Malignant Ovarian Masses Research Articles

Role of Adding Diffusion-Weighted MR Imaging to Conventional MR Imaging in Evaluation of Ovarian Masses

Abstract Background: Ovarian cancer is a leading cause of death among gynecological malignancies and the fifth most common cause of cancer deaths in women. Aim of Study: To determine whether the addition of DW sequences to a conventional MR imaging protocol can help in the prediction of the nature of suspicious ovarian masses which are detected previously by conventional ultrasound. Patients and Methods: Thirty-five female patients with initial undetermined ovarian lesions were included in this study during the period from December 2019 to September 2020. Women who present with an ovarian mass on previous US examination and were referred to the Radiology Department of Alexandria Main University Hospital and Radiology De-partment of Ain Shams University Hospitals for further assessment and characterization by MRI imaging with adding DW-MR imaging Sequence. Results: In the current study, the mean patient age was 41.00±13.37 years. 17 (48.57%) of 35 ovarian masses were benign, and 12 (34.29%) were malignant, and 6 (17.14%) were borderline. Diffusion-weighted MRI findings of the different histopathological types showed restricted diffusion in 83.3% of borderline lesions and 91.7% of malignant lesions while only 17.6% of benign lesions showed restriction diffusion with a statistically significant difference at p-value 0.025*. DWI had shown 91.7% sensitivity and low specificity 82.4%. Combined DWI and conventional MRI sequences had the highest accuracy 93.1%, and sensitivity at 95.3%. Conclusion: Our results concluded that the DWI can help and increase the confidence of MRI in assessment or exclude potential malignancy in ovarian masses.

Applying low coverage whole genome sequencing to detect malignant ovarian mass

To evaluate whether low coverage whole genome sequencing is suitable for the detection of malignant pelvic mass and compare its diagnostic value with traditional tumor markers. We enrolled 63 patients with a pelvic mass suspicious for ovarian malignancy. Each patient underwent low coverage whole genome sequencing (LCWGS) and traditional tumor markers test. The pelvic masses were finally confirmed via pathological examination. The copy number variants (CNVs) of whole genome were detected and the Stouffers Z-scores for each CNV was extracted. The risk of malignancy (RM) of each suspicious sample was calculated based on the CNV counts and Z-scores, which was subsequently compared with ovarian cancer markers CA125 and HE4, and the risk of ovarian malignancy algorithm (ROMA). Receiver Operating Characteristic Curve (ROC) were used to access the diagnostic value of variables. As confirmed by pathological diagnosis, 44 (70%) patients with malignancy and 19 patients with benign mass were identified. Our results showed that CA125 and HE4, the CNV, the mean of Z-scores (Zmean), the max of Z-scores (Zmax), the RM and the ROMA were significantly different between patients with malignant and benign masses. The area under curve (AUC) of CA125, HE4, CNV, Zmax, and Zmean was 0.775, 0.866, 0.786, 0.685 and 0.725 respectively. ROMA and RM showed similar AUC (0.876 and 0.837), but differed in sensitivity and specificity. In the validation cohort, the AUC of RM was higher than traditional serum markers. In conclusion, we develop a LCWGS based method for the identification of pelvic mass of suspicious ovarian cancer. LCWGS shows accurate result and could be complementary with the existing diagnostic methods.

Clinical analysis of 52 adolescent patients with ovarian masses ≥10 cm in diameter.

ObjectiveTo investigate the clinical characteristics and treatment of large ovarian masses in adolescents.MethodsAdolescents with large ovarian masses (≥10 cm in diameter) who were treated in Beijing Obstetrics and Gynecology Hospital from March 2010 to December 2018 were retrospectively assessed.ResultsFifty-two female patients (mean age: 16.17±2.04 years [11–19 years]) were included and 19 (36.5%) presented with abdominal pain. The blood flow signal rate in ultrasonography was significantly different among benign, borderline and malignant ovarian masses, unlike strong echo, dotted echo and septation rates. Carbohydrate antigen 125 positivity rates were significantly different among pathological types and the endometriotic cyst group showed the highest value (75.0%). Alpha-fetoprotein positivity rates were also different among pathological types. For ovarian cystectomy, 14 and 32 patients underwent laparotomy and laparoscopy, respectively. Mass diameters were significantly higher in the laparotomy group and the operative duration was significantly shorter in the laparoscopy group. There were no significant differences in intraoperative blood loss or postoperative recurrence rates between the two groups.ConclusionTeratomas constitute the greatest group of large ovarian masses in adolescents. Benign tumors should be treated by laparoscopic resection, while borderline or malignant tumors require individualized treatment of tumors and fertility-sparing treatments.

