Trans-vaginal sonography: Is it helpful in differentiating benign from malignant ovarian tumours?

Abstract

Background: The ovary is unique in the range of tumours that may arise from it, and the numbers of malignant tumours from other primary sites that can metastasize to it. Ovarian cancer is largely asymptornatic in its early stages and the majority of patients are presented with advanced intra-abdominal diseases. Objectives: To find out if trans-vaginal sonography can be helpful in differentiating benign from malignant ovarian tumours. Material and method: Prospective study carried out at Al-Jamahirya Teaching Hospital, Department of Gynaecology, Benghazi in Libya. In 162 women with ovarian mass in the age group between 16-67years. Laparatomy was performed and the mass was subjected to histopathological examination. The value of the following trans-vaginal ultrasound features were assessed: the tumour size, unilateral or bilateral, unilocular or multilocular, thin or thick wall, solid areas, papillary projections, pelvic nodules and ascitis. Results: We found that the size of the tumour is not helpful to differentiate benign from malignant ovarian lesions. Other ultrasound features seen in malignant ovarian masses are: multilocular (44.4%)of malignant and (29.9%) of benign masses; papillary projections were present (55.6%) of malignant and (22.9%) benign lesions, bilateral masses seen in (44%) malignant and (27.8%) benign masses, solid areas were found in (77.8%) of malignant and (18.8%) of benign tumours, pelvic nodules were present in (66.6%) of malignant and (0%) of benign masses, while ascitis was found in (66.7%).of malignant and (0.7%) of benign masses. Conclusion: Trans-vaginal scaning was helpful in differentiating between benign and malignant ovarian tumours. Ovarian malignancy should always be considered when the mass is bilateral, multilocular, with thick wall solid areas. When pelvic nodules or ascitis is present in association with a pelvic mass, the mass is almost always malignant. But there is no guarantee that masses not having these features are not malignant or will not undergo malignant changes if ignored.