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Pelayo M, Sancho-Sauco J, Sánchez-Zurdo J, Perez-Mies B, Abarca-Martínez L, Cancelo-Hidalgo MJ, Sainz-Bueno JA, Alcázar JL, Pelayo-Delgado I. Application of Ultrasound Scores (Subjective Assessment, Simple Rules Risk Assessment, ADNEX Model, O-RADS) to Adnexal Masses of Difficult Classification. Diagnostics (Basel) 2023; 13:2785. [PMID: 37685323 PMCID: PMC10486436 DOI: 10.3390/diagnostics13172785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Ultrasound features help to differentiate benign from malignant masses, and some of them are included in the ultrasound (US) scores. The main aim of this work is to describe the ultrasound features of certain adnexal masses of difficult classification and to analyse them according to the most frequently used US scores. METHODS Retrospective studies of adnexal lesions are difficult to classify by US scores in women undergoing surgery. Ultrasound characteristics were analysed, and masses were classified according to the Subjective Assessment of the ultrasonographer (SA) and other US scores (IOTA Simple Rules Risk Assessment-SRRA, ADNEX model with and without CA125 and O-RADS). RESULTS A total of 133 adnexal masses were studied (benign: 66.2%, n:88; malignant: 33.8%, n:45) in a sample of women with mean age 56.5 ± 7.8 years. Malignant lesions were identified by SA in all cases. Borderline ovarian tumors (n:13) were not always detected by some US scores (SRRA: 76.9%, ADNEX model without and with CA125: 76.9% and 84.6%) nor were serous carcinoma (n:19) (SRRA: 89.5%), clear cell carcinoma (n:9) (SRRA: 66.7%) or endometrioid carcinoma (n:4) (ADNEX model without CA125: 75.0%). While most teratomas and serous cystadenomas have been correctly differentiated, other benign lesions were misclassified because of the presence of solid areas or papillae. Fibromas (n:13) were better identified by SA (23.1% malignancy), but worse with the other US scores (SRRA: 69.2%, ADNEX model without and with CA125: 84.6% and 69.2%, O-RADS: 53.8%). Cystoadenofibromas (n:10) were difficult to distinguish from malignant masses via all scores except SRRA (SA: 70.0%, SRRA: 20.0%, ADNEX model without and with CA125: 60.0% and 50.0%, O-RADS: 90.0%). Mucinous cystadenomas (n:12) were misdiagnosed as malignant in more than 15% of the cases in all US scores (SA: 33.3%, SRRA: 16.7%, ADNEX model without and with CA125: 16.7% and 16.7%, O-RADS:41.7%). Brenner tumors are also difficult to classify using all scores. CONCLUSION Some malignant masses (borderline ovarian tumors, serous carcinoma, clear cell carcinoma, endometrioid carcinomas) are not always detected by US scores. Fibromas, cystoadenofibromas, some mucinous cystadenomas and Brenner tumors may present solid components/papillae that may induce confusion with malignant lesions. Most teratomas and serous cystadenomas are usually correctly classified.
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Affiliation(s)
- Mar Pelayo
- Universitary Hospital HM Puerta del Sur, HM Rivas, 3428521 Madrid, Spain;
| | - Javier Sancho-Sauco
- Department of Obstetrics and Gynecology, Universitary Hospital Ramón y Cajal, Alcalá de Henares University, 3428034 Madrid, Spain; (J.S.-S.); (L.A.-M.)
| | | | - Belén Perez-Mies
- Department of Pathology, Universitary Hospital Ramón y Cajal, Alcalá de Henares University, 3428034 Madrid, Spain;
| | - Leopoldo Abarca-Martínez
- Department of Obstetrics and Gynecology, Universitary Hospital Ramón y Cajal, Alcalá de Henares University, 3428034 Madrid, Spain; (J.S.-S.); (L.A.-M.)
| | - Mª Jesús Cancelo-Hidalgo
- Department of Obstetrics and Gynecology, Universitary Hospital of Guadalajara, Alcalá de Henares University, 3428034 Madrid, Spain;
| | | | - Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, 3431008 Pamplona, Spain;
| | - Irene Pelayo-Delgado
- Department of Obstetrics and Gynecology, Universitary Hospital Ramón y Cajal, Alcalá de Henares University, 3428034 Madrid, Spain; (J.S.-S.); (L.A.-M.)