Role of Transabdominal Ultrasound in Characterization of the Ovarian Mass

The use of grey-scale ultrasound morphology to characterize a pelvic mass may also be called ‘pattern recognition’. The grey-scale ultrasound image provides as much information as that obtained by the surgeon or pathologist when they cut a surgical specimen to see what it looks like inside. Aim of our study is to characterize the ovarian mass by ultrasound. The study was conducted in Department of Radiology and Imaging, College of Medical Sciences, Bharatpur. Patients with suspected ovarian mass in Gynecology OPD were included in our study. A prospective cross-sectional study was conducted on 60 patients in college of medical science, Bharatpur, over the period of one year (from November 2019 to October 2020). Present study showed benign ovarian (90.0%) pathology are the most commonly encountered ovarian mass. Ovarian mass is most common in adult female of age 15-30 years and malignant ovarian mass was most common among the age group of 30-60 years. Among benign pathology of ovary simple follicular cysts are most common (39.0%), followed by hemorrhagic cyst (31.0%), dermoid cyst (17.0%), chocolate cyst (9.0%) and ectopic pregnancy (4.0%). Among the malignant ovarian mass serous cystadenocarcinoma and mucinous cystadenocarcinoma showed similar frequency (33.0% each) and followed by immature teratoma and krukenberg tumor (17.0% each). Ultrasound parameters like size, septal thickness, solid component and spectral doppler (RI ans PI) are very helpful for determination of malignant pathology. In this study the sensitivity and specificity of size parameter is least (40.3% and 60.2%) and highest in solid component and spectral Doppler parameter (PI) being (82.0% and 92.0%). Combined study of grey scaleand spectral Doppler study plays crucial role in characterization of ovarian mass to differentiate between benign and malignant pathology.

Sonographic Advancements in Characterization of Benign and Malignant Ovarian Masses

Background: Characterization of ovarian masses is essentially required and inevitable for optimization of clinical decision making, patient care and management. The diagnosis of ovarian masses is a frequent dilemma in clinical work. Ultrasonography remains the modality of choice in the early investigation of suspected adnexal masses because of its availability and being a safe modality. Aim: To review the current literature on different patterns of manifestation of ovarian masses on ultrasound and its various modes, helping in differential diagnosis on the basis of morphologic, vascular and other characteristics as seen on ultrasound. Methods: Electronic database was searched (PubMed, Google Scholar, Science direct) with data ranging from year 2000 to 2021. Most relevant studies, relating to sonographic appearances of ovarian masses were selected. Results: Twenty five most relevant articles were found: 8 articles were regarding gray-scale ultrasound, 3 articles regarding three dimensional ultrasonography, 2 articles regarding contrast enhanced ultrasonography, 2 regarding elastography and rest were regarding combined use of gray-scale and Doppler ultrasound including color and power Doppler ultrasonography for the assessment of ovarian masses. Our results show that conventional 2D sonography, in conjunction with latest advancements helps improving the diagnosis based on typical sonographic appearances of masses. Screening for ovarian cancer also proves to be helpful for early diagnosis and improvement in survival rate. Conclusion: Ultrasonoraphy and its different modalities such as 3DUS, CEUS, elastography along with conventional 2D and Doppler studies accurately identifies morphologic, structural and vascular featuresof the adnexal masses and differential diagnosis by escapingunnecessary surgeries and improving the survival rate. Keywords: Ultrasonography, Ovarian masses, malignant ovarian masses, contrast enhanced ultrasound,

The diagnostic accuracy of human epididymis protein 4 (HE4) for discriminating between benign and malignant pelvic masses: a systematic review and meta-analysis.

