre and Leuven University Centre for Cancer Prevention (LUCK), University Hospitals Leuven, Leuven, Belgium
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonia Carla Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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11
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Zheng X, Lyu G, Gan Y, Hu M, Liu X, Chen S, Wu X, Yang W, Ye F, Yan X, Zhang Y. Microcystic pattern and shadowing are independent predictors of ovarian borderline tumors and cystadenofibromas in ultrasound. Eur Radiol 2020; 31:45-54. [PMID: 32780208 DOI: 10.1007/s00330-020-07113-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/06/2020] [Accepted: 07/24/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine the sonographic characteristics of borderline tumors (BoTs) and cystadenofibromas (CAFs). METHODS Preoperative sonograms from consecutive patients who had at least one primary epithelial tumor in the adnexa were retrospectively collected. All tumors were described using the International Ovarian Tumor Analysis terminology. Ultrasound variables were tested using multinomial logistic regression after univariate analysis. RESULTS A total of 650 patients were included in this study. Of these, 110 had a CAF, 128 had a BoT, 249 had a cystadenoma (CAD), and 163 had a cystadenocarcinoma (CAC). Nearly half of CAFs and more than half of BoTs and CACs appeared to be unilocular and multilocular solid on the ultrasound images, while CADs were predominantly uni- or multilocular (p < 0.001). Overall, shadowing was identified in 82/650 cases. Sixty-five of 110 (59.1%) CAFs exhibited an acoustic shadow, compared with only 4/249 (1.6%) in CADs, 7/128 (5.5%) in BoTs, and 6/163 (3.7%) in CACs (p < 0.001). Furthermore, 112/650 cases demonstrated microcystic pattern (MCP). Sixty-eight of 128 (53.1%) BoTs exhibited MCP, compared with only 5/249 (2.0%) in CADs, 19/163 (11.7%) in CACs, and 20/110 (18.2%) in CAFs (p < 0.001). Logistic regression analysis revealed that shadowing is an independent predictor of CAFs, while MCP is an independent predictor of BoTs. CONCLUSIONS Sonographic findings for CAFs and BoTs were complex and partly overlapped with those for CACs. However, proper recognition and utilization of shadowing or MCP may help to correctly discriminate CAFs and BoTs. KEY POINTS • Sonographic findings for borderline tumors and cystadenofibromas are complex and mimic malignancy. • Microcystic pattern and shadowing are independent predictors of borderline tumors and cystadenofibromas respectively.
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Affiliation(s)
- Xinying Zheng
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Licheng District, Quanzhou, 362000, Fujian, China.,Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China
| | - Guorong Lyu
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Licheng District, Quanzhou, 362000, Fujian, China. .,Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China.
| | - Yaduan Gan
- Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China.,Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Maiguo Hu
- Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China.,Department of Ultrasound, Xiamen Maternal and Child Health Care Hospital, Xiamen, Fujian, China
| | - Xianlan Liu
- Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China.,Department of Ultrasound, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Shuqiang Chen
- Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China.,Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiuming Wu
- Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China.,Department of Ultrasound, the Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Wenmin Yang
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Licheng District, Quanzhou, 362000, Fujian, China.,Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China
| | - Fengying Ye
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Licheng District, Quanzhou, 362000, Fujian, China.,Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China
| | - Xiaobin Yan
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Licheng District, Quanzhou, 362000, Fujian, China.,Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China
| | - Ying Zhang
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Licheng District, Quanzhou, 362000, Fujian, China.,Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China
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12
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Directive clinique no 403 : Évaluation initiale et prise en charge des masses annexielles. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:1030-1039.e3. [DOI: 10.1016/j.jogc.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Abdel Wahab C, Rousset P, Bolze PA, Thomassin-Naggara I. [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Imaging]. ACTA ACUST UNITED AC 2020; 48:260-276. [PMID: 32004779 DOI: 10.1016/j.gofs.2020.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine the place of imaging and the performance of different imaging techniques (transvaginal ultrasound with or without Doppler, scoring, CT, MRI) to differentiate benign tumour, borderline ovarian tumour (BOT) and malignant ovarian tumor. Differentiate the histological subtypes of BOT (serous, sero-mucinous, mucinous) and prediction in imaging of the possibility of conservative treatment. METHODS The research was carried out over the last 16 years using the terms "MeSH" based on the query of the Medline® database and supplemented by the review of references contained in the meta-analyzes, systematic reviews and original articles included. RESULTS Endo-vaginal and suprapubic ultrasonography is recommended for analysis of an ovarian mass (grade A). In the case of ultrasound by a referent, subjective analysis is the recommended technique (grade A). In case of echography by a non-referent, the use of "Simple Rules" is recommended (grade A) and should be best combined with subjective analysis to rejoin the performance of a sonographer refer (grade A). In cases of undetermined ovarian lesions in endovaginal ultrasound and suprapubic ultrasound, it is recommended to perform a pelvic MRI (grade A). The MRI protocol should include T2, T1, T1 sequences with fat saturation, diffusion, injected dynamics, and after gadolinium injection (grade B). To characterize an MRI-adnexal image, it is recommended to include a risk score for malignancy (ADNEX-MR/O-RADS) (grade C) in the report and to formulate an anatomopathological hypothesis (Grade C). The predictive signs of benignity in front of a cyst with endocystic vegetations are the low number, the small size, the presence of calcifications and the absence of Doppler flow in case of size greater than 10mm in echography (LP 4) and a curve of type 1 MRI (LP4). MRI is recommended for suspicious lesions of BOT in ultrasound (grade B) or indeterminate lesions in ultrasound (grade A). There is no data to support the usefulness of CT or PET-CT for BOT. Morphological criteria in ultrasound and MRI exist to differentiate BOT from invasive tumors regardless of grade (NP 2). Pelvic MRI is recommended to characterize a tumor suggestive of ultrasound BOT (grade C). No recommendations can be made about the use of combined ultrasound, biological, and menopausal status scores for the diagnosis of BOT. The diagnostic performance of imaging to detect peritoneal implants of BOT is not known. The assessment of the invasiveness of peritoneal implants of imaging BOT has not been evaluated. The association of macroscopic signs in MRI makes it possible to differentiate the different subtypes - serous, sero-mucinous and mucinous (intestinal type) - of BOT, despite the overlap of certain presentations (LP3). The analysis of macroscopic MRI signs must be performed to differentiate the different subtypes of TFO (grade C). No recommendation can be made on imaging prediction of the possibility of conservative BOT treatment.
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Affiliation(s)
- C Abdel Wahab
- Service de radiologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; ISCD, équipe médecine, Sorbonne université, université Paris 06, IUC, 75005 Paris, France
| | - P Rousset
- HCL, EMR 3738, service de radiologie, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Université Lyon 1, 43, boulevard du 11 Novembre 1918, 69100 Villeurbanne, France
| | - P-A Bolze
- Service de chirurgie gynécologique et oncologique, obstétrique, Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre Bénite, France
| | - I Thomassin-Naggara
- Service de radiologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; ISCD, équipe médecine, Sorbonne université, université Paris 06, IUC, 75005 Paris, France.
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14
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Zhang S, Yu S, Hou W, Li X, Ning C, Wu Y, Zhang F, Jiao YF, Lee LTO, Sun L. Diagnostic extended usefulness of RMI: comparison of four risk of malignancy index in preoperative differentiation of borderline ovarian tumors and benign ovarian tumors. J Ovarian Res 2019; 12:87. [PMID: 31526390 PMCID: PMC6747741 DOI: 10.1186/s13048-019-0568-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/12/2019] [Indexed: 12/04/2022] Open
Abstract
Background This study aimed to examine the performance of the four risk of malignancy index (RMI) in discriminating borderline ovarian tumors (BOTs) and benign ovarian masses in daily clinical practice. Methods A total of 162 women with BOTs and 379 women with benign ovarian tumors diagnosed at the Second Affiliated Hospital of Harbin Medical University from January 2012 to December 2016 were enrolled in this retrospective study. Also, we classified these patients into serous borderline ovarian tumor (SBOT) and mucinous borderline ovarian tumor (MBOT) subgroup. Preoperative ultrasound findings, cancer antigen 125 (CA125) and menopausal status were reviewed. The area under the curve (AUC) of receiver operator characteristic curves (ROC) and performance indices of RMI I, RMI II, RMI III and RMI IV were calculated and compared for discrimination between benign ovarian tumors and BOTs. Results RMI I had the highest AUC (0.825, 95% CI: 0.790–0.856) among the four RMIs in BOTs group. Similar results were found in SBOT (0.839, 95% CI: 0.804–0.871) and MBOT (0.791, 95% CI: 0.749–0.829) subgroups. RMI I had the highest specificity among the BOTs group (87.6, 95% CI: 83.9–90.7%), SBOT (87.6, 95% CI: 83.9–90.7%) and MBOT group (87.6, 95% CI: 83.9–90.7%). RMI II scored the highest overall in terms of sensitivity among the BOTs group (69.75, 95% CI: 62.1–76.7%), SBOT (74.34, 95% CI: 65.3–82.1%) and MBOT (59.18, 95% CI: 44.2–73.0%) group. Conclusion Compared to other RMIs, RMI I was the best-performed method for differentiation of BOTs from benign ovarian tumors. At the same time, RMI I also performed best in the discrimination SBOT from benign ovarian tumors.
