Analysis of echographic signs of ovarian tumors

Purpose: analysis of echographic signs of benign and malignant formations of the uterine appendages using the recommendations of the IOTA group.
Materials and methods. 17 articles published in the journal Ultrasound in Obstetrics & Gynecology for 2007–2020 were analyzed. Each article is devoted to the histologically verified pathology of the uterine appendages, of which 431 are benign and 1205 are malignant neoplasms. When describing pathological formations, the re-searchers used a single protocol recommended by the IOTA group. 21 parameters were assessed, including the morphology of the formation, the structure of fluid inclusions and solid component, the presence of fluid in the posterior uterine pocket and ascites, as well as the degree of tumor vascularization.
Results. Аll ultrasound signs of tumors were found in both groups, but the frequency of their occurrence was different. Thus, unilocular neoplasms were more often detected in benign tumors than in malignant ones (p = 0.05). Also, acoustic shadows were found significantly more frequently in benign tumors (p < 0.05). When assessing tumor morphology, attention should be paid to tendencies that are more characteristic of malignant tumors, which include a solid structure (p = 0.13) and the occurrence of ascites (p = 0.13), while a multilocular structure without a solid component was more common in benign (p = 0.10). The size of the neoplasm, uneven contour, papillary growths, hyperechoic inclusions and the nature of the internal contents of the cystic cavities are found with approximately the same frequency in both groups. When as-sessing the blood supply to a pathological formation, hypervascularization confidently indicated a malignant tumor (p < 0.05), while avascularization in such neoplasms was rare, however, the differences with benign ones were insignificant (p = 0.06).
Conclusions. There are no reliable echographic signs of the nature of the neo-plasm. The set of criteria will improve the quality of preoperative ultrasound diagnostics of ovarian tumors.

1. Novikova E.G., Chissov V.I., Chulkova O.V., Ronina E.A., Antipov V.A. Organ-preserving treatment in gynecological oncology. Moscow: Vidar, 2000. 112 p. (In Russian)

2. Aksel E.M., Vinogradova N.N. Statistics of malignant neoplasms of the female reproductive organs. Oncogynecology. 2018; 3 (27): 64–78. (In Russian)

3. Bokhman Ya.V. Guide to gynecological oncology. St. Petersburg: Folio, 2002. 542 p. (In Russian).

4. Kurman R.J., Сarcanqiu M.L., Herrington C.S., Young R.H. WHO Classificaihion of Tumours of Female Reproductive Organs. Fourth Ed. Lyon: IARS, 2014. 307 p.

5. Timmerman D., Valentin L., Bourne T.H. et al. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol. 2000; 16 (5): 500–505.

6. Testa A.C., Ferrandina G., Timmerman D. et al. Imaging in gynecological disease (1): ultrasound features of metastases in the ovaries differ depending on the origin of the primary tumor. Ultrasound Obstet. Gynecol. 2007; 29: 505–511. https://doi.org/10.1002/uog.4020

7. Demidov V.N., Lipatenkova J., Vikhareva O. et al. Imaging of gynecological disease (2): clinical and ultrasound characteristics of Sertoli cell tumors, Sertoli–Leydig cell tumors and Leydig cell tumors. Ultrasound Obstet. Gynecol. 2008; 31: 85–91. https://doi.org/10.1002/uog.5227

8. Van Holsbeke C., Domali E., Holland T. K. et al. Imaging of gynecological disease (3): clinical and ultrasound characteristics of granulosa cell tumors of the ovary. Ultrasound Obstet. Gynecol. 2008; 31: 450–456. https://doi.org/10.1002/uog.5279

9. Savelli L., Testa A.C., Timmerman D. et al. Imaging of gynecological disease (4): clinical and ultrasound haracteristics of struma ovarii. Ultrasound Obstet. Gynecol. 2008; 32: 210–219. https://doi.org/10.1002/uog.5396

10. Paladini D., Testa A., Van Holsbeke C. et al. Imaging in gynecological disease (5): clinical and ultrasound characteristics in fibroma and fibrothecoma of the ovary. Ultrasound Obstet. Gynecol. 2009; 34: 188–195. https://doi.org/10.1002/uog.6394

11. Guerriero S., Testa A.C., Timmerman D. et al. Imaging of gynecological disease (6): clinical and ultrasound characteristics of ovarian dysgerminoma. Ultrasound Obstet. Gynecol. 2011; 37: 596–602. https://doi.org/10.1002/uog.8958

12. Dierickx I., Valentin L., Van Holsbeke C. et al. Imaging in gynecological disease (7): clinical and ultrasound features of Brenner tumors of the ovary. Ultrasound Obstet. Gynecol. 2012; 40: 706–713. https://doi.org/10.1002/uog.11149

13. Franchi D., Boveri S., Fruscio R. et al. Imaging in gynecological disease (8): ultrasound characteristics of recurrent borderline ovarian tumors. Ultrasound Obstet. Gynecol. 2013; 41: 452–458. https://doi.org/10.1002/uog.12276

14. Ludovisi M., De Blasis I., Virgilio B. et al. Imaging in gynecological disease (9): clinical and ultrasound characteristics of tubal cancer. Ultrasound Obstet. Gynecol. 2014; 43: 328–335. https://doi.org/10.1002/uog.12570

