Which extrauterine pelvic masses are difficult to correctly classify as benign or malignant on the basis of ultrasound findings and is there a way of making a correct diagnosis?

Abstract

Objectives To determine which extrauterine pelvic masses are difficult to correctly classify as benign or malignant on the basis of ultrasound findings, and to determine if the use of logistic regression models for calculation of individual risk of malignancy would improve the diagnostic accuracy in difficult tumors. Methods

Confidence of expert ultrasound operators in making a diagnosis of adnexal tumor: effect on diagnostic accuracy and interobserver agreement

“…There is no doubt that the presence of morphological features typical of benign, borderline or primary invasive tumors increased the level of diagnostic confidence of the experts. However, a number of adnexal tumors exhibit complex or unusual morphological features 4 , which has a detrimental effect on diagnostic certainty.…”

“…In typical cases the ultrasound operator may be able to make the diagnosis with a high level of confidence. However, a number of adnexal tumors exhibit complex or unusual morphological features 4 . As a result, these tumors are more difficult to classify.…”

Three‐dimensional power Doppler in ovarian tumors

“…Most ovarian tumors can be correctly classified by B-mode ultrasonography. However, there are some ovarian lesions that are very difficult to classify 3 . Two-dimensional PDU may be useful for predicting malignancy in these tumors, by reducing the false-positive rate, as demonstrated in a multicenter study that included more than 800 'complex' adnexal masses 4 .…”

Struma ovarii associated with hyperthyroidism, elevated CA 125 and pseudo‐Meigs syndrome may mimic advanced ovarian cancer

“…The fact that struma ovarii may actually mimic an ovarian carcinoma, considering the clinical features of a prevalently solid ovarian mass and high titers of CA 125, has already been reported 8,9 . In particular, as far as ultrasound imaging is concerned, the large size of the mass, its prevalently solid echostructure, the irregular walls and the low-resistance blood flow are all features seen more frequently in malignant than in benign ovarian lesions 10 ; this has led to the inclusion of struma ovarii in a group of ovarian masses that are considered difficult to characterize on ultrasound examination, even when carried out by an expert 10 . In the index case, the other two clinical features, significant weight loss and diarrhea, increased even further the likelihood of an advanced ovarian cancer being present, with the latter possibly being considered as a paraneoplastic symptom.…”