OC259: Low malignant potential ovarian tumors: role of sonographic diagnostic criteria

Abstract

Oral communication abstractsremoved -there were no cases of malignancy. In a study of 55,278 pregnancy terminations, there were 2 cases of malignancy. We have prospectively evaluated 3000 consecutive women who presented to the Early Pregnancy Unit. The prevalence of ovarian cysts was 5.3%. These women were managed expectantly and followed until resolution of the ovarian cyst occurred, intervention was required or the pregnancy concluded. 72.2% resolved spontaneously, 23.6% persisted and 4.2% required intervention -there were no cases of malignancy. Only 0.13% (1.3/1000) of all women in this longitudinal study required acute intervention. We concluded that examining the ovaries in the first trimester is of no value. Expectant management is advocated, at least until the pregnancy is beyond 14 weeks' gestation. If symptomatic, simple ovarian cysts diagnosed during pregnancy can be successfully and safely treated with sonographic guided cyst aspiration. Adnexal masses can be accurately classified according to TVS. However in the few cases when the nature of the cyst is in question, one must balance the risks to the pregnancy from intervention versus the risk of malignancy. OC258aColour Doppler and morphological assessment of ovarian masses L. Valentin and P. Sladkevicius Malmö University Hospital, SwedenThe best ultrasound method for making a specific diagnosis of an adnexal mass is subjective evaluation of the gray scale ultrasound image ('pattern recognition') by an experienced examiner using a good ultrasound system. Malignant adnexal lesions can be discriminated from benign ones with a sensitivity of 92-96% and a false positive rate of 4-10%. Malignancies are characterised by the presence of solid components and irregularity. Benign tumors are characterised by absence of solid tissue and absence of irregularity. Based on pattern recognition, the following specific conditions can be correctly diagnosed: hydrosalpinx (sausage shaped cystic structure, incomplete septa, cog-wheel/beads on a string), endometrioma (thick walled cyst, homogenously echogenic contents), dermoid cyst ('white ball', shadowing), para-ovarian cyst (cyst close to but clearly separate from a normal ovary), peritoneal cyst (irregular cyst following the contour of the pelvis with an ovary suspended amongst adhesions). Sensitivity with regard to correct identification of these conditions ranges from 83 to 100% (depending upon the condition) and the false positive rate from 0 to 2%. Doppler ultrasound often increases the diagnostic confidence of the examiner but rarely changes his/her diagnosis made on the basis of the grey scale ultrasound image. Malignant masses are characterised by higher color content and higher blood flow velocities than benign ones. A uterine myoma is characterised by high color content, high blood flow velocity, and vessels following the outline of the tumor, an ovarian fibroma has low color content and low blood flow velocity, a corpus luteum cyst is surrounded by a 'ring of color' and has high blood flow velocities in its...