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6 - Ultrasound in Ovarian Carcinoma

Published online by Cambridge University Press:  11 September 2009

By
Judith A. W. Webb
Edited by
Rodney Reznek
Judith A. W. Webb
Affiliation:
Department of Diagnostic Radiology, St Bartholomew's Hospital, London, UK
Rodney Reznek
Affiliation:
St. Bartholomew's Hospital, London
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Summary

Ultrasound is the first imaging test used in most patients with an adnexal mass, and the great majority of adnexal masses are benign. Ultrasound has been shown to have a high sensitivity for detecting malignancy, but this is countered by a much lower specificity. In this chapter the ultrasonic features which suggest a malignant diagnosis and the wide differential diagnosis which often has to be considered are summarised. The performance of ultrasound in detecting malignancy in adnexal masses and its role in the diagnosis of ovarian cancer are then discussed.

Ultrasonic Technique

The patient's clinical presentation, age, menstrual status and CA125 level are all important factors influencing the differential diagnosis when the ultrasonic assessment is made.

Morphological Assessment

Most adnexal masses are assessed transvaginally because the resolution which can be obtained with high frequency transvaginal transducers (6–10 MHz) is superior to that obtained transabdominally, scanning at frequencies of 3–5 MHz. Transvaginal ultrasound is limited by a maximum depth of view of 5–6 cm and this makes it unsuitable for full examination of larger masses which have to be evaluated transabdominally. However, even when the mass is large, it is often worth doing a transvaginal examination because this allows high resolution visualisation of the inferior part of the mass and because it may be the only way to identify normal pelvic structures displaced by a large mass.

Type
Chapter
Information
Cancer of the Ovary , pp. 94 - 111
Publisher: Cambridge University Press
Print publication year: 2006