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Affiliation(s)
- Shuang Zhang
- Department of Ultrasound, The Secondary Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shan Yu
- Centre of Reproduction Development and Aging, Faculty of Health Sciences, University of Macau, Macau SAR, China.,Department of Pathology, The Secondary Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wenying Hou
- Department of Ultrasound, XuanWu Hospital of Capital Medical University, Beijing, China
| | - Xiaoying Li
- Department of Ultrasound, The Secondary Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chunping Ning
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yingnan Wu
- Department of Ultrasound, The Secondary Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Feng Zhang
- Department of Ultrasound, The Secondary Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yu Fei Jiao
- Department of Pathology, The Secondary Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Leo Tsz On Lee
- Centre of Reproduction Development and Aging, Faculty of Health Sciences, University of Macau, Macau SAR, China
| | - Litao Sun
- Department of Ultrasound, The Secondary Affiliated Hospital of Harbin Medical University, Harbin, China.
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15
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Timor-Tritsch IE, Foley CE, Brandon C, Yoon E, Ciaffarrano J, Monteagudo A, Mittal K, Boyd L. New sonographic marker of borderline ovarian tumor: microcystic pattern of papillae and solid components. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:395-402. [PMID: 30950132 DOI: 10.1002/uog.20283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/02/2019] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To describe and evaluate the utility of a new sonographic microcystic pattern, which is typical of borderline ovarian tumor (BOT) papillary projections, solid component(s) and/or septa, as a new ultrasound marker that is capable of distinguishing BOT from other adnexal masses, and to present/obtain histologic confirmation. METHODS In this retrospective study, we identified women with a histologic diagnosis of BOT following surgical resection who had undergone preoperative transvaginal ultrasound (TVS) examination. All images were reviewed for presence or absence of thin-walled, fluid-filled cluster(s) of 1-3-mm cystic formations, associated with solid component(s), papillary projections and/or septa. From the same cases, histopathologic slides of each BOT were examined for presence of any of these microcystic features which had been identified on TVS. To confirm that the microcystic TVS pattern is unique to BOTs, we also selected randomly from our ultrasound and surgical database 20 cases of epithelial ovarian cancer and 20 cases of benign cystadenoma, for review by the same pathologists. To confirm the novelty of our findings, we searched PubMed for literature published in the English language between 2010 and 2018 to determine whether the association between microcystic tissue pattern and BOT has been described previously. RESULTS Included in the final analysis were 62 patients (67 ovaries) with preoperative TVS and surgically confirmed BOT on pathologic examination. The mean patient age at surgery was 39.8 years. The mean BOT size at TVS was 60.7 mm. Of the 67 BOTs, 47 (70.1%) were serous, 15 (22.4%) were mucinous and five (7.5%) were seromucinous. We observed on TVS a microcystic pattern in the papillary projections, solid component(s) and/or septa in 60 (89.6%) of the 67 BOTs, including 46 (97.9%) of the 47 serous BOTs, 11 (73.3%) of the 15 mucinous BOTs and three (60.0%) of the five seromucinous BOTs. On microscopic evaluation, 60 (89.6%) of the 67 samples had characteristic 1-3-mm fluid-filled cysts similar to those seen on TVS. In seven cases there was a discrepancy between sonographic and histologic observation of a microcystic pattern. The 20 cystadenomas were mostly unilocular and/or multilocular and largely avascular. None of them or the 20 epithelial ovarian malignancies displayed microcystic characteristics, either on TVS or at histology. On review of 23 published articles in the English medical literature, containing 163 sonographic images of BOT, we found that, while all images contained it, there was no description of the microcystic tissue pattern. CONCLUSION We report herein a novel sonographic marker of BOT, a 'microcystic pattern' of BOT papillary projections, solid component(s) and/or septa. This was seen in the majority of both serous and mucinous BOT cases. Importantly, based on comparison of sonographic images and histopathology of benign entities and malignancies, the microcystic appearance seems to be unique to BOTs. No similar description has been published previously. Utilization of this new marker should help to identify BOT correctly, discriminating it from ovarian cancer and benign ovarian pathology, and should ensure appropriate clinical and surgical management. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- I E Timor-Tritsch
- New York University School of Medicine, Langone Health, Department of Obstetrics & Gynecology, Division of Obstetrical and Gynecologic Ultrasound, New York, NY, USA
| | - C E Foley
- New York University School of Medicine, Langone Health, Department of Obstetrics & Gynecology, Division of Obstetrical and Gynecologic Ultrasound, New York, NY, USA
| | - C Brandon
- New York University School of Medicine, Langone Health, Department of Obstetrics & Gynecology, Division of Obstetrical and Gynecologic Ultrasound, New York, NY, USA
| | - E Yoon
- New York University School of Medicine, Department of Pathology, Division of Surgical Pathology, New York, NY, USA
| | - J Ciaffarrano
- New York University School of Medicine, Department of Pathology, Division of Surgical Pathology, New York, NY, USA
| | - A Monteagudo
- Carnegie Imaging for Women, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - K Mittal
- New York University School of Medicine, Department of Pathology, Division of Surgical Pathology, New York, NY, USA
| | - L Boyd
- New York University School of Medicine, Langone Health, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, New York, NY, USA
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16
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Abstract
Ovarian cancer is the seventh most common cancer affecting women. Despite advances in cancer control and healthcare in general, mortality from ovarian cancer remains unacceptably high due to diagnosis at an advanced stage of the disease. The 5-year survival rate is 47.4% because a majority of ovarian cancers are diagnosed when advanced. Only 14.9% of ovarian cancers are diagnosed when localized where the survival rate is 92.3%. Mortality rate reduction by screening has not been proven in women at an average risk for ovarian cancer. Ultrasound remains the primary modality for assessment of ovarian tumors. The need for standardizing terminology is critical for optimal assessment of the risk of malignancy in an ovarian tumor. The international ovarian tumor analysis group and more recently the American College of Radiology Ovarian - Adnexal Reporting and Data System Committee have published standardized lexicon for ovarian lesions and encourage ultrasound imagers to adopt this standardized terminology. The aim is to apply the lexicon for risk stratification to allow for consistent follow-up and management. Various methodologies have been tested for characterization of adnexal tumors and to assess risk of malignancy preoperatively. Risk assessment models have been studied against the gold standard of a pattern recognition approach and subjective assessment by an experienced imager. The morphologic patterns of ovarian tumors are detailed and features that are more discriminatory than others in suggesting an ovarian malignancy are described. The imaging pathologic correlation for different tumor types is presented. A brief summary of the ovarian cancer pathologic types and staging of cancer is presented. Finally, the current role of transvaginal sonography as a screening modality for ovarian cancer is discussed. Recently published data show encouraging results, that a multimodal approach of screening for ovarian cancer using transvaginal sonography in women with an elevated CA-125 may prove beneficial and cost effective.
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Affiliation(s)
- Mahesh Shetty
- Department of Radiology, Baylor College of Medicine, Houston, TX.