Many women with benign pelvic masses, suspected of ovarian cancer, are unnecessarily referred for treatment at specialized centers. There is an unmet clinical need to improve diagnostic assessment in these patients. Our objective was to obtain summary estimates of the accuracy of human epididymis protein (HE4) for diagnosing ovarian cancer and to compare the performance of HE4 with that of cancer antigen 125 (CA125). We searched PubMed, Ovid and Scopus using search terms for "pelvic masses" and "HE4", to identify studies that evaluated HE4 for diagnosing malignant ovarian masses, in adult women presenting with a pelvic mass, suspected of ovarian cancer, and with diagnosis confirmed by histopathology. Screening, data extraction and Risk of Bias assessment with the QUADAS-2 tool were done independently by two authors. We performed a meta-analysis of the accuracy of HE4 and CA125 using a random-effects bivariate logit-normal model. A study protocol was registered at PROSPERO (CRD42020158073). In the 17 eligible studies, which included 3404 patients, ovarian cancer prevalence ranged from 15% to 71%. Overall, the studies were heterogeneous. All studies seemed to have recruited patients in specialized settings. A meta-analysis of seven HE4 studies resulted in a mean sensitivity of 79.4% (95% confidence interval [CI] 74.1%-83.8%) and a mean specificity of 84.1% (95% CI 79.6%-87.8%), for cut-off values of 67-72pmol/L. Based on eight studies, the mean sensitivity of CA125 was 81.4% (95% CI 74.6%-86.2%) and the mean specificity was 56.8% (95% CI 47.9%-65.4%), at a cut-off of 35U/ml. Given a 40% ovarian cancer prevalence, the positive predictive value (PPV) for HE4 would be 76.9% (71.9%-81.2%) vs 55.6% (50.2%-60.9%) for CA125. The negative predictive value (NPV) would be 85.9 (82.8%-88.6%) and 81.9% (76.2%-86.4%), respectively. At a 15% prevalence, the NPV would be 95.8% (95% CI 94.4%-96.7%) for HE4 and 94.4% (95% CI 92.3%-96.0%) for CA125. The PPV would be 46.9% (40.4%-53.4%) and 24.9% (21.1%-29.2%), respectively. HE4 had higher specificity and similar sensitivity compared with CA125. At high prevalence, PPV was also higher for HE4, but at low prevalence, it had a similar NPV to CA125. The field would benefit from studies conducted in general settings.

Nonepithelial ovarian cancers

Key content Nonepithelial ovarian cancers (NEOCs) are rare forms of ovarian cancer, including malignant ovarian germ cell tumours (MOGCTs), sex cord‐stromal tumours (SCSTs) and ovarian sarcoma. Tumour markers including alpha‐fetoprotein, human chorionic gonadotrophin, lactate dehydrogenase and inhibin can be useful in aiding preoperative diagnosis of malignant ovarian masses. NEOCs are staged using a similar classification to epithelial ovarian tumours; however, the staging system for male germ cell tumours is considered a more useful prognostic tool. These tumours can occur at any age; however, many present in the reproductive years, and fertility‐sparing treatments are often required. Advanced‐stage MOGCTs and SCSTs are managed with debulking surgery and platinum‐based adjuvant chemotherapy, with the regimen of bleomycin, etoposide and cisplatin being most widely used. Learning objectives To understand the classification and pathology of NEOCs. To describe the role of tumour markers in diagnostic criteria and to be aware of the FIGO staging classifications and their prognostic use. To understand management protocols and follow‐up regimens. Ethical issues Patients of reproductive age risk infertility if preoperative diagnosis is incorrect and more extensive surgery involving bilateral salpingo‐oophorectomy is performed.

OVARIAN MASSES IN WOMEN: A RETROSPECTIVE ANALYSIS IN TERTIARY CARE CENTER

Objective: To describe the presenting signs and symptoms, clinic-pathological findings of ovarian masses and to establish diagnostic value of clinical examination, ultrasonography and its correlation with histopathological diagnosis.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Combined Military Hospital, Rawalpindi Jun 2017 May 2018.
 Methodology: Women who underwent surgery for ovarian masses were included. Data was collected from hospital records including; age, presenting symptoms, duration of symptoms, changes in menstrual cycle, and the results of the physical examination. The preliminary diagnoses as well as the final diagnosis were noted.
 Results: A total of 83 patients with ovarian masses, who underwent surgery over the period of a year, were included. The most common symptom was abdominal pain in 56 (67.5%) followed by abdominal distention 9 (10.8%), dysmenorrhea 8(9.6%). When both clinical and sonological diagnosis were combined, the overall sensitivity, specificity, positive and negative predictive value for diagnosis and discriminating benign and malignant ovarian neoplasms were 87.5%, 96.7%, 70%, and 98.88%, respectively.
 Conclusion: In this study most, common symptom was abdominal pain both in benign and malignant ovarian masses. Whereas, abdominal distention was more common in malignant masses. Preoperative diagnostic approach should always include careful history taking, physical examination, imaging and evaluation of tumor markers. Early detection, thorough treatment and regular follow-up are the need of time to reduce the morbidity and mortality.

Prediction Models of Adnexal Masses: State-of-the-Art Review.

