The Diagnostic Value of Multi-Modal Ultrasound on the Ovarian Serous Surface Papillary Borderline Tumor

Abstract

Background: Compared with epithelial ovarian cancer, borderline ovarian tumor has earlier onset age and better prognosis. Ovarian serous surface papillary borderline tumor (SSPBT) is a special subtype of ovarian serous borderline tumor, which is rare in clinic. It is easy to be misdiagnosed as malignant before operation. SSPBT usually occurs in women of childbearing age. The operation of preserving fertility can have a higher pregnancy rate. Therefore, preoperative ultrasound for qualitative diagnosis of SSPBT is of great significance in the selection of surgical methods and treatment. There are few reports on the imaging of SSPBT, and the multimodal ultrasound features of SSPBT combined with conventional ultrasound, two-dimensional and three-dimensional contrast-enhanced ultrasound have not been reported. The purpose of this article is to explore the multimodal ultrasonic characteristics of ovarian SSPBT, combining its clinical and pathological features.Result: The conventional ultrasound of ovarian SSPBT was characterized by large patchy substantial masses wrapped around the ovary.Large flaky dense fine anechoic areas could be seen in the parenchyma,accompanied by speckle strong echo with different degrees.Peritoneal implants were observed in 3 cases(60%)and ascites were found in 4 cases(80%).On further contrast-enhanced ultrasonography,with reference to the myometrium,the tumor on 2D-CEUS showed synchronous or delayed eccentric and inhomogeneous enhancement,and subsided earlier than the uterine wall.The tortuously running tumor trophoblast vessels from the periovarian of the affected side could be further observed clearly and stereospecially on 3D-CEUS.Angiographic rising time(RT),time to peak(TTP),peak intensity(PI),area under the curve(AUC)and half time of descending peak intensity(HT)were significantly different from those of the myometrium(P<0.05).The speckled strong echo observed by conventional ultrasound was correlated with the sand body of the fiber stalk axis in the papillary structure under pathological microscope,while the tortuosity and dilation of microvessels in the fibrous connective tissue axis was the pathological basis of their CEUS perfusion.Conclusion: There are characteristic manifestations of ovarian SSPBT on multimodal ultrasound,which are closely related to the pathological structure.Multimodal ultrasound has important reference value in the diagnosis of ovarian SSPBT.