15. Mascilini F., Moruzzi C., Giansiracusa C. et al. Imaging in gynecological disease (10): clinical and ultrasound characteristics of decidualized endometriomas surgically removed during pregnancy. Ultrasound Obstet. Gynecol. 2014; 44: 354–360. https://doi.org/10.1002/uog.13323

16. Moro F., Zannoni G. F., Arciuolo D. et al. Imaging in gynecological disease (11): clinical and ultrasound features of mucinous ovarian tumors. Ultrasound Obstet. Gynecol. 2017; 50: 261–270. https://doi.org/10.1002/uog.17222

17. Moro F., Baima Poma C., Zannoni G.F. et al. Imaging in gynecological disease (12): clinical and ultrasound features of invasive and non-invasive malignant serous ovarian tumors. Ultrasound Obstet. Gynecol. 2017; 50: 788–799. https://doi.org/10.1002/uog.17414

18. Moro F., Magoga G., Pasciuto T. et al. Imaging in gynecological disease (13): clinical and ultrasound characteristics of endometrioid ovarian cancer. Ultrasound Obstet. Gynecol. 2018; 52: 535–543. https://doi.org/10.1002/uog.19026

19. Pozzati F., Moro F., Pasciuto T. et al. Imaging in gynecological disease (14): clinical and ultrasound characteristics of ovarian clear cell carcinoma. Ultrasound Obstet. Gynecol. 2018; 52: 792–800. https://doi.org/10.1002/uog.19171

20. Virgilio B.A., De Blasis I., Sladkevicius P. et al. Imaging in gynecological disease (16): clinical and ultrasound characteristics of serous cystadenofibromas in adnexa. Ultrasound Obstet. Gynecol. 2019; 54: 823–830. https://doi.org/10.1002/uog.20277

21. Anfelter P., Testa A.С., Chiappa V. et al. Imaging in gynecological disease (17): ultrasound features of malignant ovarian yolk sac tumors (endodermal sinus tumors). Ultrasound Obstet. Gynecol. 2020; 56: 276–284. https://doi.org/10.1002/uog.22002

22. Ambrosio M., Testa A.C., Moro F. et al. Imaging in gynecological disease (19): clinical and ultrasound features of extragastrointestinal stromal tumors (eGIST). Ultrasound Obstet. Gynecol. 2020; 56: 749–758. https://doi.org/10.1002/uog.21968

23. Basha M.A., Metwally M.I., Gamil S. et al. Comparison of O-RADS, GI-RADS, and IOTA simple rules regarding malignancy rate, validity, and reliability for diagnosis of adnexal masses. Eur. Radiol. 2021; 31 (2): 674–684. https://doi.org/10.1007/s00330-020-07143-7

24. Sladkevicius P., Valentin L. Intra- and interobserver agreement when describing adnexal masses using the International Ovarian Tumor Analysis terms and definitions: a study on three-dimensional ultrasound volumes. Ultrasound Obstet. Gynecol. 2013; 41: 318–327. https://doi.org/10.1002/uog.12289

25. Timmerman D., Testa A.C., Bourne T. et al. Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound Obstet. Gynecol. 2008; 31 (6): 681–690. https://doi.org/10.1002/uog.5365.155

26. Nunes N., Ambler G., Foo X. et al. Use of IOTA simple rules for diagnosis of ovarian cancer: meta-analysis. Ultrasound Obstet. Gynecol. 2014; 44: 503–514. https://doi.org/10.1002/uog.13437

27. Tavoraite I., Kronlachner L., Opolskiene G., Bartkeviciene D. Ultrasound Assessment of Adnexal Pathology: Standardized Methods and Different Levels of Experience. Medicina. 2021; 57: 708. https://doi.org/10.3390/medicina57070708

28. Borisova E.A., Bulanov M.N., Pashov A.I., Makarenko T.A., Narkevich A.N. Possibilities of complex use of echography and tumor markers (CA125, HE4, ROMA) for differential diagnosis of ovarian tumors. Ultrasound & Functional Diagnostics. 2015; 6: 36–52. (In Russian)

29. Nikogosyan S.O., Zagashtokov A.Z., Levchenko N.E., Tkhakokhov M.M. Predictive models in the diagnosis of ovarian cancer. Tumors of female reproductive system. 2018; 14 (2): 82–89. (In Russian)

30. Protasova A.E., Tsypurdeeva A.A., Tsypurdeeva N.D., Solntseva I.A. Principles of diagnosis of ovarian neoplasms: minimizing errors. Journal of obstetrics and women's diseases. 2019; 68 (4): 71–82. https://doi.org/10.17816 / JOWD68471-82 (In Russian)

31. Ulyanova A.V., Ponomareva Yu.N., Manukhin I.B., Kapustin V.V. Comparative evaluation of algorithms for differential diagnosis of ovarian formations (ROMA, RMI). Ultrasound & Functional Diagnostics. 2020; 2: 48–59. https://doi.org/10.24835/1607-0771-2020-2-48-59 (In Russian)

32. Podzolkova N.M., Osadchev V.B., Babkov K.V., Safonova N.E. Discussion issues of clinical, laboratory and instrumental diagnostics of ovarian tumors in women of reproductive age (literature review). Gynecology. 2020; 22 (1): 7–13. https://doi.org/10.26442/20795696.2 (In Russian)