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2
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Pelayo M, Sancho-Sauco J, Sanchez-Zurdo J, Abarca-Martinez L, Borrero-Gonzalez C, Sainz-Bueno JA, Alcazar JL, Pelayo-Delgado I. Ultrasound Features and Ultrasound Scores in the Differentiation between Benign and Malignant Adnexal Masses. Diagnostics (Basel) 2023; 13:2152. [PMID: 37443546 DOI: 10.3390/diagnostics13132152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Several ultrasound (US) features help ultrasound experts in the classification of benign vs. malignant adnexal masses. US scores serve in this differentiation, but they all have misdiagnoses. The main objective of this study is to evaluate what ultrasound characteristics are associated with malignancy influencing ultrasound scores. METHODS This is a retrospective analysis of ultrasound features of adnexal lesions of women managed surgically. Ultrasound characteristics were analyzed, and masses were classified by subjective assessment of the ultrasonographer (SA) and other ultrasound scores (IOTA Simple Rules Risk Assessment SRRA, ADNEX model, and O-RADS). RESULTS Of a total of 187 adnexal masses studied, 134 were benign (71.7%) and 53 were malignant (28.3%). SA, IOTA SRRA, ADNEX model with or without CA125 and O-RADS had high levels of sensitivity (93.9%, 81.1%, 94.3%, 88.7%, 98.1%) but lower specificity (80.2%, 82.1%, 82.8%, 77.6%, 73.1%) with similar AUC (0.87, 0.87, 0.92, 0.90, 0.86). Ultrasound features significantly related with malignancy were the presence of irregular contour, absence of acoustic shadowing, vascularized solid areas, ≥1 papillae, vascularized septum, and moderate-severe ascites. CONCLUSION IOTA SRRA, ADNEX model, and O-RADS can help in the classification of benign and malignant masses. Certain ultrasound characteristics studied in ultrasound scores are associated with malignancy.
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Affiliation(s)
- Mar Pelayo
- HM Puerta del Sur, HM Rivas Hospital, 3428521 Madrid, Spain
| | - Javier Sancho-Sauco
- Department of Obstetrics and Gynecology, Universitary Hospital Ramón y Cajal, Alcalá de Henares University, 3428034 Madrid, Spain
| | | | - Leopoldo Abarca-Martinez
- Department of Obstetrics and Gynecology, Universitary Hospital Ramón y Cajal, Alcalá de Henares University, 3428034 Madrid, Spain
| | | | | | - Juan Luis Alcazar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, 3431008 Pamplona, Spain
| | - Irene Pelayo-Delgado
- Department of Obstetrics and Gynecology, Universitary Hospital Ramón y Cajal, Alcalá de Henares University, 3428034 Madrid, Spain
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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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Ultrasound Characteristics of Cystadenofibromas: A Retrospective Multicenter Study. Ultrasound Q 2021; 37:349-356. [PMID: 34855711 DOI: 10.1097/ruq.0000000000000506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Cystadenofibromas (CAFs) are relatively rare benign ovarian tumors. This study was to describe the ultrasound (US) findings of CAFs. Preoperative US information of 86 CAFs was retrospectively collected. To better illustrate their characteristic, 173 cystadenomas (CADs), 103 borderline ovarian tumors (BOTs), and 129 cystadenocarcinomas (CACs) were recruited as match groups. Besides morphology evaluation, tumors were categorized by the Ovarian-Adnexal Reporting and Data System US system. Higher-risk stratification in CAFs was more often being seen than CADs (63% of CAFs classified as Ovarian-Adnexal Reporting and Data System 4 or 5 vs 35% in CADs). Cystadenofibromas more commonly appeared as unilocular or multilocular solid than CADs. Solid components presented in 59% of CAFs and papillary projections presented in 45%. More CAFs contained solid components and papillary projections than CADs (P < 0.0001). When compared with BOTs and CACs, less CAFs contained solid components (P < 0.017 and P < 0.0001). However, no significant difference was found in CAFs versus BOTs or CACs about the presence of papillary projections. Shadowing was identified in 58% of CAFs; however, in CADs, BOTs, and CACs, the proportion was 2%, 11%, and 11%, respectively. Presence of shadowing in CAFs was noticeably more than CADs, BOTs, and CACs (P < 0.017 or P < 0.0001). Similar to CADs, most CAFs were avascular (76%) and without ascites (99%), which were significantly different from BOTs and CACs. We concluded that the sonographic markers for CAFs that differ from malignant were presence of shadowing, avascular, and absence of ascites.
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5
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Krohn KA. Sonographic Evaluation of Serous Cystadenofibroma With Evidence of Intermittent Torsion. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479321989664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Serous cystadenofibromas are benign surface epithelial stromal tumors of the ovary. Many of the sonographic features of serous cystadenofibromas mimic what are traditionally considered possible characteristics of malignancy. Depending on the size of the ovarian neoplasm, there can be increased risk for ovarian torsion. Meticulous sonographic evaluation and appropriate optimization are critical for establishing the risk for malignancy and likelihood of torsion. This case describes how sonography was used to help identify a serous cystadenofibroma in a postmenopausal woman.