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References

Hillaby, K., Aslam, N., Salim, R., et al. The value of detection of normal ovarian tissue (the ‘ovarian crescent sign’) in the differential diagnosis of adnexal masses. Ultrasound Obstet Gynecol (2004), 23:63–7.CrossRefGoogle ScholarPubMed
Guerriero, S., Alcazar, J. L., Ajossa, S., et al. Comparison of conventional colour Doppler imaging and power Doppler imaging for the diagnosis of ovarian cancer: results of a European study. Gynecol Oncol (2001), 83:299–304.CrossRefGoogle Scholar
Kurjak, A., Zalud, I. and Alfirevic, Z.. Evaluation of adnexal masses with transvaginal colour ultrasound. J Ultrasound Med (1991), 10:295–9.CrossRefGoogle Scholar
Fleischer, A. C., Rodgers, W. H., Kepple, D. M., et al. Color Doppler sonography of benign and malignant ovarian masses. Radiographics (1992), 12:879–85.CrossRefGoogle ScholarPubMed
Jeong, Y. Y., Outwater, E. K. and Kang, H. K.. Imaging evaluation of ovarian masses. Radiographics (2000), 20:1445–70.CrossRefGoogle ScholarPubMed
Kurjak, A., Kupesic, S., Sparac, V. and Kosuta, D.. Three-dimensional ultrasonographic and power Doppler characterization of ovarian lesions. Ultrasound Obstet Gynaecol (2000), 16:365–71.CrossRefGoogle ScholarPubMed
Alcazar, J. L. and Castillo, G.. Comparison of 2-dimensional and 3-dimensional power-Doppler imaging in complex adnexal masses for the prediction of ovarian cancer. Am J Obstet Gynecol (2005), 192:807–12.CrossRefGoogle ScholarPubMed
Orden, M. R., Jurvelin, J. S. and Kirkinen, P. P.. Kinetics of a US contrast agent in benign and malignant adnexal tumours. Radiology (2003), 226:405–10.CrossRefGoogle Scholar
d'Arcy, T. J., Jayaram, V., Lynch, M., et al. Ovarian cancer detected non-invasively by contrast-enhanced power Doppler. Br J Obstet Gynaecol (2004), 111:619–22.CrossRefGoogle ScholarPubMed
Marret, H., Sauget, S., Giraudeau, B., et al. Contrast-enhanced sonography helps in discrimination of benign from malignant adnexal masses. J Ultrasound Med (2004), 23:1629–39.CrossRefGoogle ScholarPubMed
E. Robbins, R. Kumar and R. S. Cotran. Female genital tract. In: Cotran, R. S., Kumar, V., Collins, T., eds., Robbins Pathologic Basis of Disease, 6th edn. Philadelphia: W. B. Saunders, (1998), pp. 1035–92.Google Scholar
Granberg, S., Wikland, M. and Jansson, I.. Macroscopic characterization of ovarian tumours and the relation to the histological diagnosis: criteria to be used for ultrasound evaluation. Gynecol Oncol (1989), 35:139–44.CrossRefGoogle ScholarPubMed
Lerner, J. P., Timor-Tritsch, I. E., Federman, A. and Abramovich, G.. Transvaginal ultrasonographic characterization of ovarian masses with an improved, weighted scoring system. Am J Obstet Gynecol (1994), 170:81–5.CrossRefGoogle ScholarPubMed
Wagner, B. J., Buck, J. L., Seidman, J. D. and McCabe, K. M.. From the Archives of the AFIP – Ovarian epithelial neoplasms: radiologic-pathologic correlation. Radiographics (1994), 14:1351–74.CrossRefGoogle ScholarPubMed
Zanetta, G., Lissoni, A., Cha, S., et al. Preoperative morphological and colour Doppler features of borderline ovarian tumours. Br J Obstet Gynaecol (1995), 102:990–6.CrossRefGoogle ScholarPubMed
Pascual, M. A., Tresserra, F., Grases, P. J., et al. Borderline cystic tumours of the ovary: gray-scale and color Doppler sonographic findings. J Clin Ultrasound (2002), 30:76–82.CrossRefGoogle ScholarPubMed
Exacoustas, C., Romanini, M. E., Rinaldo, D., et al. Preoperative sonographic features of borderline ovarian tumours. Ultrasound Obstet Gynecol (2005), 25:50–9.CrossRefGoogle Scholar
Megibow, A. J., Hulnick, D. H., Bosniak, M. A. and Balthazar, E. J.. Ovarian metastases: computed tomographic appearances. Radiology (1985), 156:161–4.CrossRefGoogle ScholarPubMed
Brown, D. L., Zou, K. H., Tempany, C. M., et al. Primary versus secondary ovarian malignancy: imaging findings of adnexal masses in the Radiology Diagnostic Oncology Group Study. Radiology (2001), 219:213–18.CrossRefGoogle ScholarPubMed
Wolf, S. I., Gosink, B. B., Feldesman, M. R., et al. Prevalence of simple adnexal cysts in postmenopausal women. Radiology (1991), 180:65–71.CrossRefGoogle ScholarPubMed
Modesitt, S. C., Pavlik, E. J., Veland, F. R., et al. Risk of malignancy in unilocular ovarian cystic tumours less than 10 cm in diameter. Obstet Gynecol (2003), 102: 594–9.Google Scholar
Castillo, G., Alcazar, J. L. and Jurado, M.. Natural history of sonographically detected simple unilocular adnexal cysts in asymptomatic postmenopausal women. Gynecol Oncol (2004), 92:965–9.CrossRefGoogle ScholarPubMed
Patel, M. D., Feldstein, V. A. and Lipson, S. D.. Cystic teratomas of the ovary: diagnostic value of sonography. AJR Am J Roentgenol (1998), 171:1061–5.CrossRefGoogle ScholarPubMed
Outwater, E. K., Siegelman, E. J. and Hunt, J. L.. Ovarian teratomas: tumor types and imaging characteristics. Radiographics (2001), 21:475–90.CrossRefGoogle ScholarPubMed
Kim, H-C., Kim, S. H., Lee, H. J., et al. Fluid-fluid levels in ovarian teratomas. Abdom Imaging (2002), 27:100–5.CrossRefGoogle ScholarPubMed
Patel, M. D., Feldstein, V. A., Chen, D. C., et al. Endometriomas: diagnostic performance of US. Radiology (1999), 210:739–45.CrossRefGoogle Scholar
Umaria, N. and Olliff, J. F.. Imaging features of pelvic endometriosis. Br J Radiol (2001), 74:556–62.CrossRefGoogle ScholarPubMed
Diakoumakis, E., Vieux, U. and Seife, B.. Sonographic demonstration of thecoma: report of two cases. Am J Obstet Gynecol (1984), 150:787–8.CrossRefGoogle ScholarPubMed
