Diagnostic Parameters to Differentiate Benign From Malignant Ovarian Masses With Contrast-Enhanced Transvaginal Sonography

Abstract

Objective. The aim of this study was to evaluate diagnostic parameters to differentiate between benign versus malignant ovarian masses using contrast-enhanced transvaginal sonography (TVS). Methods. Thirty-three consecutive patients with 36 morphologically abnormal ovarian masses (solid or cystic with papillary excrescences, focally thickened walls, or irregular solid areas) smaller than 10 cm received a microbubble contrast agent intravenously while undergoing pulse inversion harmonic TVS. The following parameters were assessed: presence of contrast enhancement, time to peak enhancement, peak contrast enhancement, half wash-out time, and area under the enhancement curve (AUC). Tumor histologic analysis was used to distinguish benign from malignant ovarian tumors. Results. Twenty-six benign masses and 10 malignancies were studied. Of all examined criteria, an AUC of greater than 787 seconds -1 was the most accurate diagnostic criterion for ovarian cancer, with 100.0% sensitivity and 96.2% specificity. Additionally, peak contrast enhancement of greater than 17.2 dB (90.0% sensitivity and 98.3% specificity) and half wash-out time of greater than 41.0 seconds (100.0% sensitivity and 92.3% specificity) proved to be useful. Conclusions. Our data suggest that the AUC, peak enhancement, and half wash-out time had the greatest diagnostic accuracy for contrast-enhanced TVS in differentiation between benign and malignant ovarian masses. Key words: ovarian cancer; contrast-enhanced transvaginal sonography; pulse inversion harmonic imaging. Obstetrics and Gynecology (A.C.F., H.W.J., M.A.C., R.F.A.) Received April 21, 2009, from the Departments of Radiology (A.C.F., A.L., R.F.A., P.K.W.) and

Biomarkers for ovarian cancer detection and therapy

“…85 The enhanced ability to accurately visualize vascular changes specific to early stage EOC may help to detect early ovarian cancer with greater sensitivity and specificity. 86 Quantification of contrast enhancement kinetics obtained with pulse inversion harmonic ultrasound has shown potential to accurately differentiate benign from malignant ovarian tumors with a sensitivity of 100% and specificity of 96.2%. 85,86 Our findings suggest that contrast-enhanced ultrasound may have a high enough sensitivity and specificity to differentiate benign disease from malignant, and thus, shows great promise as a potential imaging technique for ovarian cancer detection.…”

Differential ultrasound diagnosis of benign ovarian tumors: History and the present-day status of the problem

“…Однако если использовать данную методику ис-следования одновременно с внутривенным введением контрастного вещества, результаты дифференциальной диагностики доброкачественных и злокачественных про-цессов улучшаются [69][70][71][72][73]. Использование контрастных веществ значительно повышает точность диагностики сосудистых изменений, которые происходят на ранних этапах развития опухоли [74][75][76][77].…”

“…[69], для злокачественной опухоли яичника ха-рактерны более высокий пик контрастного усиления (23,3±2,8 и 12,3±3,9 dB соответственно) и более длитель-ное время вымывания контрастного вещества (139,9±43,6 и 46,3±19,7 с соответственно). Чувствительность и специ-фичность дифференциальной диагностики злокачествен-ных и доброкачественных образований на основе этих диагностических критериев составили 100 и 96,2% соот-ветственно [70].…”

“…Современные методики УЗИ с ЦДК, трехмерной ре-конструкцией и с использованием контрастных веществ широко применяются в дифференциальной диагностике злокачественных и доброкачественных опухолей яични-ков [57,58,70].…”

Diagnostic Performance of Contrast-Enhanced Ultrasound for Ovarian Cancer: A Meta-Analysis

“…A few studies have investigated the use of contrast-enhanced sonography in the differential diagnosis of malignant versus benign ovarian masses. Diagnostic accuracy in these published studies varied widely, with the sensitivity ranging from 74% to 100% and the specificity ranging from 42% to 98% (D'Arcy et al 2004;Fleischer et al 2009;Huchon et al 2012;Kupesic and Kurjak 2000;Marret et al 2004;Orden et al 2003;Testa et al 2007Testa et al , 2009Veyer et al 2010;Xiang et al 2013), probably as a result of advances in technology, the heterogeneity of patient populations and so on. The overall accuracy of CEUS in the diagnosis of ovarian cancer has never been systematically assessed.…”