Reaffirming microcystic ultrasound appearance of borderline ovarian tumors using three‐dimensional ‘silhouette’ rendering

Abstract

Borderline ovarian tumors (BOTs) are primary epithelial tumors with histological features of malignancy. Clinically, they exhibit a relatively benign course, since they are minimally invasive, and fertility-sparing surgery can be employed 1 . The International Federation of Gynecology and Obstetrics (FIGO) and the World Health Organization recognize BOTs as an intermediate entity, referring to them as tumors with 'borderline malignancy' or of 'low malignant potential' 2 . BOTs comprise approximately 4-14% of all epithelial tumors 3 . They tend to affect women of reproductive age and are therefore often first encountered by general gynecologists rather than gynecologic oncologists.When a BOT is detected early, the long-term prognosis and survival rate are good 3,4 . Transvaginal sonography (TVS) is the best diagnostic tool for their detection [4][5][6][7] . The most common signs of BOT on ultrasound (US) are reported to be: a septate cyst with solid component(s) and/or mural nodules containing blood vessels in papillary projections [6][7][8] . Furthermore, we have described a new sonographic marker of BOT 9 : microcystic tissue pattern resembling a cluster of tiny bubbles, seen in papillary projections, solid component(s) and/or septa. This appearance was observed on TVS in 89.6% (60/67) of our sample of BOTs, including 97.9% (46/47) of the serous BOTs, 73.3% (11/15) of the mucinous BOTs and 60.0% (3/5) of the seromucinous BOTs. Herein, we provide further evidence of this finding, supporting its credibility, using a dedicated three-dimensional (3D) display rendering application: 'silhouette' mode.This was a retrospective Internal Review Boardapproved (#i21-0104) gynecologic US study. From the