Diagnostic value of contrast-enhanced ultrasonography in the characterization of ovarian tumors

Abstract

KEYWORDSAdnexal masses; Contrast-enhanced ultrasound; Ovarian cancer.Abstract Introduction: Vascularity influences the characteristics of gynecologic tumors observed with direct imaging techniques that reveal the macrovascular component of these lesions (color and power Doppler) and with indirect imaging involving the administration of contrast agents to examine the microcirculation and interstitial perfusion (contrast-enhanced computed tomography [CT] and magnetic resonance [MR] imaging). The purpose of this study was to determine whether contrast-enhanced ultrasonography (CEUS) of ovarian lesions provides useful information that cannot be obtained with conventional US. Materials and methods: We used CEUS to assess 72 nonspecific adnexal lesions in 61 patients. CEUS was performed with a 4.8-ml bolus of a second-generation ultrasonographic contrast agent and dedicated imaging algorithms. For each lesion, B-mode morphology, CEUS morphology, and time/intensity curves were evaluated. Results: In 8/61 cases (13.1%) CEUS offered no additional morphovascular information. In 38/61 cases (62.3%), it provided additional information that did not modify the management of the lesion, and in 15/61 cases (24.6%) it gave additional information that modified the management of the lesion. Malignant lesions were characterized by significantly shorter times to peak enhancement (11.9 AE 3.1 s vs 19.8 AE 4.0 s p < 0.01) and significantly higher peak intensity (24.7 AE 4.2 dB vs 17.8 AE 3.3 dB p < 0.01) compared with benign lesions. Conclusions: CEUS improves diagnostic confidence in the characterization of liquid-corpuscular lesions where conventional US is inconclusive. CEUS can be proposed as a valid alternative to CT and MR. However, information obtained by CEUS influences the therapy in a limited percentage of cases (24.6%). Sommario Introduzione: La ricchezza della componente vascolare dei tumori ginecologici influenza le caratteristiche dell'imaging diretto, utilizzando metodiche che evidenziano la componente macrovascolare delle lesioni (color e power Doppler), e di quello indiretto, mediante somministrazione di mezzi di contrasto (MdC) per lo studio del microcircolo e della perfusione interstiziale. Lo scopo di questo lavoro è di valutare l'aggiunta di informazioni diagnostiche fornite dalla valutazione ecografica con MdC nello studio delle lesioni ovariche. Materiali e metodi: Abbiamo valutato 72 lesioni annessiali in 61 pazienti con lesioni ovariche di incerta interpretazione mediante somministrazione di 4,8 ml di MdC ecoamplificatore di II generazione. Per ogni lesione, abbiamo valutato la morfologia basale, quella contrastografica e le curve intensità/tempo. Risultati: La valutazione post-contrasto confrontata con la basale non ha apportato informazioni aggiuntive morfovascolari in 8 pazienti (13,1%); in 38 pazienti (62,3%) ha apportato informazioni senza modifiche del comportamento clinico; in 15 soggetti (24,6%) ha apportato elementi che hanno modificato il comportamento clinico. Le lesioni maligne presentavano valori...

The Contribution of Qualitative CEUS to the Determination of Malignancy in Adnexal Masses, Indeterminate on Conventional US – A Multicenter Study

“…The contrast enhancement variables such as peak intensity, area under the intensity curve (AUC), time to peak (TTP), sharpness and half wash-out time were studied by Testa et al and Fleischer et al [19], [21], in which a second-generation contrast agent and low-MI CEUS were used. They found that AUC and peak values were highest in the malignant tumors and TTP values were similar in the benign and malignant tumors while a study by Sconfienza et al [20]. They found that TTP performed better than the other parameters.…”

Contrast-enhanced ultrasound for differential diagnosis of malignant and benign ovarian tumors: systematic review and meta-analysis

“…After screening titles and abstracts, a further 55 were excluded. After examination of the full text of the remaining 48 candidate studies, a further 34 were excluded, leaving 14 articles considered as being eligible for the systematic review. Three of these were not eligible for meta‐analysis due to missing sensitivity, specificity, accuracy or correlation values; thus, 11 studies were eligible for the meta‐analysis according to our inclusion criteria.…”

“…The I 2 values for sensitivity, specificity and DOR were 38.3%, 31.7% and 48.4%, respectively, indicating moderate heterogeneity for all three. The conclusions from three studies that examined CE‐US but were not included in the quantitative analysis were also assessed (data not shown); all three suggested that CE‐US is useful for discriminating benign from malignant ovarian tumors.…”

Combination of serum CA19-9 and CA125 levels and contrast-enhanced ultrasound parametric data facilitates to differentiate ovarian serous carcinoma from ovarian malignant epithelial cancer

“…Although the final diagnosis of ovarian masses is based on histology, preoperative differentiation of benign and malignant lesions is essential for decisions on the timing and technical characteristics of the surgery. [ 8 ]…”