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17
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Pozzati F, Moro F, Pasciuto T, Gallo C, Ciccarone F, Franchi D, Mancari R, Giunchi S, Timmerman D, Landolfo C, Epstein E, Chiappa V, Fischerova D, Fruscio R, Zannoni GF, Valentin L, Scambia G, Testa AC. Imaging in gynecological disease (14): clinical and ultrasound characteristics of ovarian clear cell carcinoma. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:792-800. [PMID: 29978567 DOI: 10.1002/uog.19171] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/21/2018] [Accepted: 06/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To describe the clinical and ultrasound characteristics of ovarian pure clear cell carcinoma. METHODS This was a retrospective study involving data from 11 ultrasound centers. From the International Ovarian Tumor Analysis (IOTA) database, 105 patients who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 1999 and 2016 were identified with a histologically confirmed pure clear cell carcinoma of the ovary. An additional 47 patients diagnosed with pure clear cell carcinoma between 1999 and 2016 and with available complete preoperative ultrasound reports were identified retrospectively from the databases of the departments of gynecological oncology in the participating centers. The ultrasound images of all tumors were described using IOTA terminology. Clinical and ultrasound characteristics were analyzed for the whole group, and separately, for patients with and those without histologically confirmed endometriosis, and for patients with evidence of tumor developing from endometriosis. RESULTS Median age of the 152 patients was 53.5 (range, 28-92) years and 92/152 (60.5%) tumors were FIGO Stage I. Most tumors (128/152, 84.2%) were unilateral. On ultrasound examination, all tumors contained solid components and 36/152 (23.7%) were completely solid masses. The median largest diameter of the lesion was 117 (range, 25-310) mm. Papillary projections were present in 58/152 (38.2%) masses and, in most of these (51/56, 91.1%), vascularized papillary projections were seen. Information regarding the presence, site and type of pelvic endometriosis at histology was available for 130/152 patients. Endometriosis was noted in 54 (41.5%) of these. In 24/130 (18.6%) patients, the tumor was judged to have developed from endometriosis. Patients with, compared to those without, evidence of tumor developing from endometriosis were younger (median 47.5 vs 55.0 years, respectively), and ground-glass echogenicity of cyst fluid was more common in pure clear cell cancers developing from endometriosis (10/20 vs 13/79 (50.0% vs 16.5%), respectively). CONCLUSIONS Ovarian pure clear cell carcinoma is usually diagnosed at an early stage and typically appears as a large unilateral mass with solid components. Patients with clear cell carcinoma developing from endometriosis are younger than other patients with clear cell carcinoma, and clear cell cancers developing from endometriosis more often manifest ground-glass echogenicity of cyst fluid. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Pozzati
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A.Gemelli, IRCCS, Rome, Italy
| | - F Moro
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A.Gemelli, IRCCS, Rome, Italy
| | - T Pasciuto
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A.Gemelli, IRCCS, Rome, Italy
| | - C Gallo
- Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Ciccarone
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A.Gemelli, IRCCS, Rome, Italy
| | - D Franchi
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - R Mancari
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - S Giunchi
- Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - D Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - C Landolfo
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - E Epstein
- Departments of Obstetrics and Gynecology at Karolinska University Hospital, Stockholm, Sweden
| | - V Chiappa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - D Fischerova
- Gynecological Oncology Center, Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic
| | - R Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - G F Zannoni
- Institute of Histopathology, Catholic University of the Sacred Heart, Rome, Italy
| | - L Valentin
- Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - G Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A.Gemelli, IRCCS, Rome, Italy
| | - A C Testa
- Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
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18
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Moro F, Magoga G, Pasciuto T, Mascilini F, Moruzzi MC, Fischerova D, Savelli L, Giunchi S, Mancari R, Franchi D, Czekierdowski A, Froyman W, Verri D, Epstein E, Chiappa V, Guerriero S, Zannoni GF, Timmerman D, Scambia G, Valentin L, Testa AC. Imaging in gynecological disease (13): clinical and ultrasound characteristics of endometrioid ovarian cancer. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:535-543. [PMID: 29418038 DOI: 10.1002/uog.19026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/17/2018] [Accepted: 01/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To describe the clinical and ultrasound characteristics of ovarian pure endometrioid carcinomas. METHODS This was a retrospective multicenter study of patients with a histological diagnosis of pure endometrioid carcinoma. We identified 161 patients from the International Ovarian Tumor Analysis (IOTA) database who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 1999 and 2016, and another 78 patients from the databases of the departments of gynecological oncology in the participating centers. All tumors were described using IOTA terminology. In addition, one author reviewed all available ultrasound images and described them using pattern recognition. RESULTS Median age of the 239 patients was 55 years (range, 19-88 years). On ultrasound examination, two (0.8%) endometrioid carcinomas were described as unilocular cysts, three (1.3%) as multilocular cysts, 37 (15.5%) as unilocular-solid cysts, 115 (48.1%) as multilocular-solid cysts and 82 (34.3%) as solid masses. Median largest tumor diameter was 102.5 mm (range, 20-300 mm) and median largest diameter of the largest solid component was 63 mm (range, 9-300 mm). Papillary projections were present in 70 (29.3%) masses. Most cancers (188 (78.7%)) were unilateral. In 49 (20.5%) cases, the cancer was judged by the pathologist to develop from endometriosis. These cancers, compared with those without evidence of tumor developing from endometriosis, more often manifested papillary projections on ultrasound (46.9% (23/49) vs 24.7% (47/190)), were less often bilateral (8.2% (4/49) vs 24.7% (47/190)) and less often associated with ascites (6.1% (3/49) vs 28.4% (54/190)) and fluid in the pouch of Douglas (24.5% (12/49) vs 48.9% (93/190)). Retrospective analysis of available ultrasound images using pattern recognition revealed that many tumors without evidence of tumor developing from endometriosis (36.3% (41/113)) had a large central solid component entrapped within locules, giving the tumor a cockade-like appearance. CONCLUSIONS Endometrioid cancers are usually large, unilateral, multilocular-solid or solid tumors. The ultrasound characteristics of endometrioid carcinomas developing from endometriosis differ from those without evidence of tumor developing from endometriosis, the former being more often unilateral cysts with papillary projections and no ascites. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Moro
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - G Magoga
- Instituo di Ginecologia e Obstetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - T Pasciuto
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - F Mascilini
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - M C Moruzzi
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - D Fischerova
- Gynecological Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - L Savelli
- Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - S Giunchi
- Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - R Mancari
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - D Franchi
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - A Czekierdowski
- First Department of Gynecological Oncology and Gynecology, Medical University of Lublin, Lublin, Poland
| | - W Froyman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - D Verri
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - E Epstein
- Department of Clinical Science and Education, Södersjukhuset and Department of Women's and Children's Health Karolinska Institutet, Stockholm, Sweden
| | - V Chiappa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - S Guerriero
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - G F Zannoni
- Institute of Histopathology, Catholic University of the Sacred Heart, Rome, Italy
| | - D Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - G Scambia
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - L Valentin
- Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - A C Testa
- Instituo di Ginecologia e Obstetricia, Università Cattolica del Sacro Cuore, Rome, Italy
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19
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Landolfo C, Valentin L, Franchi D, Van Holsbeke C, Fruscio R, Froyman W, Sladkevicius P, Kaijser J, Ameye L, Bourne T, Savelli L, Coosemans A, Testa A, Timmerman D. Differences in ultrasound features of papillations in unilocular-solid adnexal cysts: a retrospective international multicenter study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:269-278. [PMID: 29119698 DOI: 10.1002/uog.18951] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/26/2017] [Accepted: 10/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To identify ultrasound features of papillations or of the cyst wall that can discriminate between benign and malignant unilocular-solid cysts with papillations but no other solid components. METHODS From the International Ovarian Tumor Analysis (IOTA) database derived from seven ultrasound centers, we identified patients with an adnexal lesion described at ultrasonography as unilocular-solid with papillations but no other solid components. All patients had undergone transvaginal ultrasound between 1999 and 2007 or 2009 and 2012, by an experienced examiner following the IOTA research protocol. Information on four ultrasound features of papillations had been collected prospectively. Information on a further seven ultrasound features was collected retrospectively from electronic or paper ultrasound images of good quality. The histological diagnosis of the surgically removed adnexal lesion was considered the gold standard. RESULTS Of 204 masses included, 131 (64.2%) were benign, 42 (20.6%) were borderline tumors, 30 (14.7%) were primary invasive tumors and one (0.5%) was a metastasis. Multivariate logistic regression analysis showed the following ultrasound features to be associated independently with malignancy: height of the largest papillation, presence of blood flow in papillations, papillation confluence or dissemination, and shadows behind papillations. Shadows decreased the odds of malignancy, while the other features increased them. CONCLUSION We have identified ultrasound features that can help to discriminate between benign and malignant unilocular-solid cysts with papillations but no other solid components. Our results need to be confirmed in prospective studies. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Landolfo
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - D Franchi
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - C Van Holsbeke
- Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - R Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - W Froyman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - P Sladkevicius
- Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - J Kaijser
- Department of Obstetrics and Gynecology, Ikazia Hospital Rotterdam, Rotterdam, The Netherlands
| | - L Ameye
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - T Bourne
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK
| | - L Savelli
- Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - A Coosemans
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven, Leuven, Belgium
| | - A Testa
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
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Moro F, Baima Poma C, Zannoni GF, Vidal Urbinati A, Pasciuto T, Ludovisi M, Moruzzi MC, Carinelli S, Franchi D, Scambia G, Testa AC. Imaging in gynecological disease (12): clinical and ultrasound features of invasive and non-invasive malignant serous ovarian tumors. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:788-799. [PMID: 28101917 DOI: 10.1002/uog.17414] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To describe clinical and ultrasound features of different subclasses of malignant serous ovarian tumors according to the World Health Organization 2014 classification. METHODS Patients with a histological diagnosis of borderline tumor (BOT), non-invasive and invasive low-grade serous carcinoma (LGSC) and high-grade serous carcinoma (HGSC), who had undergone preoperative ultrasound examination, were retrospectively identified from two ultrasound centers. The masses were described using the terms of the International Ovarian Tumor Analysis Group. RESULTS Sixty-four (15.8%) women had a serous BOT, 11 (2.7%) a non-invasive LGSC, 31 (7.6%) an invasive LGSC and 300 (73.9%) had a HGSC. The vast majority of BOTs (82.3%) and non-invasive LGSCs (90.9%) were Stage I according to the International Federation of Gynecology and Obstetrics (FIGO) classification scheme, whereas most invasive LGSCs (74.2%) and HGSCs (74.0%) were FIGO Stage III. On ultrasound examination, most borderline lesions were described as unilocular-solid (54.7%) or as multilocular-solid (29.7%) cysts. Papillary projections were present in 52 (81.3%) BOTs. Most non-invasive LGSCs (63.6%) were multilocular-solid cysts and 81.8% had papillary projections. Invasive LGSCs were multilocular-solid cysts in 54.8% of cases, and papillary projections were present in 32.3% of lesions. HGSCs were multilocular-solid (32.7%) or solid (64.0%) masses, with papillary projections in only 7% of cases. CONCLUSIONS Papillary projections were the most typical ultrasound feature of non-invasive (borderline and low-grade) malignant serous tumors, while the presence of solid components but few, if any, papillations was the most representative feature of invasive (low-grade and high-grade) serous tumors. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Moro
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
| | - C Baima Poma
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
| | - G F Zannoni
- Institute of Histopathology, Catholic University of the Sacred Heart, Rome, Italy
| | - A Vidal Urbinati
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - T Pasciuto
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
| | - M Ludovisi
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
| | - M C Moruzzi
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
| | - S Carinelli
- Institute of Histopathology, European Institute of Oncology, Milan, Italy
| | - D Franchi
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - G Scambia
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
| | - A C Testa
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
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21
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Moro F, Zannoni GF, Arciuolo D, Pasciuto T, Amoroso S, Mascilini F, Mainenti S, Scambia G, Testa AC. Imaging in gynecological disease (11): clinical and ultrasound features of mucinous ovarian tumors. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:261-270. [PMID: 28782867 DOI: 10.1002/uog.17222] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/30/2016] [Accepted: 08/05/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To describe the clinical and ultrasound findings in patients with mucinous ovarian tumors. METHODS In this retrospective study, women with a histological diagnosis of mucinous ovarian tumor who had undergone preoperative ultrasound examination were identified from the database of a single ultrasound center. The histological examination was performed by the same pathologist in all cases, and the ultrasound appearance of the tumors was described using the terms and definitions of the International Ovarian Tumor Analysis group. RESULTS We identified 123 women with a histological diagnosis of mucinous ovarian tumor, of whom 57 (46%) had benign cystadenoma, 34 (28%) had gastrointestinal (GI)-type borderline tumor, 10 (8%) had endocervical-type borderline tumor and 22 (18%) had GI-type invasive carcinoma. On ultrasound examination, 65% (37/57) of cystadenomas were multilocular, of which 59% had ≤ 10 locules, and 79% (27/34) of GI-type borderline tumors were multilocular, of which 89% had > 10 locules. Conversely, 60% (6/10) of endocervical-type borderline tumors had papillations. Eighty-two percent (18/22) of invasive masses contained solid components and 55% (12/22) were multilocular-solid cysts. Bilateral mucinous cystadenomas were found in two women (4% of women with benign tumors) and bilateral borderline tumors of endocervical type in two women (20% of women with borderline tumors of endocervical type). No woman had a bilateral GI-type borderline tumor or a bilateral invasive tumor. CONCLUSIONS A multilocular cyst with 2-10 locules is representative of a benign cystadenoma, whereas a multilocular cyst with > 10 locules is indicative of a GI-type borderline tumor. Most invasive tumors of mucinous GI-type contain solid components, the most typical ultrasound appearance being that of a multilocular-solid tumor. Papillary projections are typical features of endocervical-type borderline tumors. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Moro
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - G F Zannoni
- Department of Histopathology, Catholic University of the Sacred Heart, Rome, Italy
| | - D Arciuolo
- Department of Histopathology, Catholic University of the Sacred Heart, Rome, Italy
| | - T Pasciuto
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - S Amoroso
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - F Mascilini
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - S Mainenti
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - G Scambia
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - A C Testa
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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Glanc P, Benacerraf B, Bourne T, Brown D, Coleman BG, Crum C, Dodge J, Levine D, Pavlik E, Timmerman D, Ueland FR, Wolfman W, Goldstein SR. First International Consensus Report on Adnexal Masses: Management Recommendations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:849-863. [PMID: 28266033 DOI: 10.1002/jum.14197] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The First International Consensus Conference on Adnexal Masses was convened to thoroughly examine the state of the science and to formulate recommendations for clinical assessment and management. The panel included representatives of societies in the fields of gynecology, gynecologic oncology, radiology, and pathology and clinicians from Europe, Canada, and the United States. In the United States, there are approximately 9.1 surgeries per malignancy compared to the European International Ovarian Tumor Analysis center trials, with only 2.3 (oncology centers) and 5.9 (other centers) reported surgeries per malignancy, suggesting that there is room to improve our preoperative assessments. The American College of Obstetricians and Gynecologists Practice Bulletin on "Management of Adnexal Masses," reaffirmed in 2015 (Obstet Gynecol 2007; 110:201-214), still states, "With the exception of simple cysts on a transvaginal ultrasound finding, most pelvic masses in postmenopausal women will require surgical intervention." The panel concluded that patients would benefit not only from a more conservative approach to many benign adnexal masses but also from optimization of physician referral patterns to a gynecologic oncologist in cases of suspected ovarian malignancies. A number of next-step options were offered to aid in management of cases with sonographically indeterminate adnexal masses. This process would provide an opportunity to improve risk stratification for indeterminate masses via the provision of alternatives, including but not limited to evidence-based risk-assessment algorithms and referral to an "expert sonologist" or to a gynecologic oncologist. The panel believed that these efforts to improve clinical management and preoperative triage patterns would ultimately improve patient care.
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Affiliation(s)
- Phyllis Glanc
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Beryl Benacerraf
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Tom Bourne
- Department of Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College, London, England
| | - Douglas Brown
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Beverly G Coleman
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christopher Crum
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason Dodge
- Departments of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Deborah Levine
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward Pavlik
- Division of Gynecologic Oncology, University of Kentucky, Lexington, Kentucky, USA
| | - Dirk Timmerman
- Department of Obstetrics and Gynecology, University Hospitals, KU Lueven, Leuven, Belgium
| | - Frederick R Ueland
- Division of Gynecologic Oncology, University of Kentucky, Lexington, Kentucky, USA
| | - Wendy Wolfman
- Departments of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Steven R Goldstein
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York, USA
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23
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Gaurilcikas A, Gedgaudaite M, Strolyte D, Celkiene I, Paskauskas S, Vaitkiene D. Evaluation of a transvaginal ultrasound report quality in cases of borderline ovarian tumours: a retrospective study. Eur J Obstet Gynecol Reprod Biol 2016. [DOI: 10.1016/j.ejogrb.2016.07.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Ludovisi M, Foo X, Mainenti S, Testa AC, Arora R, Jurkovic D. Ultrasound diagnosis of serous surface papillary borderline ovarian tumor: A case series with a review of the literature. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:573-577. [PMID: 25706035 DOI: 10.1002/jcu.22266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 10/06/2014] [Accepted: 11/16/2014] [Indexed: 06/04/2023]
Abstract
Serous surface papillary borderline ovarian tumors (SSPBOTs) are a rare morphologic variant of serous ovarian tumors that are typically confined to the ovarian surface, while the ovaries themselves tend to appear normal in size and shape. In this report, we describe the findings from five premenopausal women diagnosed with SSPBOTs, in whom ultrasound showed grossly normal ovaries that were partially or wholly covered with irregular solid tumors. In all five cases, histologic examination showed evidence of borderline serous tumors. These findings demonstrate that SSPBOTs can be diagnosed on a preoperative sonographic examination, which could facilitate conservative, fertility-sparing surgery in young women affected by this condition.
