Transvaginal color Doppler ultrasonic characterization of benign and malignant ovarian cystic teratomas and comparison with serum squamous cell carcinoma antigen

Abstract

BACKGROUND The preoperative diagnosis of squamous cell carcinoma (SCC) arising in mature cystic teratoma of the ovary remains difficult. The purpose of this study is to examine the usefulness of transvaginal color Doppler ultrasound (TV‐CDU) in differentiating malignant (SCC) from benign cystic teratoma of the ovary. METHODS Eighty‐eight patients with an ovarian tumor showing gray scale sonographic appearances of mature cystic teratoma were preoperatively evaluated for the presence or absence of intratumoral blood flow by TV‐CDU. The blood flow characteristics of the tumor vessels were analyzed using the resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV). The serum levels of SCC antigen were also randomly examined preoperatively in 50 patients. RESULTS Intratumoral blood flow was significantly detected in malignant teratomas (SCCs) (80.0%; 4 of 5) compared with benign teratomas (20.5%; 17 of 83) (P < 0.01). All malignant teratomas with intratumoral blood flow showed both RI less than 0.4 and PI less than 0.6, whereas no benign teratomas showed any such value except for 1 case with struma ovarii. In addition, both the mean RI and the mean PI values in the tumor vessels were significantly lower in the malignant teratomas (RI: 0.31 ± 0.07; PI: 0.40 ± 0.16) than in the benign teratomas (RI: 0.62 ± 0.13; PI: 1.06 ± 0.44) (P < 0.001). However, the mean PSV value of the malignant teratomas (PSV: 20.6 ± 8.33) was not significantly different from the benign teratomas (PSV: 18.1 ± 9.9). Elevation of serum SCC was found in 4 of 5 patients (80%) with malignant teratomas, whereas the elevation was found in 11 of 45 patients (24.4%) with benign teratomas (P < 0.05). The diagnostic accuracy using the RI (cutoff value 0.4) as well as the PI (cutoff value 0.6) was thus 95.2%, which was significantly superior to that obtained by using the serum SCC (76%) (cutoff value, 1.5 ng/mL). CONCLUSIONS Evaluating the presence or absence of intratumoral blood flow, together with blood flow resistance, in tumor vessels using TV‐CDU thus may be more useful to differentiate malignant (SCC) from benign cystic teratomas of the ovary than by measuring serum SCC levels. Cancer 2000;88:2298–304. © 2000 American Cancer Society.

Squamous Cell Carcinoma Arising in Mature Cystic Teratoma of the Ovary

“…from Japan has differentiated malignant transformation from benign cystic teratomas of the ovary by evaluating the presence or absence of intratumoral blood flow along with blood flow resistance in tumor vessels by using transvaginal color Doppler ultrasound. 10 We advocate the use of the combined diagnostic modality to increase the sensitivity and specificity of the malignant transformation of the teratoma.…”

Strumal Carcinoid Tumor Originating from Mature Cystic Teratoma of Ovary

“…3,8,9 Malign dönüşümü belirlemede tümör belirteçlerinden de yararlanılabilmektedir. Yükselmiş CA125 ve CA19-9 malign dönüşümde uyarıcı olmalıdır.…”

“…Ayrıca skuamöz hücreli karsinom diferansiasyonu varlığında, serum skuamöz hücreli kanser antijeninin, malign dönüşümü belirlemede yararlı olabileceği bildirilmektedir. 9 FIGO Evre IA olarak değerlendirilen olguda, batın yıkama sıvısı ve TAH, bilateral SO tedavisi yeterli bulundu. İntraoperatif frozen kesit incelemesinde malign tanısı alan ya da daha ileri evre olduğu düşünülen tüm hastalarda tam cerrahi evreleme yapılmalı, klinikopatolojik prognostik faktörler eşliğinde hastalar adjuvan tedavi ve izlem açısından değerlendirilmelidir.…”

Malignant transformation of mature cystic teratoma of the ovary including three cases occurring during follow-up period

“…These results suggested that, so far, a CT or MRI is helpful only when characteristic images such as transmural invasion or the spread of malignant tumors become apparent (15). Another report suggested that evaluating the presence or absence of intratumoral blood flow, together with blood flow resistance in tumor vessels using transvaginal color Doppler ultrasound may be more useful in differentiating malignant (SCC) from benign cystic teratomas of the ovary than by measuring serum SCC levels (16).…”