Sonographic Pattern Recognition of Endometriomas Mimicking Ovarian Cancer

Abstract

Background: To assess the accuracy of ultrasound in differentiating endometrioma from ovarian cancer and to describe pattern recognition for atypical endometriomas mimicking ovarian cancers. Materials and Methods: Patients scheduled for elective surgery for adnexal masses were sonographically evaluated for endometrioma within 24 hours of surgery. All examinations were performed by the same experienced sonographer, who had no any information of the patients, to differentiate between endometriomas and non-endometriomas using a simple rule (classic ground-glass appearance) and subjective impression (pattern recognition). The final diagnosis as a gold standard relied on either pathological or post-operative findings. Results: Of 638 patients available for analysis, 146 were proven to be endometriomas. Of them, the simple rule and subjective impression could sonographically detect endometriomas with sensitivities of 64.4% (94/146) and 89.7% (131/146), respectively. Of 52 endometriomas with false negative tests by the simple rule, 13 were predicted as benign masses and 39 were mistaken for malignancy. Solid masses and papillary projections were the most common forms mimicking ovarian cancer, consisting of 38.5% of the missed diagnoses. However, with pattern recognition (subjective impression), 32 from 39 cases mimicking ovarian cancer were correctly predicted for endometriomas. All endometriomas subjectively predicted for ovarian malignancy were associated with high vascularization in the solid masses. Conclusions: Pattern recognition of endometriomas by subjective assessment had a higher sensitivity than the simple rule in characterization of endometriomas. Most endometriomas mimicking ovarian malignancy could be correctly predicted by subjective impression based on familiarity of pattern recognition.

Factors that Differentiate between Endometriosis-associated Ovarian Cancer and Benign Ovarian Endometriosis with Mural Nodules

“… 9 However, the ultrasound morphology of OE is variable, possibly due to the appearances of solid components, mural nodules, or papillary projections from a cyst wall and the degradation of internal blood products or retracted blood clots that appeared solid over time. 10 A blood clot next to the inner wall of the cyst containing the ground glass background shows an oval- or crescent-shaped lesion. 11 In general, the presence of mural nodules and papillary projections is considered to constitute evidence of malignancy.…”

Use of tumor markers to distinguish endometriosis-related ovarian neoplasms from ovarian endometrioma

“…[14][15][16] The presence of mural nodule suggests malignancy, and solid masses and papillary projections in ovarian endometriomas were the most common forms mimicking ovarian cancer on sonographic morphology. 17 Therefore, sonographic appearances are generally less objective. Meanwhile, according to the International Ovarian Tumor Analysis (IOTA) studies, transvaginal ultrasound characteristics could contribute to the improvement of the management of suspicious ovarian masses.…”

Atypical Endometriosis: A Comprehensive Systematic Review of Pathological Patterns and Diagnostic Challenges

“…Finally, 134 articles were considered eligible for the systematic review; of these, 118 were also excluded for the absence of reported outcomes related to AE or the design of the study not in line with the inclusion criteria. Overall, 16 studies were finally selected for this review, 14 retrospective studies [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ], and 2 prospective studies [ 27 , 28 ]. The selection process is summarized in the PRISMA flowchart in Figure 1 .…”

“…Three articles investigated the role of sonography in the evaluation and differential diagnosis between AE and EAOC ( Table 4 ). Subjective assessment by expert operators demonstrated higher sensitivity (89.73% vs. 64.38%) and specificity (97.15% vs. 96.54%) compared to simple rules [ 28 ].…”