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Affiliation(s)
- Manuela Ludovisi
- Gynaecology Diagnostic and Treatment Unit, University College Hospital, London, UK
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Xulin Foo
- Gynaecology Diagnostic and Treatment Unit, University College Hospital, London, UK
| | - Sara Mainenti
- Gynaecology Diagnostic and Treatment Unit, University College Hospital, London, UK
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonia Carla Testa
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Rupali Arora
- Department of Hystopathology, University College Hospital, London, UK
| | - Davor Jurkovic
- Gynaecology Diagnostic and Treatment Unit, University College Hospital, London, UK
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25
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Sayasneh A, Kaijser J, Preisler J, Smith AA, Raslan F, Johnson S, Husicka R, Ferrara L, Stalder C, Ghaem-Maghami S, Timmerman D, Bourne T. Accuracy of ultrasonography performed by examiners with varied training and experience in predicting specific pathology of adnexal masses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:605-612. [PMID: 25270506 DOI: 10.1002/uog.14675] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 09/14/2014] [Accepted: 09/19/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To assess the diagnostic performance of subjective assessment by Level II ultrasound examiners in predicting the specific histology of adnexal masses. METHODS The women included in this prospective multicenter cross-sectional study were older than 16 years of age and had at least one adnexal mass. They underwent transvaginal sonography (TVS) performed by Level II examiners, all of whom were familiar with the International Ovarian Tumor Analysis (IOTA) group definitions of ultrasound features of ovarian masses. The final outcome was histology. Specific diagnoses were categorized into 16 groups. Agreement between subjective assessment and final histology was measured using unweighted kappa coefficients. Sensitivities and specificities were obtained for subjective assessment. RESULTS Of the 1279 women who underwent TVS, 313 were included in the final analysis. Overall agreement (16 × 16 table) between subjective assessment and histology was moderate, with a Cohen's kappa coefficient of 0.59 (95% CI, 0.53-0.65). The specificity of subjective assessment ranged between 91% and 100% for all histological subgroups. Highest sensitivities were achieved in the diagnosis of simple cysts (100% (95% CI, 61-100%)), hydrosalpinges (100% (95% CI, 34-100%)), mature teratomas (88% (95% CI, 74-96%)), endometriomas (75% (95% CI, 61-85%)), ovarian fibromas (88% (95% CI, 47-100%)), tubo-ovarian abscesses (88% (95% CI, 47-100%)) and serous cystadenocarcinomas (82% (95% CI, 66-93%)). Serous cystadenomas were misdiagnosed most commonly (40.5%). The sensitivity of subjective assessment in diagnosing adnexal torsion was 54% (95% CI, 25-81%); the 17 confirmed and/or suspected cases of adnexal torsion were not included in the 313 cases examined and analyzed for diagnostic performance. CONCLUSION Overall, subjective assessment by Level II examiners was good for the detection of simple cysts, endometriomas, mature teratomas, hydrosalpinges, fibroma, tubo-ovarian abscess and serous cystadenocarcinomas.
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Affiliation(s)
- A Sayasneh
- Department of Cancer and Surgery, Imperial College London, Hammersmith Campus, London, UK; Early Pregnancy and Acute Gynaecology Unit, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
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26
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Naqvi J, Nagaraju E, Ahmad S. MRI appearances of pure epithelial papillary serous borderline ovarian tumours. Clin Radiol 2014; 70:424-32. [PMID: 25515794 DOI: 10.1016/j.crad.2014.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 11/01/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
Abstract
Borderline epithelial ovarian tumours (BOT) represent 15-20% of all non-benign ovarian epithelial neoplasms. Compared to malignant ovarian tumours, they usually present at a younger age and carry a far superior prognosis. Fertility-conserving surgery is an important treatment option for patients with BOT. Ultrasound and CT are both widely available and play roles in the initial investigation and staging of BOT, respectively. However, lack of soft-tissue contrast limits their ability to characterize BOT. MRI can facilitate recognition of pure epithelial serous BOT (SBOT), including the cystic papillary and surface papillary subtypes. An abundance of hyperintense papillary projections with low signal internal branching and ovarian stroma preservation with a hypointense ovarian capsular margin on T2-weighted imaging are features strongly suggestive of SBOT. In this review we will discuss the general morphological features of SBOT, the benefits and drawbacks of ultrasound and CT in the initial work-up, and the principal MRI features enabling recognition of surface papillary and cystic papillary SBOT.
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Affiliation(s)
- J Naqvi
- Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Haslingden Road, Blackburn BB2 3HH, UK.
| | - E Nagaraju
- Burnley General Hospital, East Lancashire Hospitals NHS Trust, Casterton Avenue, Burnley BB10 2PQ, UK
| | - S Ahmad
- Burnley General Hospital, East Lancashire Hospitals NHS Trust, Casterton Avenue, Burnley BB10 2PQ, UK
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27
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Magnetic resonance imaging findings of mucinous borderline ovarian tumors: comparison of intestinal and endocervical subtypes. ACTA ACUST UNITED AC 2014; 40:1753-60. [DOI: 10.1007/s00261-014-0325-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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28
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Sayasneh A, Ekechi C, Ferrara L, Kaijser J, Stalder C, Sur S, Timmerman D, Bourne T. The characteristic ultrasound features of specific types of ovarian pathology (review). Int J Oncol 2014; 46:445-58. [PMID: 25406094 PMCID: PMC4277251 DOI: 10.3892/ijo.2014.2764] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 09/22/2014] [Indexed: 01/05/2023] Open
Abstract
Characterizing ovarian masses enables patients with malignancy to be appropriately triaged for treatment by subspecialist gynecological oncologists, which has been shown to optimize care and improve survival. Furthermore, correctly classifying benign masses facilitates the selection of patients with ovarian pathology that may either not require intervention, or be suitable for minimal access surgery if intervention is required. However, predicting whether a mass is benign or malignant is not the only clinically relevant information that we need to know before deciding on appropriate treatment. Knowing the specific histology of a mass is becoming of increasing importance as management options become more tailored to the individual patient. For example predicting a mucinous borderline tumor gives the opportunity for fertility sparing surgery, and will highlight the need for further gastrointestinal assessment. For benign disease, predicting the presence of an endometrioma and possible deeply infiltrating endometriosis is important when considering both who should perform and the extent of surgery. An examiner’s subjective assessment of the morphological and vascular features of a mass using ultrasonography has been shown to be highly effective for predicting whether a mass is benign or malignant. Many masses also have features that enable a reliable diagnosis of the specific pathology of a particular mass to be made. In this narrative review we aim to describe the typical morphological features seen on ultrasound of different adnexal masses and illustrate these by showing representative ultrasound images.
