Imaging in gynecological disease (16): clinical and ultrasound characteristics of serous cystadenofibromas in adnexa

Abstract

Objective To describe the clinical and ultrasound characteristics of serous cystadenofibromas in the adnexa. Methods This was a retrospective study of patients identified in the International Ovarian Tumor Analysis (IOTA) database, who had a histological diagnosis of serous cystadenofibroma and had undergone preoperative ultrasound examination by an experienced ultrasound examiner, between 1999 and 2012. In the IOTA database, which contains data collected prospectively, the tumors were described using the terms and definitions of the IOTA group. In addition, three authors reviewed, first independently and then together, ultrasound images of serous cystadenofibromas and described them using pattern recognition. Results We identified 233 women with a histological diagnosis of serous cystadenofibroma. In the IOTA database, most cystadenofibromas (67.4%; 157/233) were described as containing solid components but 19.3% (45/233) were described as multilocular cysts and 13.3% (31/233) as unilocular cysts. Papillary projections were described in 52.4% (122/233) of the cystadenofibromas. In 79.5% (97/122) of the cysts with papillary projections, color Doppler signals were absent in the papillary projections. Most cystadenofibromas (83.7%; 195/233) manifested no or minimal color Doppler signals. On retrospective analysis of 201 ultrasound images of serous cystadenofibromas, using pattern recognition, 10 major types of ultrasound appearance were identified. The most common pattern was a unilocular solid cyst with one or more papillary projections, but no other solid components (25.9%; 52/201). The second most common pattern was a multilocular solid mass with small solid component(s), but no papillary projections (19.4%; 39/201). The third and fourth most common patterns were multi‐ or bilocular cyst (16.9%; 34/201) and unilocular cyst (11.9%; 24/201). Using pattern recognition, shadowing was identified in 39.8% (80/201) of the tumors, and microcystic appearance of the papillary projections was observed in 34 (38.6%) of the 88 tumors containing papillary projections. Conclusions The ultrasound features of serous cystadenofibromas vary. The most common pattern is a unilocular solid cyst with one or more papillary projections but no other solid components, with absent color Doppler signals. Most serous cystadenofibromas were poorly vascularized on color Doppler examination and many manifested acoustic shadowing. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Validation of models to diagnose ovarian cancer in patients managed surgically or conservatively: multicentre cohort study

“…Because of the low malignancy rate (2%) in this subgroup, the confidence interval around the AUC was wide. Calibration analysis indicated that the risk of malignancy was overestimated in this subgroup (supplementary figs[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. The results obtained in the sensitivity analyses were similar to those in the primary analysis (supplementary figs[35][36][37][38][39][40][41][42][43].…”

“…Most masses managed conservatively probably manifested clearly benign ultrasound signs, few were malignant, and most malignancies managed conservatively were borderline tumours, with ultrasound features that could be confused with those of benign tumours. 31 32 All models overestimated the risk of malignancy in patients who were managed conservatively, which was expected because none of the models was developed for this population.…”

Sonographic Evaluation of Serous Cystadenofibroma With Evidence of Intermittent Torsion

“…In previous studies, their size has been reported up to 30 cm, with an average diameter of 5-8 cm. 4 These neoplasms are complex, yet predominantly cystic. 5 The cysts are thin walled with a shiny exterior and are filled with clear, watery fluid or thin mucoid material.…”

“…To be considered a papillary projection, its height must measure at least 3 mm. 4 The second most common pattern of serous cystadenofibromas was discovered to be a multiloculated cyst that did not contain papillary projections, but did have small, solid internal components. Although less common, the third presentation was determined to be bilocular or multilocular cysts, and the fourth was a unilocular cyst.…”

“…1,4 Benign serous cystadenofibromas are typically unilateral, although they can occasionally be seen on both ovaries. 4,5,8 Laterality can provide important information on the type of ovarian tumor as malignancies are more often seen bilaterally. 3 One of the biggest complications of the sonographic evaluation of benign serous cystadenofibromas is that they have many features that mimic those of malignant neoplasms.…”