Reliability of gynecologic sonographic diagnosis, 1978-1984

Transvaginal aspiration of ovarian cysts: long-term follow-up

BACKGROUND AND PURPOSE

Transvaginal aspiration of ovarian cysts has been advocated as a viable alternative to surgery in patients who are high-risk surgical candidates. We describe a retrospective study evaluating the results of transvaginal aspirations of benign ovarian cysts in patients at increased surgical risk, focusing on long-term follow-up for recurrence of the cyst and/or development of malignancy.

METHODS

Twenty-four women with ovarian cysts underwent 34 transvaginal drainages between October 1998 and December 2004. All patients were referred following diagnosis of a persistent ovarian cyst with a benign appearance on ultrasound. All patients were unsuitable candidates for surgery (history of previous pelvic surgery, n = 21; high risk for anesthesia, n = 1; and unsuitable for laparoscopy due to obesity, n = 2). Patients with a history of pregnancy, acute abdominal symptoms, or previous gynecologic malignancy were excluded. A 20G x 20 cm Chiba needle was used for transvaginal aspiration using an endocavity probe (Acuson XP, Mountain View, CA, USA; Siemens Sololine, Erlangen, Germany) and intravenous sedoanalgesia. Cysts were aspirated to dryness.

RESULTS

Long-term follow-up of patients was performed and revealed a recurrence rate of 75%. Eighty-three percent of cysts on the left and 42% of those on the right recurred. Nine of 15 (60%) patients with recurrence required further intervention. Two of 9 underwent surgical intervention only, 4 of 9 had repeat transvaginal aspiration(s) performed, and 3 of 9 had a combination of both transvaginal aspiration and surgery. No patient developed ovarian malignancy.

CONCLUSION

Transvaginal cyst aspiration has many advantages including short hospital stay, rapid recovery, excellent patient tolerance, and a low rate of procedure-related complications. Our study demonstrates that ovarian cyst recurrence following transvaginal drainage is a more significant problem than previously documented, especially if the cyst is on the left side. However, when recurrences do occur, repeat transvaginal aspirations may be considered in the symptomatic patient.

MRI of female uterine and juxta-uterine masses: clinical application in 25 patients

The clinical utility of magnetic resonance imaging (MRI) in the diagnosis of gynecologic masses was evaluated in 25 patients. In each patient the final pathologic diagnosis was semiquantitatively correlated with the diagnostic impressions from pelvic examination, ultrasound and MRI. There were 9 uterine, 11 ovarian and 5 nonovarian pelvic masses. Pelvic examination correlation with final diagnosis was 26%, consistent with the literature. Ultrasound fared surprisingly poorly, with only 44% correlation. MRI showed an 87% correlation with the final diagnosis. MRI was able to accurately identify masses, discriminate adnexal masses from fluid-filled bowel, identify dermoids, and in one case obviated surgery in a pregnant patient. MRI provided significant clinical management information with greater accuracy than did ultrasound or pelvic examination.

Ultrasound examination of adolescent females with lower abdominal pain

We evaluated pelvic ultrasound examination in adolescent females as an aid in the diagnosis of acute and chronic lower abdominal pain resulting from suspected gynecologic disease. Of 41 subjects, 35 (85.4%) had a final diagnosis of a gynecologic disorder. Pelvic ultrasound examination was positive in 19 of 35 (54.3%). Ten positive tests had relatively specific findings that supported (seven) or helped change (three) the initial clinical diagnosis. Nine positive tests had nonspecific findings that were consistent with (six) or helped change (three) the initial diagnosis. Twenty-one negative tests helped change the initial diagnosis (13); ruled out complications of acute salpingitis (five); or discriminated between alternative diagnoses (three). One test was falsely positive. Ultrasonography was most clearly cost-effective when surgery was being considered. We conclude that pelvic ultrasound examination may be a useful diagnostic adjunct in this type of adolescent patient.

Misdiagnoses in obstetric and gynecologic ultrasound examinations: causes and possible solutions

Two small series of cases documenting ultrasound misdiagnoses are presented. The first concerns obstetric ultrasound misdiagnoses originating in the private offices of physicians. The second concerns gynecologic ultrasound misdiagnoses originating in a level II medical center. A dichotomy exists in the use of diagnostic ultrasound examination in the practice of obstetrics and gynecology. The dichotomy is a serious defect in our specialty that needs urgent addressing. The institutional problem can be partially resolved by furnishing the sonographer with the referred patient's history and physical findings. The problem of the ultrasound machine in the office of a private physician is much more complex. It may require government intervention and strict licensing measures for resolution.