Several predictive models and scoring systems have been developed to differentiate between benign and malignant ovarian masses, in order to guide effective management. These models use combinations of patient characteristics, ultrasound markers, and biochemical markers. The aim of this study was to describe, compare, and prioritize, according to their strengths and qualities, all the adnexal prediction models. This was a state-of-the-art review, synthesizing the findings of the current published literature on the available prediction models of adnexal masses. The existing models include subjective assessment by expert sonographers, the International Ovarian Tumor Analysis models (logistic regression models 1 and 2, Simple Rules, 3-step strategy, and ADNEX [Assessment of Different NEoplasias in the adneXa] model), the Risk of Malignancy Index, the Risk of Malignancy Ovarian Algorithm, the Gynecologic Imaging Reporting and Data System, and the Ovarian-Adnexal Reporting and Data System. Overall, subjective assessment appears to be superior to all prediction models. However, the International Ovarian Tumor Analysis models are probably the best available methods for nonexpert examiners. The Ovarian-Adnexal Reporting and Data System is an international approach that incorporates both the common European and North American approaches, but still needs to be validated. Many prediction models exist for the assessment of adnexal masses. The adoption of a particular model is based on local guidelines, as well as sonographer's experience. The safety of expectant management of adnexal masses with benign ultrasound morphology is still under investigation.

An Evaluation of the Effectiveness of Image-based Texture Features Extracted from Static B-mode Ultrasound Images in Distinguishing between Benign and Malignant Ovarian Masses

Significant successes in machine learning approaches to image analysis for various applications have energized strong interest in automated diagnostic support systems for medical images. The evolving in-depth understanding of the way carcinogenesis changes the texture of cellular networks of a mass/tumor has been informing such diagnostics systems with use of more suitable image texture features and their extraction methods. Several texture features have been recently applied in discriminating malignant and benign ovarian masses by analysing B-mode images from ultrasound scan of the ovary with different levels of performance. However, comparative performance evaluation of these reported features using common sets of clinically approved images is lacking. This paper presents an empirical evaluation of seven commonly used texture features (histograms, moments of histogram, local binary patterns [256-bin and 59-bin], histograms of oriented gradients, fractal dimensions, and Gabor filter), using a collection of 242 ultrasound scan images of ovarian masses of various pathological characteristics. The evaluation examines not only the effectiveness of classification schemes based on the individual texture features but also the effectiveness of various combinations of these schemes using the simple majority-rule decision level fusion. Trained support vector machine classifiers on the individual texture features without any specific pre-processing, achieve levels of accuracy between 75% and 85% where the seven moments and the 256-bin LBP are at the lower end while the Gabor filter is at the upper end. Combining the classification results of the top k (k = 3, 5, 7) best performing features further improve the overall accuracy to a level between 86% and 90%. These evaluation results demonstrate that each of the investigated image-based texture features provides informative support in distinguishing benign or malignant ovarian masses.

Struma ovarii-A rare entity

Struma ovarii, also known as goiter of the ovary is a rare disease.1 Considering the rarity of this tumor and constrained literature in Nepal’s context, we hereby present a case of a 46-year-old female, asymptomatic, with normal blood parameters who presented with an abdominal mass. She was suspected of malignant ovarian mass on an ultrasonogram. Intraoperative frozen section examination revealed a benign tumor suggestive of dermal tumor versus struma ovarii. Postoperatively, histopathological examination was performed to assess the percentage of thyroid tissue and a diagnosis of benign struma ovarii was made which was confirmed by thyroglobulin positivity on immunohistochemistry. No features of immature teratoma and malignancy were identified.

Role of HE4 and ROMA Score in Diagnosis of Ovarian Cancer in Egyptian Women

Background: Risk of ovarian malignancy algorithm (ROMA) combining human epididymis secretory protein 4 (HE4) and CA125 is a novel score, specific for epithelial ovarian cancer (EOC). Method: Our cohort prospective study aimed to evaluate the role of HE4 and ROMA score in the diagnosis of EOC. We determined CA125 and HE4 serum levels in 56 premenopausal women with ovarian mass (38 women with benign ovarian mass and 18 women with malignant ovarian mass), 56 postmenopausal women with ovarian mass (20 women with benign ovarian mass and 36 women with malignant ovarian mass), and 56 healthy women as control. Results: Serum CA125 and HE4 and ROMA score were significantly higher among postmenopausal group compared with premenopausal and control groups (P< 0.001), and the median serum CA125 and HE4 and ROMA levels were statistically higher among malignant lesions compared with benign lesions and control group (P< 0.001). The sensitivity and specificity of HE4 and ROMA vs. CA125 in discriminating ovarian cancer from benign ovarian tumor was (88% and 98% vs. 90%) and (97% and 99% vs. 80%), respectively. ROMA had better sensitivity and specificity compared to CA125 and HE4 in premenopausal and postmenopausal women (P <0.001) In premenopausal patients, there was a statistically significant difference regarding the area under the curve (AUC) of ROMA vs. CA125 (P=0.004) and ROMA vs. HE4 (P =0.02). Conclusion: ROMA score showed a better performance in comparison with either CA125 or HE4 alone in premenopausal patients. HE4 and ROMA score significantly differentiated early from late stage ovarian cancer.