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Affiliation(s)
- Kaela A. Krohn
- Diagnostic Medical Sonography Program, University of Colorado Hospital, Aurora, CO, USA
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6
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Bhalla D, Manchanda S, Vyas S. Algorithmic Approach to Sonography of Adnexal Masses: An Evolving Paradigm. Curr Probl Diagn Radiol 2020; 50:703-715. [PMID: 32958313 DOI: 10.1067/j.cpradiol.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/25/2020] [Accepted: 08/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pelvic US remains the workhorse for detection and characterization of adnexal masses in most centers worldwide. While the differentiation of benign from malignant masses remains the foremost concern, it is imperative to narrow the differential diagnosis for management of benign masses as well as prognostication of malignant masses. The IOTA group as well as ACR have described a five category classification system for adnexal lesions based on morphological patterns. In addition, a six category risk stratification has been proposed, incorporating the probability of malignancy as well as management recommendations. LEARNING OBJECTIVES 1) Understand pattern based approach to adnexal lesion classification and the possible entities fitting into each pattern with the help of illustrations. 2) Classify lesions into appropriate risk categories based on diagnostic algorithms provided at the end of each section.
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Affiliation(s)
- Deeksha Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar East, ND, 110029, India
| | - Smita Manchanda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar East, ND, 110029, India.
| | - Surabhi Vyas
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar East, ND, 110029, India
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7
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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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8
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Abstract
This article provides an overview of the imaging evaluation of benign ovarian and adnexal masses in premenopausal and postmenopausal women and lesions discovered during pregnancy. Current imaging techniques are discussed, including pitfalls and differential diagnosis when necessary, as well as management. It also reviews the now well-established American College of Radiology (ACR)/Society of Radiologists in Ultrasound consensus guidelines and covers the more recently introduced Ovarian-Adnexal Reporting and Data System by the ACR and the recently published ADNEx Scoring System.
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Affiliation(s)
- Nadia J Khati
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA.
| | - Tammy Kim
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA
| | - Joanna Riess
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA
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9
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Virgilio BA, De Blasis I, Sladkevicius P, Moro F, Zannoni GF, Arciuolo D, Mascilini F, Ciccarone F, Timmerman D, Kaijser J, Fruscio R, Van Holsbeke C, Franchi D, Epstein E, Leone FPG, Guerriero S, Czekierdowski A, Scambia G, Testa AC, Valentin L. Imaging in gynecological disease (16): clinical and ultrasound characteristics of serous cystadenofibromas in adnexa. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:823-830. [PMID: 30937992 DOI: 10.1002/uog.20277] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/19/2019] [Accepted: 03/23/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To describe the clinical and ultrasound characteristics of serous cystadenofibromas in the adnexa. METHODS This was a retrospective study of patients identified in the International Ovarian Tumor Analysis (IOTA) database, who had a histological diagnosis of serous cystadenofibroma and had undergone preoperative ultrasound examination by an experienced ultrasound examiner, between 1999 and 2012. In the IOTA database, which contains data collected prospectively, the tumors were described using the terms and definitions of the IOTA group. In addition, three authors reviewed, first independently and then together, ultrasound images of serous cystadenofibromas and described them using pattern recognition. RESULTS We identified 233 women with a histological diagnosis of serous cystadenofibroma. In the IOTA database, most cystadenofibromas (67.4%; 157/233) were described as containing solid components but 19.3% (45/233) were described as multilocular cysts and 13.3% (31/233) as unilocular cysts. Papillary projections were described in 52.4% (122/233) of the cystadenofibromas. In 79.5% (97/122) of the cysts with papillary projections, color Doppler signals were absent in the papillary projections. Most cystadenofibromas (83.7%; 195/233) manifested no or minimal color Doppler