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Abstract
Introduction/Background Several ultrasound features help ultrasound experts in the characterization of adnexal masses. Ultrasound scores can be applied to differentiate benignity and malignancy. The main aim of this work is to evaluate the ultrasound characteristics of adnexal serous carcinoma and how can ultrasound scores help in their differentiation.
Methodology Retrospective study of ultrasound adnexal lesions of women managed surgically during 2021–2022 in a tertiary centre in Madrid (Spain). Ultrasound characteristics were analysed, and masses were classified according to Subjective Assessment of the ultrasonographer (SA) and other ultrasound scores (IOTA simple rules risk assessment SRRA, O-RADS and ADNEX model with CA125).
Results Of 187 adnexal masses studied, 19 were adnexal serous carcinoma. Mean age of presentation was 61.9 years ±11.3 (range: 42–91), most of them postmenopausal (89.5%, 17/19), 5 asymptomatic (26.3%, 5/19), and 10 bilateral masses (52.6%, 10/19). Most tumors were in advanced surgical stages (IA n:1; IC n:2; II-III n:12; IV n:4). Mean value of maximum size of the lesion was 88.8 ±33.1 mm (range: 44–160), with irregular contour (n:14, 73.7%) and 5 with ascites (26.3%). In all cases a solid part was found (mean size: 53.6 ±23.9 mm, range: 17–98), 13 of them highly vascularized (score color 3–4) and 8 with a papillae (mean size: 34.1 ±26.6 mm, range: 9.5–90), 3 with score color 3–4. Most of them were solid/uni-bilocular (n:17). Mean level of CA125 was 1661.4 ±3414.7 IU/ml (12.4–12059), only two with CA125<35 IU/ml. In all cases malignancy was suspected in SA and ADNEX model with CA125 (mean: 80.7% ±20.4, range: 32.6–100). SRRA suspected malignancy in 17 cases (mean: 64.6% ±36.0, range: 3.1–99.8). O-RADS also classified all masses as suspicious (O-RADS 4: n:8, O-RADS 5 n:11).
Comparison of ultrasound scores applied for serous adnexal carcinoma. SRRA: Simple Rules Risk Assessment figure 1. Ultrasound image shows a solid mass with moderate-intense Doppler color (score 3–4) with an irregular external contour, corresponding to a serous ovarian carcinoma in a 64 year-old woman. Histopathologycal image shows residual high grade serous tumoral cells embebed in a desmoplastic stroma. This patient had great response to neoadyuvant treatment (H&E 20x).
Conclusion IOTA SRRA, ADNEX model and ORADS can help in the identification of malignant features associated with adnexal serous carcinoma.
Disclosures The use of different scores such as IOTA simple rules risk assessment, O-RADS and ADNEX model may help in the identification of malignancy in adnexal serous carcinoma. They can present ultrasound features related with malignancy (irregular contour, vascularized solid areas or papillae).