Laparoscopic management of ovarian parasitic myoma: a case report

Background: Ovarian leiomyoma is very rare and constitutes 0.5%-1% of ovarian benign masses. Although most adnexal masses are benign, primary purpose of the assessment is to eliminate any malignancies. The most important issue in the evaluation of ovarian masses is to differentiate between malignant and benign masses. Laparoscopy is an important diagnostic and minimally invasive method for these purposes. Case Presentation: In this paper, we present a case report on laparoscopic evaluation of a patient who was diagnosed with right ovarian spontaneous parasitic myoma and who did not have a history of uterine surgery. Conclusion: Uterine ovarian myoma is extremely rare and can be confused with malignant ovarian masses. Laparoscopy option should be considered as the primary approach in the management of masses with suspicious location and appearance and in the differentiation of benign and malignant.

Evaluation of Low Coverage Whole Genome Sequencing as a New Method for Detecting Malignant Ovarian Mass

Evaluation of Low Coverage Whole Genome Sequencing as a New Method for Detecting Malignant Ovarian Mass

Evaluation of Risk of Malignancy Index in the Preoperative Assessment of the Patients with Ovarian Mass

Background: Adnexal masses indicate a variety of gynecological and non-gynecological disorders, which may be benign or malignant. Early detection of malignancy is crucial to a proper planning of treatment and improvement of survival. Objective: The purpose of the study was to evaluate predictive value of risk of malignancy index (RMI) in differentiating between benign and malignant ovarian masses preoperatively. Study Design: Cross sectional (Validation) study. Settings: Obstetrics &amp; Gynecology Department of Madinah Teaching Hospital affiliated with University Medical &amp; Dental College Faisalabad Pakistan. Duration: One year from January 2018 to December 2018. Methodology: Total 86 patients were included in the study. Ultrasound was performed then staging laparotomy done followed by histopathological examination. Results: A total of 86 patients were included in the study. Out of which 50 patients (58.1%) were premenopausal and 36 patients (41.9%) were menopausal. The mean age of the patients was 55.79 years. According to histopathological examination of the specimens 44 were malignant and 42 were benign. The sensitivity of the RMI for malignant ovarian tumor is 70.45% and specificity is 69.05%. Conclusion: RMI was considered to have significant importance in preoperative evaluation and treatment of women with an adnexal mass, and was helpful in-patient referral to higher Centre for suitable and effective surgical intervention.

How should the management of ovarian masses in children?

Introduction: Prevalence of ovarian masses in children increase due to easy access to imaging techniques. There are conflicting views about evaluation and classification of ovarian masses for neoplasia in such age group in the literature. Material and methods: The patients who were monitored and treated because of ovarian mass in pediatric surgery and obstetrics and gynaecology clinics were reviewed retrospectively. Demographic data, symptoms, dimensions and lateralization of the mass, serum tumour markers, histopathological evaluation results, and treatment outcomes of the patients enrolled in were recorded. Ovarian masses of the participants were divided into two groups as non-neoplastic group (NNG) and neoplastic group (NG) depending on imaging techniques, serum tumour markers and histopathological analysis results. Results were statistically reviewed. Results: There was not any statistical difference between NG and NNG for age, body mass index, mass diameter, initial symptoms, and mass lateralization (p>0.05). Review of ovarian masses reported by imaging techniques revealed that pure cystic appearance was statistically significant for NNG (p=0.012). Duration of the surgery and hospitalization were detected shorter in NNG treated laparoscopically (p=0.023). Conclusion: Surgical treatment of ovarian masses in children should be ovarian protective as much as possible. However, there is not any reliable and proven marker that may differentiate a benign ovarian mass from a malignant ovarian mass in paediatric patients like adult population. A detailed medical history, physical examination, imaging methods, and adequate tumour markers should be used for preoperative evaluation of adnexial masses.