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Affiliation(s)
- Ahmad Sayasneh
- Department of Cancer and Surgery, Imperial College London, Hammersmith Campus, London, UK
| | - Christine Ekechi
- Early Pregnancy and Acute Gynecology Unit, Queen Charlottes and Chelsea Hospital, Imperial College London, London, W12 0HS, UK
| | - Laura Ferrara
- Early Pregnancy and Acute Gynecology Unit, Queen Charlottes and Chelsea Hospital, Imperial College London, London, W12 0HS, UK
| | - Jeroen Kaijser
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Catriona Stalder
- Early Pregnancy and Acute Gynecology Unit, Queen Charlottes and Chelsea Hospital, Imperial College London, London, W12 0HS, UK
| | - Shyamaly Sur
- Early Pregnancy and Acute Gynecology Unit, Queen Charlottes and Chelsea Hospital, Imperial College London, London, W12 0HS, UK
| | - Dirk Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Tom Bourne
- Department of Cancer and Surgery, Imperial College London, Hammersmith Campus, London, UK
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29
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Jokubkiene L, Sladkevicius P, Valentin L. Prevalence of extrauterine pelvic lesions on transvaginal ultrasound in asymptomatic 20-39-year-old women. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:228-237. [PMID: 24375888 DOI: 10.1002/uog.13294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 11/12/2013] [Accepted: 12/20/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To estimate the prevalence of extrauterine pelvic lesions on transvaginal ultrasound examination of gynecologically asymptomatic women of fertile age, and to compare this prevalence between women with spontaneous menstrual cycles, those using the combined oral contraceptive (COC) pill and those using a gestagen intrauterine contraceptive device (IUD). METHODS Six hundred and forty-four gynecologically asymptomatic 20-39-year-old Caucasian women with no current or previous gynecological problems, who were recruited from a Swedish population registry, were examined with transvaginal ultrasound on cycle day 4-8. Our definition of ovarian cyst was a unilocular cyst with anechoic cyst contents ≥ 35 mm in mean diameter, or any other type of intraovarian lesion. The prevalence of extrauterine pelvic lesions was compared between women not using hormonal contraception and those using COC or a gestagen IUD. RESULTS Ovarian lesions were found in 24 (3.7%) women. One woman had bilateral ovarian lesions. An ultrasound diagnosis of paraovarian cyst was made in 41 (6.4%) women, of peritoneal cyst in four (0.6%) women and of hydrosalpinx in one (0.2%) woman. All incidentally detected lesions had a mean diameter of ≤ 5 cm. One 17-mm intraovarian lesion was suspicious for malignancy, and histology confirmed a Sertoli-Leydig cell tumor. The ultrasound diagnoses in the remaining 23 women were endometrioma (n = 10 (1.6%)), dermoid cyst (n = 5 (0.8%)), cystadenofibroma (n = 1 (0.2%)), mature teratoma (n = 1 (0.2%)) and functional cyst, i.e. a cyst that resolved within 3-5 months (n = 6 (0.9%)). Four women with an ultrasound diagnosis of a benign lesion were operated on, and the ultrasound diagnoses of endometrioma (n = 2), dermoid cyst (n = 1) and mature teratoma (n = 1) were confirmed histologically. The prevalence of persisting ovarian lesions was highest in women with spontaneous menstrual cycles (4.4% vs 0.9% and 0% in women using COC and gestagen IUD, respectively; P = 0.025), but age was the only factor independently associated with persisting ovarian masses, the prevalence increasing with age. CONCLUSIONS Benign ovarian lesions are found in about 1 in 25 gynecologically asymptomatic women aged 20-39 years with no history of gynecological disease. To be able to offer optimal management of such masses, their natural history needs to be elucidated in a large prospective observational study.
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Affiliation(s)
- L Jokubkiene
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Malmö, Sweden
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30
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Franchi D, Boveri S, Fruscio R, Fischerova D, Guerriero S, Moruzzi MC, Colombo N, Timmerman D, Valentin L, Testa AC. Imaging in gynecological disease (8): ultrasound characteristics of recurrent borderline ovarian tumors. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:452-458. [PMID: 22858859 DOI: 10.1002/uog.12276] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To describe the sonographic characteristics of borderline ovarian tumor (BOT) recurrence. METHODS From the databases of five ultrasound centers, we retrospectively identified 68 patients with histological diagnosis of recurrent BOT who had undergone preoperative ultrasound examination. All recurrences were detected during planned follow-up ultrasound examinations. Recurrent lesions were described using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. RESULTS Sixty-two patients had a serous BOT recurrence and six a mucinous BOT recurrence. All patients except one were premenopausal, 84% of them being < 40 years old. All but one patient were asymptomatic at diagnosis of the recurrence. Fertility-sparing surgery of the recurrent tumor was performed in 57/68 (84%) patients. The most frequent ultrasound feature of recurrent serous BOT was a unilocular solid cyst (49/62, 79%) and almost half of the recurrent serous BOTs (29/62, 47%) had multiple papillary projections. In 89% of the recurrent serous BOTs there was at least one papillation with irregular surface and in 73% there was at least one papillation vascularized at color Doppler examination. Recurrent mucinous BOTs appeared mainly as multilocular or multilocular solid cysts (5/6, 83%). CONCLUSION Sonographic features of recurrent BOT resemble those described by others for different subtypes of primary BOT.
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Affiliation(s)
- D Franchi
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, Milan, Italy.
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31
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Valentin L, Ameye L, Franchi D, Guerriero S, Jurkovic D, Savelli L, Fischerova D, Lissoni A, Van Holsbeke C, Fruscio R, Van Huffel S, Testa A, Timmerman D. Risk of malignancy in unilocular cysts: a study of 1148 adnexal masses classified as unilocular cysts at transvaginal ultrasound and review of the literature. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:80-89. [PMID: 23001924 DOI: 10.1002/uog.12308] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/19/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The aim of this study was to estimate the rate of malignancy in adnexal lesions described as unilocular cysts at transvaginal ultrasound examination and to investigate if there are differences in clinical and ultrasound characteristics between benign and malignant unilocular cysts. METHODS A total of 3511 patients with an adnexal mass underwent transvaginal ultrasound examination between 1999 and 2007. Sonologists used the International Ovarian Tumor Analysis terms and definitions to describe their ultrasound findings. Only masses operated on within 120 days after the ultrasound examination were included in the analysis and the histopathological diagnosis of the mass was used as the gold standard. RESULTS Of the 3511 masses, 1148 (33%) were classified as unilocular cysts on ultrasound. Of these, 11 (0.96% (95% CI, 0.48-1.71)) were malignant. The malignancy rate was lower in premenopausal than in postmenopausal women: 0.54% (5/931; 95% CI, 0.17-1.25) vs. 2.76% (6/217; 95% CI, 1.02-5.92); P = 0.009. More patients with malignant unilocular cysts had a personal history of breast cancer (18% vs. 2%; P = 0.02) or ovarian cancer (18% vs 0.6%; P = 0.003). Hemorrhagic cyst contents on ultrasound were more common in malignant than in benign unilocular cysts (18% vs. 2%; P = 0.03). In seven of the 11 malignancies judged to be unilocular cysts at scan, papillary projections or other solid components were seen at macroscopic inspection of the surgical specimen. CONCLUSIONS The malignancy rate in surgically removed adnexal lesions judged to be unilocular cysts at transvaginal scan is c 1%. Postmenopausal status, personal history of breast or ovarian cancer and hemorrhagic cyst contents on ultrasound increase the risk of malignancy. To avoid misclassifying adnexal lesions as unilocular cysts at scan, it is important to scrutinize unilocular cysts for the presence of solid components.
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Affiliation(s)
- L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Malmo, Sweden.
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Is MRI a useful tool to distinguish between serous and mucinous borderline ovarian tumours? Clin Radiol 2012; 68:e1-8. [PMID: 23044365 DOI: 10.1016/j.crad.2012.08.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 08/07/2012] [Accepted: 08/20/2012] [Indexed: 01/09/2023]
Abstract
AIM To analyse the morphological magnetic resonance imaging (MRI) features of borderline ovarian tumours (BOT) and to evaluate whether MRI can be used to distinguish serous from mucinous subtypes. MATERIALS AND METHODS A retrospective study of 72 patients who underwent BOT resection was undertaken. MRI images were reviewed blindly by two radiologists to assess MRI features: size, tumour type, grouped and irregular thickened septa, number of septa, loculi of different signal intensity, vegetations, solid portion, signal intensity of vegetations, normal ovarian parenchyma, and pelvic ascites. Statistical analysis was performed using Mann-Whitney and Fisher's exact tests. Logistic regression analysis was used to assess the predictive value of the MRI findings for histological subtypes. RESULTS At histology, there were 33 serous BOT (SBOT) and 39 mucinous BOT (MBOT). Predictive MRI criteria for SBOT were bilaterality, predominantly solid tumour, and the presence of vegetations, especially exophytic or with a high T2 signal (p < 0.01), whereas predictive MRI criteria for MBOT were multilocularity, number of septa, loculi of different signal intensity, and grouped and irregular thickened septa (p < 0.01). Using multivariate analysis, vegetations were independently associated with SBOT [odds ratio (OR) = 29.5] and multilocularity with MBOT (OR = 3.9). CONCLUSION Vegetations and multilocularity are two independent MRI features that can help to distinguish between SBOT and MBOT.
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Fischerova D, Zikan M, Dundr P, Cibula D. Diagnosis, treatment, and follow-up of borderline ovarian tumors. Oncologist 2012; 17:1515-33. [PMID: 23024155 PMCID: PMC3528384 DOI: 10.1634/theoncologist.2012-0139] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 08/26/2012] [Indexed: 12/22/2022] Open
Abstract
Borderline ovarian tumors represent a heterogeneous group of noninvasive tumors of uncertain malignant potential with characteristic histology. They occur in younger women, are present at an early stage, and have a favorable prognosis, but symptomatic recurrence and death may be found as long as 20 years after therapy in some patients. The molecular changes in borderline ovarian tumors indicate linkage of this disease to type I ovarian tumors (low-grade ovarian carcinomas). The pathological stage of disease and subclassification of extraovarian disease into invasive and noninvasive implants, together with the presence of postoperative macroscopic residual disease, appear to be the major predictor of recurrence and survival. However, it should be emphasized that the most important negative prognostic factor for recurrence is just the use of conservative surgery, but without any impact on patient survival because most recurrent diseases are of the borderline type-easily curable and with an excellent prognosis. Borderline tumors are difficult masses to correctly preoperatively diagnose using imaging methods because their macroscopic features may overlap with invasive and benign ovarian tumors. Over the past several decades, surgical therapy has shifted from a radical approach to more conservative treatment; however, oncologic safety must always be balanced. Follow-up is essential using routine ultrasound imaging, with special attention paid to the remaining ovary in conservatively treated patients. Current literature on this topic leads to a number of controversies that will be discussed thoroughly in this article, with the aim to provide recommendations for the clinical management of these patients.
