Abstract:
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Purpose: Because of the high incidence of benign ovarian pathology and because the sonographic appearance is non-specific, most surgically resected ovarian masses are benign. The purpose of this study was to test a classification system for ovarian lesions to determine its value in reducing unnecessary resections.
Methods and Materials: Sonography features of 505 consecutive resected adnexal masses in 443 patients mean age 46+/-14 years over 3.5 years were correlated with the final pathologic diagnosis. Mean time between ultrasound and surgery was 48+/-39 days. Two readers blinded to the histology retrospectively evaluated by consensus both transabdominal and transvaginal images. Morphologic features noted included lesion size, presence of cystic or solid elements, and blood flow.
Results: 457/505 (90%) lesions were benign. Non-benign histology included primary epithelial tumors, borderline tumors, metastases, and malignant stromal tumors. 179/179 (100%) of lesions without solid component and 278/326 (85%) of lesions with solid components were benign (p < 0.001). 211/218 (97%) lesions < 4cm and 246/287 (86%) > 4cm were benign (<0.001). 244/250 (98%) lesions without and 76/106 (725) lesions with flow were benign (<0.001). These criteria resulted in four categories of lesions: 1a. Benign, lesion with no solid components; 1b. Benign, lesion with solid components measuring <4 cm and demonstrating no flow; 2a. Indeterminate, lesion with solid components measuring >4 cm; 2b. Indeterminate, lesion with solid components of any size demonstrating flow.
Conclusion: Ovarian lesions can be classified as: 1. Benign requiring no further workup or; 2. Indeterminate requiring further evaluation. Subjecting only the Indeterminate lesions to further imaging or laparoscopy would result in missing no non-malignant lesions and avoid operation in 239/505 (47%) of patients who now have surgery.
Akman MD, MBBS, A,
Sonographics Evaluation of Ovarian Masses: Which Ones Really Need Further Work-up?. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3105605.html
