Role of ultrasonography and magnetic resonance imaging in evaluation of female pelvic masses from reproductive organs with histopathological correlation

Abstract

Female pelvis houses urological and reproductive organs with perplexing pathologies often because of poor clinical characterization of lesion as it poses overlapping clinical features and difficulty in physical examination. Histopathology is considered gold standard, however the radiological imaging modalities revolutionized the diagnostic and presurgical workup with superior characterization of the lesion, guiding procedures and defining the extensions. In the present study we evaluated different pelvic pathologies using ultrasonography and MRI and these radiological findings were correlated with histopathology findings. This is a prospective study involving 50 female patients with complaints of lower abdominal pain and irregular bleeding were selected. These patients had undergone trans abdominal sonography (transvaginal when needed) and MRI pelvis imaging. Subsequently these findings were correlated with the histopathological findings, whenever needed. Age range of 18-87 were included which showed benign lesions (USG – 43, MRI – 36 and Histopathology – 31) and malignant lesions (USG – 7, MRI – 14 and Histopathology – 19). Most common solid malignant uterocervical lesions are cervical and endometrial cancer and most common malignant cystic adnexial lesions are ovarian neoplasms. The data was statistically analyzed using SPSS software which showed USG (sensitivity – 26.3%, specificity – 93.5%, PPV – 80.3%, NPV – 55.9% & Accuracy – 68%) & MRI (sensitivity – 73.6%, specificity – 100%, PPV – ∞, NPV – 79.1% & Accuracy – 90%). Conclusion: The poor ultrasound sensitivity in the present study can be attributed to the low study population, considering the indeterminate lesions as non-malignant and difficulty in analyzing the small cervical and small adnexial pathologies. MRI showed superior soft tissue resolution, better characterization of lesion compared to Trans abdominal and Trans vaginal sonography. High specificity, high accuracy, low radiation exposure would definitely make MRI pelvis the best imaging modality in diagnostic as well as in presurgical evaluation. On the other hand, ultrasonography with decent specificity and accuracy can be used as first line investigation for its cost efficiency, reproducibility and lack of radiation.