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Affiliation(s)
- Daniela Fischerova
- Gynecological Oncology Center, Department of Obstetrics and Gynecology, Apolinaska 18, 120 00 Prague, Czech Republic.
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Sobiczewski P, Dańska-Bidzińska A, Rzepka J, Kupryjańczyk J, Gujski M, Bidziński M, Michalski W. Evaluation of selected ultrasonographic parameters and marker levels in the preoperative differentiation of borderline ovarian tumors and ovarian cancers. Arch Gynecol Obstet 2012; 286:1513-9. [PMID: 22821506 PMCID: PMC3490072 DOI: 10.1007/s00404-012-2453-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 07/02/2012] [Indexed: 12/30/2022]
Abstract
Abstract Objectives In young patients with borderline tumors the fertility-sparing treatment is indicated, thus the preoperative investigation is important. The aim of this study was to perform a comparative assessment of sensitivity and specificity of selected ultrasonographic and clinical parameters for the diagnoses of borderline tumors and ovarian cancers. Methods We retrospectively analyzed 57 patients who underwent surgical treatment in the Maria Sklodowska-Curie Memorial Cancer Center from Jan 01, 2008 to Dec 31, 2009. Ovarian cancers were diagnosed in 41 patients, and borderline ovarian tumors in 16 patients. Statistical model was developed to determine independent predictive factors that would be useful in preoperative differentiation between both tumors. The model included the following factors: menopausal status, tumor morphology, wall thickness (including outgrowths), septal thickness, echogenicity, resistive index, serum CA-125 level, and free fluid in the peritoneal cavity. Results Based on the statistical model developed, independent predictive factors in the differentiation between ovarian cancers and borderline tumors included the menopausal status (P = 0.005), tumor echogenicity (P = 0.047) and the presence of free fluid in the Douglas pouch (P = 0.043). With the cutoff value of 13 (with scores below 13 indicating a borderline ovarian tumor, and scores of ≥13 indicating ovarian cancer), sensitivity was 90.2 % and specificity was 87 %. Conclusions Our proposed model of preoperative evaluation has a sensitivity of 90 % in the differentiation between ovarian cancers and borderline tumors. When combined with intraoperative findings, it allows optimal surgical therapeutic decisions to be made in patients with borderline ovarian tumors.
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Affiliation(s)
- Piotr Sobiczewski
- Gynecologic Oncology Department, The Maria Sklodowska-Curie Memorial Cancer Center, Medical University, 02-781, Warsaw, Poland.
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Fagotti A, Ludovisi M, De Blasis I, Virgilio B, Di Legge A, Mascilini F, Moruzzi M, Giansiracusa C, Fanfani F, Tropeano G, Di Bidino R, Scambia G, Testa A. The sonographic prediction of invasive carcinoma in unilocular-solid ovarian cysts in premenopausal patients: a pilot study. Hum Reprod 2012; 27:2676-83. [PMID: 22740492 DOI: 10.1093/humrep/des231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Unilocular-solid ovarian cysts are a rare but challenging pathology in young women, with a desire to spare their fertility. In these cases, the risks of borderline and invasive disease are around 10 and 20%, respectively. No ultrasound rule has yet demonstrated the ability to discriminate with high accuracy, a borderline tumor from a benign tumor or 'invasive tumor'. The aim of this study was to assess the predictive performance of different ultrasound parameters in differentiating benign and borderline tumors versus invasive malignant tumors in premenopausal patients with unilocular-solid ovarian masses. METHODS Women aged ≤ 50 years with unilocular-solid adnexal masses with a maximum diameter ≤ 10 cm, undergoing surgery in our department within 3 months from ultrasound examination, were included in this retrospective study. A standardized ultrasound examination technique and predefined definitions of ultrasound characteristics were used. The results of ultrasound examination using gray scale and color Doppler were compared with the histological examination of the respective surgical specimens. RESULTS The study included 51 patients. On histological examination, 36 (70%) lesions were classified as benign, 10 (20%) as borderline ovarian tumors and 5 (10%) as invasively malignant tumors. In receiver-operating characteristic curve analysis, the best cut-off for the largest solid component with regard to discriminating non-invasive (benign or borderline) from invasive tumors was 14 mm. A largest solid component >14 mm, the presence of papillation blood flow and the combination of the two parameters provided a sensitivity of 100% and a specificity of 63, 63 and 80%, respectively. CONCLUSIONS Transvaginal ultrasound examination seems to be able to discriminate between invasive and non-invasive tumors in the premenopausal patients with unilocular-solid adnexal masses. Because of the retrospective nature of the study, further prospective clinical trials are needed to confirm the accuracy of the selected sonographic parameters in discriminating the invasive and non-invasive adnexal tumors.
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Affiliation(s)
- A Fagotti
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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Bazot M, Cortez A, Daraï É, Froment-Leonetti V, Nassar-Slaba J, Haouy D, Morel A, Dechoux-Vodovar S, Thomassin-Naggara I. Imagerie des tumeurs ovariennes épithéliales frontières. IMAGERIE DE LA FEMME 2012. [DOI: 10.1016/j.femme.2012.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Morotti M, Menada MV, Gillott DJ, Venturini PL, Ferrero S. The preoperative diagnosis of borderline ovarian tumors: a review of current literature. Arch Gynecol Obstet 2011; 285:1103-12. [DOI: 10.1007/s00404-011-2194-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 12/19/2011] [Indexed: 12/14/2022]
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Yazbek J, Ameye L, Testa AC, Valentin L, Timmerman D, Holland TK, Van Holsbeke C, Jurkovic D. Confidence of expert ultrasound operators in making a diagnosis of adnexal tumor: effect on diagnostic accuracy and interobserver agreement. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:89-93. [PMID: 19757401 DOI: 10.1002/uog.7335] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the degree of confidence with which expert ultrasound operators make a diagnosis of benign, borderline and invasive malignant ovarian tumors and its effect on diagnostic accuracy and interobserver agreement. METHOD Digitally stored static two-dimensional B-mode images of representative cases of benign, borderline and invasive malignant ovarian tumors were independently assessed by three expert ultrasound operators who had not performed the original real-time ultrasound examination. The experts classified the tumors as benign, borderline or invasive malignant and they also indicated the degree of confidence with which they made the diagnosis (certain, probable and uncertain). The diagnostic accuracy and interobserver agreement, in differentiating benign, borderline and invasive malignant ovarian tumors, were calculated depending on the level of confidence with which the diagnosis was made. RESULTS One hundred and sixty-six cases were included in the final data analysis. The diagnostic accuracy of all three experts decreased with decreasing level of confidence. Interobserver agreement between any two experts was very high when they were certain of the diagnosis (rates of agreement 98%, 99% and 100%), but it was significantly lower with a moderate level of confidence (rates of agreement 78%, 71% and 76%) (P < 0.01 for any two experts). The agreement in both diagnosis and confidence was lowest in cases of borderline ovarian tumors compared to benign and primary invasive lesions. CONCLUSIONS The accuracy of expert ultrasound operators using pattern recognition depends on the degree of certainty with which the diagnosis is made. Interobserver variability is also influenced by the operators' confidence in making the diagnosis. Our findings suggest that the level of confidence with which the diagnosis is made should be included in the ultrasound report.
