OC25.03: Ultrasound appearance of cystadenofibroma: can we reduce surgical intervention?

Abstract

Objectives: Transvaginal ultrasound has greatly improved our understanding of ovarian neoplasms. Transvaginal ultrasound has had a very high negative predictive value for excluding ovarian malignancy in cases of unilocular cysts and or minimal septations. Solid components and/or mural nodules have been felt to be a more ominous sonographic finding. Cystadenofibromas are benign ovarian neoplasms that originate from the surface epithelium as well as underlying cortical connective tissue of the ovary. Sonographically they often have solid areas that appear to be papillations coming off the cyst wall (‘‘mural nodules’’) and thus are almost always surgically removed to exclude malignancy. This study was undertaken to determine if any consistent finding of cystadenofibroma could be discerned thereby increasing the negative predictive value of transvaginal ultrasound and color flow Doppler in identifying them as benign. Material and methods: Over a 6 year period 58 cases of pathologically proven cystadenofibromas were identified from our hospital’s pathology database. Of these 32 had transvaginal ultrasound with color flow Doppler performed in our imaging facility. The images were analyzed for size, presence of features beyond simple cystic appearance, and presence or absence of blood flow. Results: 22 of the tumors presented as unilocular cystic structures with one or more solid mural nodules projecting from the cyst wall. None of these displayed any discernable blood flow within the solid area. Ten were multi loculated with multiple solid areas and did not follow this more typical classic appearance. Conclusion: Not all cystadenofribromas will look the same on transvaginal ultrasound and color flow Doppler. The majority(69% in our series) presented as unilocular cysts with a small solid non vascular projection from the cyst wall. This particular presentation was virtually pathognomonic and when present seemed to have reliability for benign cystadenofribroma that approached 100% in this small series. Further study is clearly necessary.