Bazot, M., Ghossain, M. A., Buy, J-N., et al. Fibrothecomas of the ovary: CT and US findings. J Comput Assist Tomogr (1993), 17:754–9.CrossRefGoogle ScholarPubMed
Atri, M., Nazarnia, S., Bret, P. M., et al. Endovaginal sonographic appearance of benign ovarian masses. Radiographics (1994), 14:747–60.CrossRefGoogle ScholarPubMed
Sharony, R., Aviram, R., Fishman, A., et al. Granulosa cell tumours of the ovary: do they have any unique ultrasonographic and color Doppler flow features?Int J Gynecol Cancer (2001), 11:229–33.CrossRefGoogle ScholarPubMed
Foshager, M. C., Hood, L. L. and Walsh, J. W.. Masses simulating gynaecologic diseases at CT and MR imaging. Radiographics (1996), 16:1085–99.CrossRefGoogle Scholar
Sassone, A. M., Timor-Tritsch, I. E., Artner, A., et al. Transvaginal sonographic characterization of ovarian disease: evaluation of a new scoring system to predict ovarian malignancy. Obstet Gynecol (1991), 78:70–6.Google ScholarPubMed
Stein, S. M., Laifer-Narin, S., Johnson, M. B., et al. Differentiation of benign and malignant adnexal masses: relative value of gray-scale, color Doppler and spectral Doppler sonography. AJR Am J Roentgenol (1995), 164:381–6.CrossRefGoogle ScholarPubMed
Yamashita, Y., Torashima, M., Hatanake, Y., et al. Adnexal masses: accuracy of characterization with transvaginal US and precontrast and postcontrast MR imaging. Radiology (1995), 194: 557–65.CrossRefGoogle ScholarPubMed
Buy, J. N., Ghossain, M. A., Hugol, D., et al. Characterization of adnexal masses: combination of color Doppler and conventional sonography compared with spectral Doppler analysis alone and conventional sonography alone. AJR Am J Roentgenol (1996), 166:385–93.CrossRefGoogle ScholarPubMed
Komatsu, T., Konishi, I., Mendai, M., et al. Adnexal masses: transvaginal US and gadolinium-enhanced MR imaging assessment of intratumoral structure. Radiology (1996), 198:109–15.CrossRefGoogle ScholarPubMed
Reles, A., Wein, U. and Lichtenegger, W.. Transvaginal color Doppler sonography and conventional sonography in the preoperative assessment of adnexal masses. J Clin Ultrasound (1997), 25:217–25.3.0.CO;2-G>CrossRefGoogle ScholarPubMed
Rieber, A., Nussle, K., Stohr, I., et al. Preoperative diagnosis of ovarian tumors with MR imaging: comparison with transvaginal sonography, positron emission tomography and histologic findings. AJR Am J Roentgenol (2001), 177:123–9.CrossRefGoogle ScholarPubMed
Sohaib, S. A., Mills, T. D., Sahdev, A., et al. The role of magnetic resonance imaging and ultrasound in patients with adnexal masses. Clin Radiol (2005), 60:340–8.CrossRefGoogle ScholarPubMed
Kurjak, A., Schulman, H., Sosic, A., et al. Transvaginal ultrasound color flow and Doppler waveform of the postmenopausal adnexal mass. Obstet Gynecol (1992), 80:917–21.Google ScholarPubMed
Brown, D. L., Frates, M. C., Laing, F. C., et al. Ovarian masses: can benign and malignant lesions be differentiated with color and pulsed Doppler US?Radiology (1994), 190:330–6.CrossRefGoogle ScholarPubMed
Jain, K. A.. Prospective evaluation of adnexal masses with endovaginal gray-scale and duplex and color Doppler US: correlation with pathological findings. Radiology (1994), 191:63–7.CrossRefGoogle Scholar
Levine, D., Feldstein, V. A., Babcook, C. J. and Filly, R. A.. Sonography of ovarian masses: poor sensitivity of resistance index for identifying malignant lesions. AJR Am J Roentgenol (1994), 162:1355–9.CrossRefGoogle Scholar
Schneider, V. L., Schneider, A., Reed, K. L. and Hatch, K. D.. Comparison of Doppler with two-dimensional sonography and CA-125 for prediction of malignancy of pelvic masses. Obstet Gynecol (1993), 81:931–8.Google ScholarPubMed
Brown, D. L., Doubilet, P. M., Miller, F. H., et al. Benign and malignant ovarian masses: selection of the most discriminating gray-scale and Doppler sonographic features. Radiology (1998), 208:103–10.CrossRefGoogle ScholarPubMed
Valentin, L.. Comparison of Lerner score, Doppler ultrasound examination and their combination for discrimination between benign and malignant adnexal masses. Ultrasound Obstet Gynecol (2000), 15:143–7.CrossRefGoogle ScholarPubMed
Kinkel, K., Hricak, H., Ying, L., et al. US characterisation of ovarian masses: a meta-analysis. Radiology (2000), 217:803–11.CrossRefGoogle Scholar
Spencer, J. A., Swift, S. E., Wilkinson, N., et al. Peritoneal carcinomatosis: image-guided peritoneal core biopsy for tumor type and patient care. Radiology (2001), 221:173–7.CrossRefGoogle ScholarPubMed
Tempany, C. M. C., Zou, K. H., Silverman, S. G., et al. Staging of advanced ovarian cancer: comparison of imaging modalities – report from the Radiological Diagnostic Oncology Group. Radiology (2000), 215:761–7.CrossRefGoogle ScholarPubMed
Nagell, J. R., Priest, P. D., Reedy, M. B., et al. The efficacy of transvaginal sonographic screening in asymptomatic women at risk for ovarian cancer. Gynecol Oncol (2000), 77:350–6.CrossRefGoogle ScholarPubMed
Jacobs, I. J., Skates, S. J., MacDonald, N., et al. Screening for ovarian cancer: a pilot randomised controlled trial. Lancet (1999), 353:1207–10.CrossRefGoogle ScholarPubMed
Menon, U.. Ovarian cancer screening. Can Med Assoc J (2004), 171:323–4.CrossRefGoogle ScholarPubMed
Togashi, K.. Ovarian cancer: the clinical role of US, CT and MRI. Eur Radiol (2003), 13 (Suppl 4):87–104.CrossRefGoogle ScholarPubMed

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