signals. On retrospective analysis of 201 ultrasound images of serous cystadenofibromas, using pattern recognition, 10 major types of ultrasound appearance were identified. The most common pattern was a unilocular solid cyst with one or more papillary projections, but no other solid components (25.9%; 52/201). The second most common pattern was a multilocular solid mass with small solid component(s), but no papillary projections (19.4%; 39/201). The third and fourth most common patterns were multi- or bilocular cyst (16.9%; 34/201) and unilocular cyst (11.9%; 24/201). Using pattern recognition, shadowing was identified in 39.8% (80/201) of the tumors, and microcystic appearance of the papillary projections was observed in 34 (38.6%) of the 88 tumors containing papillary projections. CONCLUSIONS The ultrasound features of serous cystadenofibromas vary. The most common pattern is a unilocular solid cyst with one or more papillary projections but no other solid components, with absent color Doppler signals. Most serous cystadenofibromas were poorly vascularized on color Doppler examination and many manifested acoustic shadowing. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- B A Virgilio
- Istituto di Ginecologia ed Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
| | - I De Blasis
- Istituto di Ginecologia ed Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Sladkevicius
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| | - F Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - G F Zannoni
- Dipartimento Scienze della Salute della Donna e del Bambino, Unità di Ginecopatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Arciuolo
- Dipartimento Scienze della Salute della Donna e del Bambino, Unità di Ginecopatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - F Mascilini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - F Ciccarone
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium
| | - J Kaijser
- Department of Obstetrics and Gynecology, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium
| | - R Fruscio
- Clinic of Obstetrics and Gynecology, Department of Medicine and Surgery, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy
| | - C Van Holsbeke
- Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - D Franchi
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, IRCCS, Milan, Italy
| | - E Epstein
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - F P G Leone
- Department of Obstetrics and Gynecology, Clinical Sciences Institute, L. Sacco, Milan, Italy
| | - S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - A Czekierdowski
- First Department of Gynecological Oncology and Gynecology, Medical University of Lublin, Lublin, Poland
| | - G Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - A C Testa
- Istituto di Ginecologia ed Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Institution of Clinical Sciences Malmö, Lund University, Lund, Sweden
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10
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Timor-Tritsch IE, Yoon E, Monteagudo A, Ciaffarano J, Brandon C, Mittal KR, Wallach RC, Boyd LR. Ultrasound and Histopathologic Correlation of Ovarian Cystadenofibromas: Diagnostic Value of the "Shadow Sign". JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2973-2978. [PMID: 30927305 DOI: 10.1002/jum.15003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/22/2019] [Accepted: 02/26/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Cystadenofibromas (CAFs) are rare benign ovarian tumors without a widely accepted ultrasound (US) pattern. They are usually described by as thin-walled, unilocular or multilocular, and at times septated cysts with scant blood flow and no solid components. We describe a unique US feature, the "shadow sign," seen in prospectively diagnosed benign CAFs. We also provide the histopathologic basis for this typical US appearance. METHODS Ultrasound (US) examinations were performed in our obstetric and gynecologic US unit. Pathologic examinations were performed by a dedicated gynecologic pathology team. The US and pathology department's database was searched for the diagnosis of a CAF between 2010 and 2017. RESULTS We identified 20 patients who underwent transvaginal US examinations with a sole US diagnosis of a CAF, and the tumors were surgically removed. The common US feature across the 20 cases was the presence of hyperechoic avascular shadowing nodules. The correlating histologic features were unilocular or multilocular cysts with a smooth internal wall surface lined by a simple epithelium and occasional robust polypoid fibrous stroma. CONCLUSIONS This US marker helps in differentiating CAFs from borderline ovarian tumors, which do not show this US feature. We hope that recognizing the suggested shadow sign as an additional descriptor of CAFs will lead to minimizing their unnecessary removal and eliminating additional and unnecessary imaging by computed tomography and magnetic resonance imaging.
