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Clinical and ultrasound characteristics of surgically removed adnexal lesions with largest diameter ≤ 2.5 cm : a pictorial essay

Di Legge, A.; Pollastri, P.; Mancari, R.; Ludovisi, M.; Mascilini, F.; Franchi, D.; Jurkovic, D.; Coccia, M. E.; Timmerman, D. and Scambia, G., et al. (2017) In Ultrasound in Obstetrics and Gynecology 50(5). p.648-656
Abstract

Objectives: To describe the ultrasound characteristics, indications for surgery and histological diagnoses of surgically removed adnexal masses with a largest diameter of ≤ 2.5 cm (very small tumors), to estimate the sensitivity and specificity of diagnosis of malignancy by subjective assessment of ultrasound images of very small tumors and to present a collection of ultrasound images of surgically removed very small tumors, with emphasis on those causing diagnostic difficulty. Methods: Information on surgically removed adnexal tumors with a largest diameter of ≤ 2.5 cm was retrieved from the ultrasound databases of seven participating centers. The ultrasound images were described using the International Ovarian Tumor Analysis... (More)

Objectives: To describe the ultrasound characteristics, indications for surgery and histological diagnoses of surgically removed adnexal masses with a largest diameter of ≤ 2.5 cm (very small tumors), to estimate the sensitivity and specificity of diagnosis of malignancy by subjective assessment of ultrasound images of very small tumors and to present a collection of ultrasound images of surgically removed very small tumors, with emphasis on those causing diagnostic difficulty. Methods: Information on surgically removed adnexal tumors with a largest diameter of ≤ 2.5 cm was retrieved from the ultrasound databases of seven participating centers. The ultrasound images were described using the International Ovarian Tumor Analysis terminology. The original diagnosis, based on subjective assessment of the ultrasound images by the ultrasound examiner, was used to calculate the sensitivity and specificity of diagnosis of malignancy. Results: Of the 129 identified adnexal masses with largest diameter ≤ 2.5 cm, 104 (81%) were benign, 15 (12%) borderline malignant and 10 (8%) invasive tumors. The main indication for performing surgery was suspicion of malignancy in 22% (23/104) of the benign tumors and in all 25 malignant tumors. None of the malignant tumors was a unilocular cyst (vs 50% of the benign tumors), all malignancies contained solid components (vs 43% of the benign tumors), 80% of the borderline tumors had papillary projections (vs 21% of the benign tumors and 20% of the invasive malignancies) and all invasive tumors and 80% of the borderline tumors were vascularized on color/power Doppler examination (vs 44% of the benign tumors). The ovarian crescent sign was present in 85% of the benign tumors, 80% of the borderline tumors and 50% of the invasive malignancies. The sensitivity of diagnosis of malignancy by subjective assessment of ultrasound images was 100% (25/25) and the specificity was 86% (89/104). Excluding unilocular cysts, the specificity was 71% (37/52). Analysis of images illustrated the difficulty in distinguishing benign from borderline very small cysts with papillations and benign from malignant very small well vascularized (color score 3 or 4) solid adnexal tumors. Conclusions: Very small malignant tumors manifest generally accepted ultrasound signs of malignancy. Small unilocular cysts are usually benign, while small non-unilocular masses, particularly ones with solid components, incur a risk of malignancy and pose a clinical dilemma.

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publication status
published
subject
keywords
adnexal lesion, Doppler, ovarian neoplasm, ultrasonography
in
Ultrasound in Obstetrics and Gynecology
volume
50
issue
5
pages
9 pages
publisher
John Wiley & Sons
external identifiers
  • scopus:85032892452
  • wos:000414460200017
ISSN
0960-7692
DOI
10.1002/uog.17392
language
English
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yes
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d69d1cfe-f7a2-4d47-a6f2-fa41d21fa5a2
date added to LUP
2017-11-22 13:26:41
date last changed
2018-01-16 13:26:20
@article{d69d1cfe-f7a2-4d47-a6f2-fa41d21fa5a2,
  abstract     = {<p>Objectives: To describe the ultrasound characteristics, indications for surgery and histological diagnoses of surgically removed adnexal masses with a largest diameter of ≤ 2.5 cm (very small tumors), to estimate the sensitivity and specificity of diagnosis of malignancy by subjective assessment of ultrasound images of very small tumors and to present a collection of ultrasound images of surgically removed very small tumors, with emphasis on those causing diagnostic difficulty. Methods: Information on surgically removed adnexal tumors with a largest diameter of ≤ 2.5 cm was retrieved from the ultrasound databases of seven participating centers. The ultrasound images were described using the International Ovarian Tumor Analysis terminology. The original diagnosis, based on subjective assessment of the ultrasound images by the ultrasound examiner, was used to calculate the sensitivity and specificity of diagnosis of malignancy. Results: Of the 129 identified adnexal masses with largest diameter ≤ 2.5 cm, 104 (81%) were benign, 15 (12%) borderline malignant and 10 (8%) invasive tumors. The main indication for performing surgery was suspicion of malignancy in 22% (23/104) of the benign tumors and in all 25 malignant tumors. None of the malignant tumors was a unilocular cyst (vs 50% of the benign tumors), all malignancies contained solid components (vs 43% of the benign tumors), 80% of the borderline tumors had papillary projections (vs 21% of the benign tumors and 20% of the invasive malignancies) and all invasive tumors and 80% of the borderline tumors were vascularized on color/power Doppler examination (vs 44% of the benign tumors). The ovarian crescent sign was present in 85% of the benign tumors, 80% of the borderline tumors and 50% of the invasive malignancies. The sensitivity of diagnosis of malignancy by subjective assessment of ultrasound images was 100% (25/25) and the specificity was 86% (89/104). Excluding unilocular cysts, the specificity was 71% (37/52). Analysis of images illustrated the difficulty in distinguishing benign from borderline very small cysts with papillations and benign from malignant very small well vascularized (color score 3 or 4) solid adnexal tumors. Conclusions: Very small malignant tumors manifest generally accepted ultrasound signs of malignancy. Small unilocular cysts are usually benign, while small non-unilocular masses, particularly ones with solid components, incur a risk of malignancy and pose a clinical dilemma.</p>},
  author       = {Di Legge, A. and Pollastri, P. and Mancari, R. and Ludovisi, M. and Mascilini, F. and Franchi, D. and Jurkovic, D. and Coccia, M. E. and Timmerman, D. and Scambia, G. and Testa, A. and Valentin, L.},
  issn         = {0960-7692},
  keyword      = {adnexal lesion,Doppler,ovarian neoplasm,ultrasonography},
  language     = {eng},
  month        = {11},
  number       = {5},
  pages        = {648--656},
  publisher    = {John Wiley & Sons},
  series       = {Ultrasound in Obstetrics and Gynecology},
  title        = {Clinical and ultrasound characteristics of surgically removed adnexal lesions with largest diameter ≤ 2.5 cm : a pictorial essay},
  url          = {http://dx.doi.org/10.1002/uog.17392},
  volume       = {50},
  year         = {2017},
}