The ability of ultrasound to detect gynaecological neoplasms and their ultrasound morphological features

Abstract

To determine first, the accuracy of a gynaecological ultrasound service in the detection of four clinically significant pathologies, namely, uterine body malignancy, ovarian malignancy, ovarian dermoid cysts and other benign ovarian pathologies and second, to review the ultrasound imaging appearances of ovarian masses with histopathological correlation. Retrospective data collection from consecutive weekly multidisciplinary team meetings over a 12-month period. All patients had undergone ultrasound examination before surgery. Data included patient demographics, menopausal status, indications for ultrasound, type of practitioner carrying out the scan, operative findings and final histopathological diagnosis. Ultrasound imaging appearances were correlated to histology. Of the 47 cases of uterine malignancy, 45 had endometrial carcinoma. All had either a thickened or poorly seen or not seen endometrium. Twenty-four per cent of these women were premenopausal. Forty-seven of the 48 cases of ovarian malignancy had abnormal ultrasound findings. In six of these, the findings were of a purely cystic lesion. There were 62 cases of benign ovarian pathology (excluding dermoid cyst), all of which had an abnormal ultrasound; 16 of these had possible ultrasound features of malignancy. All 30 cases of ovarian dermoid cyst had an abnormal ultrasound with a specific diagnosis being made in 27. This study shows that ultrasound is accurate in the detection of both endometrial and ovarian disease. The endometrium that is not seen or is poorly seen is an indication for endometrial biopsy in women with postmenopausal bleeding. There is considerable overlap in the ultrasound appearances of benign and malignant ovarian lesions. Ultrasound is a good method for the accurate and specific diagnosis of an ovarian dermoid cyst.