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Affiliation(s)
- J Yazbek
- Early Pregnancy and Gynaecology Assessment Unit, King's College Hospital, London, UK
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Yazbek J, Ameye L, Timmerman D, Testa AC, Valentin L, Holland TK, Van Holsbeke C, Jurkovic D. Use of ultrasound pattern recognition by expert operators to identify borderline ovarian tumors: a study of diagnostic performance and interobserver agreement. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:84-88. [PMID: 19746450 DOI: 10.1002/uog.7334] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the accuracy and reproducibility of ultrasound 'pattern recognition' for the diagnosis of borderline ovarian tumors by asking experienced ultrasound operators to evaluate representative images of different types of adnexal tumor. METHODS Digitally stored static two-dimensional B-mode images of representative cases of benign, borderline and invasive malignant ovarian tumors were independently assessed by three expert sonologists who had not performed the original real-time ultrasound examination. The outcome measures included diagnostic accuracy and interobserver agreement in the diagnosis of benign, borderline or invasive malignant ovarian tumors. RESULTS One hundred and sixty-six cases were included in the final data analysis. A correct classification was made by all three experts in 83% of the primary invasive cancers, 76% of the benign masses and in 44% of the borderline malignant tumors (P < 0.01). The experts showed a tendency to misclassify borderline tumors as benign rather than primary invasive (ratio of 8 : 1 for Expert A, 4 : 1 for B and 6 : 1 for C). The interobserver agreement between any two experts was very good when they were tested for their ability to discriminate between invasive and non-invasive (benign and borderline) ovarian tumors (Cohen's kappa 0.85-0.88), but poorer for the discrimination between malignant (invasive and borderline) and benign tumors (kappa 0.70-0.78). CONCLUSIONS The accuracy of ultrasound diagnosis of borderline tumors is lower in comparison with benign and invasive malignant lesions. The diagnostic performance and interobserver agreement are better when the outcomes are dichotomized into non-invasive and invasive malignant lesions, as opposed to the traditional diagnosis of benign and malignant tumors.
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Affiliation(s)
- J Yazbek
- Early Pregnancy and Gynaecology Assessment Unit, King's College Hospital, London, UK.
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Testa AC, Bourne TH. Characterising pelvic masses using ultrasound. Best Pract Res Clin Obstet Gynaecol 2009; 23:725-38. [DOI: 10.1016/j.bpobgyn.2009.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 02/11/2009] [Indexed: 10/21/2022]
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Van Holsbeke C, Daemen A, Yazbek J, Holland TK, Bourne T, Mesens T, Lannoo L, De Moor B, De Jonge E, Testa AC, Valentin L, Jurkovic D, Timmerman D. Ultrasound methods to distinguish between malignant and benign adnexal masses in the hands of examiners with different levels of experience. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:454-461. [PMID: 19736644 DOI: 10.1002/uog.6443] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To determine the effect of an ultrasound training course on the performance of pattern recognition when used by less experienced examiners and to compare the performance of pattern recognition, a logistic regression model and a scoring system to estimate the risk of malignancy between examiners with different levels of experience. METHODS Using ultrasound images of selected adnexal masses, two trainees classified the masses as benign or malignant by using pattern recognition both before and after they had attended a theoretical gynecological ultrasound course. They also classified the masses by using a logistic regression model and a scoring system, but only after they had attended the course. The performance of these three methods when they were used by the trainees was then compared with that when they were used by experts. RESULTS One hundred and sixty-five adnexal masses were included, of which 42% were malignant (21% invasive tumors and 21% borderline tumors). The area under the receiver-operating characteristics curve of pattern recognition when used by the trainees was similar before and after they had attended the course. Training decreased sensitivity (84% vs. 70% for Trainee 1, P = 0.004; 70% vs. 61% for Trainee 2, P = 0.058) and increased specificity (77% vs. 92% for Trainee 1, P = 0.001; 89% vs. 95% for Trainee 2, P = 0.058). The performance of pattern recognition was poorer in the hands of the trainees than in the hands of the experts. The sensitivities of the logistic regression model were 70% and 54% for the trainees vs. 83% for an expert (P = 0.020 and < 0.001, respectively) and the specificities were 84% and 94% vs. 89% (P = 0.25 and 0.59, respectively). The sensitivities of the scoring system were 59% and 54% for the trainees vs. 75% for the expert (P = 0.002 and < 0.001, respectively), and the specificities were 90% and 93% vs. 85% (P = 0.103 and 0.008, respectively). CONCLUSION Theoretical ultrasound teaching did not seem to improve the performance of pattern recognition in the hands of trainees. A logistic regression model and a scoring system to classify adnexal masses as benign or malignant perform less well when they were used by inexperienced examiners than when used by an expert. Before using a model or a scoring system, experience and/or proper training are likely to be of paramount importance if diagnostic performance is to be optimized.
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Affiliation(s)
- C Van Holsbeke
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Belgium.
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Marret H, Lhommé C, Lécuru F, Canis M, Léveque J, Golfier F, Morice P. [French recommendations for ovarian cancer management during pregnancy]. ACTA ACUST UNITED AC 2009; 37:752-63. [PMID: 19709917 DOI: 10.1016/j.gyobfe.2009.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Evaluation of the fetus using prenatal ultrasound has resulted in increased detection of asymptomatic adnexal masses during pregnancy. Such masses are rarely malignant (1/10 000 to 1/50 000 pregnancies), but the possibility of borderline or cancer must be considered. It is a common assumption by both patients and physicians that if an ovarian cancer is diagnosed during pregnancy, treatment necessitates sacrificing the well-being of the fetus. However, in most cases, it is possible to offer appropriate treatment to the mother without placing the fetus at serious risk. The care of a pregnant woman with cancer involves evaluation of sometimes competing maternal and fetal risks and benefits. These recommendation approaches attempt to balance these risks and benefits; however, they should be considered advisory and should not replace specific interdisciplinary consultation with specialists in maternal-fetal medicine, gynecologic oncology, and pediatrics, as well as imaging and pathology, as needed. Second level ultrasound including Doppler is needed. MRI is not often necessary, and CA 125 is of low contribution. We suggest surgery be performed after 15 SA for ovarian masses which (1) persist into the second trimester, (2) are greater than 5 to 10 cm in diameter, or (3) have solid or mixed solid and cystic ultrasound characteristics. During antepartum surgical staging and debulking, homolateral salpingo-oophorectomy and peritoneal cytology and exploration are necessary. Women found to have advanced stage epithelial ovarian cancer should consider having completion of the debulking of the reproductive organs at the conclusion of the pregnancy. If chemotherapy is indicated, we recommend delaying administration, if possible, after the delivery or at least after 20 SA in order to minimize the potential fetal toxicity.
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Affiliation(s)
- H Marret
- Service de gynécologie, hôpital Bretonneau, centre hospitalo-universitaire de Tours, 37044 Tours cedex 1, France.
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Testa AC. Malignant ovarian neoplasms: the sonographic voyage of discovery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 31:611-614. [PMID: 18504774 DOI: 10.1002/uog.5379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Timmerman D, Valentin L. Imaging in gynecological disease. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:483-4. [PMID: 17444563 DOI: 10.1002/uog.4025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Yazbek J, Raju KS, Ben-Nagi J, Holland T, Hillaby K, Jurkovic D. Accuracy of ultrasound subjective 'pattern recognition' for the diagnosis of borderline ovarian tumors. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:489-95. [PMID: 17444554 DOI: 10.1002/uog.4002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To assess the value of pattern recognition for the preoperative ultrasound diagnosis of borderline ovarian tumors (BOTs). METHODS This was a prospective study of women who were referred to our regional cancer center with the diagnosis of an adnexal mass on a Level II (routine) gynecological ultrasound scan. Women with lesions of uncertain nature were referred for a Level III (expert) ultrasound scan in our tertiary center. The tumor pattern recognition method was used to differentiate between various types of ovarian tumors. Morphological features suggestive of BOTs were: unilocular cyst with a positive ovarian crescent sign and extensive papillary projections arising from the inner wall, or a cyst with a well defined multilocular nodule. The ultrasound findings were compared with the final histological diagnosis. RESULTS A total of 224 women with an adnexal mass of uncertain nature were referred for an expert scan, 166 (74.1%) of whom underwent surgery. In this group of women the final histological diagnoses were: 99 (60%) benign lesions, 32 (19%) invasive ovarian cancer and 35 (21%) BOTs. Using pattern recognition combining the different morphological features, a correct preoperative diagnosis of BOT was made in 24/35 (68.6%) women: area under the receiver-operating characteristics curve 0.812 (standard error 0.049; 95% CI, 0.716-0.908), sensitivity 0.69 (95% CI, 0.52-0.81), specificity 0.94 (95% CI, 0.88-0.97), positive likelihood ratio 11.3 (95% CI, 5.53-22.8) and negative likelihood ratio 0.34 (95% CI, 0.21-0.55). CONCLUSIONS Ultrasound diagnosis of BOTs is highly specific. However, typical features are absent in one-third of cases, which are typically misdiagnosed as benign lesions.
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Affiliation(s)
- J Yazbek
- Early Pregnancy and Gynaecology Assessment Unit, King's College Hospital, London, UK.
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