Ultrasound differentiation of benign versus malignant adnexal masses
- Maitray D Patel, MD
Maitray D Patel, MD
- Associate Professor of Radiology
- Department of Radiology
- Mayo Clinic Arizona
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Director of Ob/Gyn Ultrasound
- Department of Radiology
- Beth Israel Deaconess Medical Center
An adnexal mass (mass of the ovary, fallopian tube, or surrounding connective tissues) is a common gynecologic problem. Pelvic ultrasound is typically the first-line imaging study used to characterize an adnexal mass . Adnexal masses may present as pelvic pain or pressure and may be found on pelvic examination or be an incidental finding on pelvic imaging.
A principal concern regarding adnexal masses is whether a malignancy is present. Sonographic findings enable imagers to establish when an adnexal mass is almost certainly benign compared with when an adnexal mass has a reasonable chance of being malignant. Characterization of the mass into one of these two categories is of paramount importance, since clinical management of the mass will greatly depend upon this categorization.
The sonographic findings that help to distinguish a benign from a malignant adnexal mass are reviewed here. The general diagnostic approach and differential diagnosis of adnexal masses are discussed separately. (See "Approach to the patient with an adnexal mass" and "Differential diagnosis of the adnexal mass".)
OVERVIEW OF SONOGRAPHIC APPROACH
The sonographic approach to the evaluation of adnexal masses is based upon the ability to evaluate the likelihood of malignancy and also to recognize masses that are consistent with a normal physiologic structure or a benign neoplasm. To accomplish this, the sonologist must take into consideration normal and abnormal anatomy and physiology, clinical information, and ultrasound techniques, and they must set appropriate diagnostic thresholds to help guide further management.
Goals of sonographic evaluation — The goal of ultrasound evaluation of the adnexal mass is not, strictly speaking, to determine if the mass is "definitely" benign versus "definitely" malignant. Instead, the goal is to determine whether the mass is almost certainly benign or whether the mass has some reasonable chance of being malignant.
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- OVERVIEW OF SONOGRAPHIC APPROACH
- Goals of sonographic evaluation
- Anatomy and physiology of adnexal masses
- Sonographic techniques
- - Gray-scale
- - Doppler
- - Combined gray-scale and Doppler evaluation
- - Auxiliary techniques
- Three-dimensional techniques
- Spectral Doppler
- Pertinent clinical information
- Diagnostic performance of ultrasound
- STEPS IN CHARACTERIZING A MASS
- Step one: Is it a simple cyst?
- Step two: Is there a physiologic process that can account for potentially confusing findings?
- Step three: Are there characteristics of specific entities?
- - Endometrioma
- - Mature teratoma
- - Pedunculated leiomyoma
- - Hydrosalpinx
- - Peritoneal inclusion cyst
- - Malignancy
- Step four: Follow-up ultrasound or additional testing?
- - Serial ultrasound
- - Magnetic resonance imaging
- - Other additional tests
- CA 125
- Multimodal tests
- SUMMARY AND RECOMMENDATIONS