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Affiliation(s)
- Ilan E Timor-Tritsch
- Departments of Obstetrics and Gynecology, New York University School of Medicine, New York, New York, USA
| | - Esther Yoon
- Surgical Pathology, New York University School of Medicine, New York, New York, USA
| | - Ana Monteagudo
- Carnegie Imaging for Women, Icahn School of Medicine, New York, New York, USA
| | - Jeanine Ciaffarano
- Surgical Pathology, New York University School of Medicine, New York, New York, USA
| | - Caroline Brandon
- Departments of Obstetrics and Gynecology, New York University School of Medicine, New York, New York, USA
| | - Kushbakhat R Mittal
- Surgical Pathology, New York University School of Medicine, New York, New York, USA
| | - Robert C Wallach
- Departments of Obstetrics and Gynecology, New York University School of Medicine, New York, New York, USA
| | - Leslie R Boyd
- Departments of Obstetrics and Gynecology, New York University School of Medicine, New York, New York, USA
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11
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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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12
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Di Legge A, Pollastri P, Mancari R, Ludovisi M, Mascilini F, Franchi D, Jurkovic D, Coccia ME, Timmerman D, Scambia G, Testa A, Valentin L. Clinical and ultrasound characteristics of surgically removed adnexal lesions with largest diameter ≤ 2.5 cm: a pictorial essay. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:648-656. [PMID: 28004457 DOI: 10.1002/uog.17392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 12/05/2016] [Accepted: 12/13/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To describe the ultrasound characteristics, indications for surgery and histological diagnoses of surgically removed adnexal masses with a largest diameter of ≤ 2.5 cm (very small tumors), to estimate the sensitivity and specificity of diagnosis of malignancy by subjective assessment of ultrasound images of very small tumors and to present a collection of ultrasound images of surgically removed very small tumors, with emphasis on those causing diagnostic difficulty. METHODS Information on surgically removed adnexal tumors with a largest diameter of ≤ 2.5 cm was retrieved from the ultrasound databases of seven participating centers. The ultrasound images were described using the International Ovarian Tumor Analysis terminology. The original diagnosis, based on subjective assessment of the ultrasound images by the ultrasound examiner, was used to calculate the sensitivity and specificity of diagnosis of malignancy. RESULTS Of the 129 identified adnexal masses with largest diameter ≤ 2.5 cm, 104 (81%) were benign, 15 (12%) borderline malignant and 10 (8%) invasive tumors. The main indication for performing surgery was suspicion of malignancy in 22% (23/104) of the benign tumors and in all 25 malignant tumors. None of the malignant tumors was a unilocular cyst (vs 50% of the benign tumors), all malignancies contained solid components (vs 43% of the benign tumors), 80% of the borderline tumors had papillary projections (vs 21% of the benign tumors and 20% of the invasive malignancies) and all invasive tumors and 80% of the borderline tumors were vascularized on color/power Doppler examination (vs 44% of the benign tumors). The ovarian crescent sign was present in 85% of the benign tumors, 80% of the borderline tumors and 50% of the invasive malignancies. The sensitivity of diagnosis of malignancy by subjective assessment of ultrasound images was 100% (25/25) and the specificity was 86% (89/104). Excluding unilocular cysts, the specificity was 71% (37/52). Analysis of images illustrated the difficulty in distinguishing benign from borderline very small cysts with papillations and benign from malignant very small well vascularized (color score 3 or 4) solid adnexal tumors. CONCLUSIONS Very small malignant tumors manifest generally accepted ultrasound signs of malignancy. Small unilocular cysts are usually benign, while small non-unilocular masses, particularly ones with solid components, incur a risk of malignancy and pose a clinical dilemma. © 2016 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Di Legge
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - P Pollastri
- Istituti Ospitalieri di Cremona, Cremona, Lombardia, Italy
| | - R Mancari
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - M Ludovisi
- Department of Obstetrics and Gynaecology, University College Hospital, London, UK
| | - F Mascilini
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - D Franchi
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - D Jurkovic
- Department of Obstetrics and Gynaecology, University College Hospital, London, UK
| | - M E Coccia
- Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - D Timmerman
- Department of Obstetrics and Gynecology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - G Scambia
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - A Testa
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - L Valentin
- Department of Obstetrics and Gynecology, Skane University Hospital, Lund University, Malmo, Sweden
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13
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Suh-Burgmann E, Kinney W. The Value of Ultrasound Monitoring of Adnexal Masses for Early Detection of Ovarian Cancer. Front Oncol 2016; 6:25. [PMID: 26904503 PMCID: PMC4748035 DOI: 10.3389/fonc.2016.00025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/25/2016] [Indexed: 12/19/2022] Open
Abstract
Although ultrasound has so far been found to be ineffective as a screening tool for ovarian cancer, it is commonly used as a means of evaluating or following ovarian or adnexal masses once they are detected. We review the use of serial ultrasound for the management of adnexal masses and propose an approach to monitoring based on an understanding of the overall risk of cancer among the population in question and an assessment of how the potential benefit of monitoring compares with potential risk. In our approach, masses that are symptomatic, large (>10 cm), associated with an elevated CA 125 level or overt signs of malignancy, or that are determined to have a worrisome appearance by stringent ultrasound criteria should be evaluated surgically. Women with masses that have none of these characteristics should be offered monitoring. Short-term initial ultrasound monitoring carries significant potential benefit in terms of aiding detection of early malignancy and avoidance of unnecessary surgery. However, if a mass remains stable but persistent, the potential benefit of ongoing monitoring wanes with time, whereas the potential harms, in terms of patient anxiety, cost, and the risk of incidental findings and unnecessary surgery increase. Therefore, monitoring of stable lesions should be limited in duration in order to limit potential harms from overtreatment and overdiagnosis.
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Affiliation(s)
| | - Walter Kinney
- Division of Gynecologic Oncology, The Permanente Medical Group , Walnut Creek, CA , USA
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