The characteristic ultrasound features of specific types of ovarian pathology (Review)

Abstract

Characterizing ovarian masses enables patients with malignancy to be appropriately triaged for treatment by subspecialist gynecological oncologists, which has been shown to optimize care and improve survival. Furthermore, correctly classifying benign masses facilitates the selection of patients with ovarian pathology that may either not require intervention, or be suitable for minimal access surgery if intervention is required. However, predicting whether a mass is benign or malignant is not the only clinically relevant information that we need to know before deciding on appropriate treatment. Knowing the specific histology of a mass is becoming of increasing importance as management options become more tailored to the individual patient. For example predicting a mucinous borderline tumor gives the opportunity for fertility sparing surgery, and will highlight the need for further gastrointestinal assessment. For benign disease, predicting the presence of an endometrioma and possible deeply infiltrating endometriosis is important when considering both who should perform and the extent of surgery. An examiner’s subjective assessment of the morphological and vascular features of a mass using ultrasonography has been shown to be highly effective for predicting whether a mass is benign or malignant. Many masses also have features that enable a reliable diagnosis of the specific pathology of a particular mass to be made. In this narrative review we aim to describe the typical morphological features seen on ultrasound of different adnexal masses and illustrate these by showing representative ultrasound images.

Ultrasound and Histopathologic Correlation of Ovarian Cystadenofibromas: Diagnostic Value of the “Shadow Sign”

“…Cystadenofibromas occur in an older age group (age range, 23–80 years; mean, 59 years), constituting around half of all benign serous ovarian cysts. They are usually round and unilocular (rarely they may be septated and multilocular), and more than 50% have solid inner‐wall nodules, which are hyperechoic and cast acoustic shadows . We alluded to hyperechoic fibrotic nodules with acoustic shadowing in our previous communication .…”

“…They are usually round and unilocular (rarely they may be septated and multilocular), and more than 50% have solid inner-wall nodules, which are hyperechoic and cast acoustic shadows. [10][11][12] We alluded to hyperechoic fibrotic nodules with acoustic shadowing in our previous communication. 7 Cystadenofibromas tend to be smaller than cystadenomas.…”

Results of conservative treatment of endometriomas

“…Ультразвуковая диагностика помогает уточнить наличие эндометриоза яичников в отличие от им-плантов эндометриоидной ткани другой локализа-ции [14,15]. Во время эхографического исследова-ния яичников проводилась детализация следующих признаков: наличие опухолевидного образования в яичнике, сохраняющегося при динамическом на-блюдении и лечении КОК (в течение 3 мес); его ло-кализация (одностороннее, двустороннее); оценка размеров кисты; уточнение структуры образования -однородная (анэхогенная) или неоднородная, с наличием включений внутри кисты (высокоэхоген-ная или среднеэхогенная мелкодисперсная взвесь, не смещаемая при перкуссии образования) или сóлидная структура; отсутствие/наличие капсулы и ее толщина, двойного контура стенки кисты.…”

Clinical and sonohysterography evaluation of infertile women

“…The Sonohysterography is more sensitive than Transvaginal ultrasonography and is as good as hysteroscopy in detecting intracavitary pathologies like polyps, submucosal myomas which can be asymptomatic in infertile women. [1][2][3][4][5][6] It can be performed in outpatient clinics with minimal side effects to the patient, in a short time, with simple and inexpensive instruments. [7][8][9] Several modifications have been made to this basic procedure of sonohysterosalpingography (SHSG) to improve its diagnostic accuracy as well as an investigative modality for tubal assessment.…”