Comparison of the four malignancy risk indices in the discrimination of malignant ovarian masses: A cross-sectional study

ObjectiveTo evaluate the accuracy of the four malignancy risk indices to distinguish benign from malignant ovarian masses Materials and methodsThis was an observational cross-sectional study conducted on 155 patients between January 2016 and January 2019. Women with ovarian masses planned for surgical management were recruited from the outpatient Gynecology clinic of the hospital. The risk of malignancy index (RMI 1–4) was calculated for all women with ovarian masses. Biopsies obtained from the ovarian masses after the surgical intervention was sent to the pathology lab for histopathological examination. The histopathologic diagnosis of the ovarian masses was considered the gold standard for diagnosis. ResultsThe participants' mean age in the group of patients with benign masses was 33.50 ± 14.53 years versus 45.09 ± 13.67 years in the malignant group. The two most prominent features in the malignant group were solid areas in 85.3 % of malignant masses and about 91.2 % of malignant masses showing size <7 cm in their largest diameter. The RMI's most sensitive individual parameter was the CA-125 level, while the lowest sensitivity was for the menopausal status. RMI 2 had the highest sensitivity of 76.47 %, while RMI 1 and 3 had the highest specificity, 92.56 %. RMI 2 had the highest AUC, 0.83. ConclusionsRMI 2 is a simple and reliable tool and had the best performance among all RMIs in benign discrimination from malignant ovarian masses with high sensitivity and accuracy.

Ultrasound, macroscopic and histological features of malignant ovarian tumors

Ultrasound examination is considered to be the first line imaging method to diagnose an ovarian mass with a high degree of accuracy, discriminating between benign and malignant ovarian masses in...

Guideline No. 404: Initial Investigation and Management of Benign Ovarian Masses.

To provide recommendations for a systematic approach to the initial investigation and management of a benign ovarian mass and facilitate patient referral to a gynaecologic oncologist for management. Obstetricians, gynaecologists, family physicians, internists, nurse practitioners, radiologists, general surgeons, medical students, medical residents, fellows, and other health care providers. Women ≥18 years of age presenting for evaluation of an ovarian mass (including simple and unilocular cystic masses, endometriomas, dermoids, fibromas, and hemorrhagic cysts) who are not acutely symptomatic and without known genetic predisposition to ovarian cancer. This guideline aims to encourage conservative management and help reduce unnecessary surgery and long-term health complications, maintain fertility, and decrease operative costs and improve overall patient care and outcomes by providing criteria for referral of patients with ultrasound imaging findings suggestive of a malignant mass to a gynaecologic oncologist. Databases searched: Medline, Cochrane, and PubMed. Medical terms used: benign asymptomatic and symptomatic ovarian cysts, adnexal masses, oophorectomy, ultrasound diagnosis of cysts, simple ultrasound rules, surgical and medical therapies for cysts, screening for ovarian cancer, ovarian torsion, and menopause. Initial search was completed by 2017 and updated in 2018. Exclusion criteria were malignant ovarian cystic masses, endometriosis therapies, and other adnexal pathologies unrelated to the ovary. The content and recommendations were drafted and agreed upon by the authors. The Society of Obstetricians and Gynaecologists of Canada's Board of Directors approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation methodology framework. Implementation of the recommendations could reduce costs due to unnecessary surgeries and hospitalizations and reduce lost work days and the risk of loss of fertility, early menopause, and surgical complications. RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).

Role of Combining Colour Doppler and Grey Scale Ultrasound in Differentiating Benign from Malignant Ovarian Masses

Abstract The aim of this study was to evaluate ovarian masses with conventional grey scale ultrasonography and colour Doppler flow imaging and to assess the diagnostic reliability of these methods in differentiating benign and malignant ovarian masses. We assessed 56 patients with an ovarian mass. Morphological characterisation of the mass was performed utilising the Sassone score. Colour Doppler parameters were recorded for each patient, and the Caruso vascular score was also applied. The results were compared with surgical/pathological and/or follow-up scans. Using the Sassone score, overall reliability in differentiating ovarian masses had a sensitivity of 89.5% and a specificity of 78.4%. Using the Caruso score alone, we found a sensitivity of 89.5% and a specificity of 86.5%. Using the Sassone and Caruso scores together, we found a sensitivity of 94.7% and a specificity of 89.1%. Combining both morphological and colour Doppler scores in the evaluation of ovarian masses obtained higher specificity, sensitivity, and accuracy than was obtained using a single score only.