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Abstract
Introduction/Background Several ultrasound features help ultrasound experts in the characterization of adnexal masses. Different ultrasound scores can be applied to differentiate benignity and malignancy. The main aim of this work is to evaluate the ultrasound characteristics of adnexal borderline tumors and how can ultrasound scores can help in their differentiation.
Methodology This is a 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 Asssesment of the ultrasonographer (SA) and other ultrasound scores (IOTA simple rules risk assessment SRRA, O-RADS and ADNEX model with CA125).
Comparison of ultrasound scores applied for borderline carcinoma (mucinous/serous). SRRA: Simple Rules Risk Assessment figure 1. Ultrasound image shows a 49 year old woman with a borderline serous ovarian carcinoma showing a nonvascularized papillae. Histologically, the papillae are composed of a fibrovascular stalk covered by proliferating seorus epithelium (H&E 5x).
Results Of 187 adnexal masses studied, 13 were Borderline tumors. Mean age of presentation was 50.3 years (±13.6, range: 28–70), 6 women were postmenopausal (46.2%, 6/13), 6 were asymptomatic (46.2%, 6/13), and 4 were bilateral masses (30.8%, 4/13). Mean value of the maximum size of the lesion was 112.1 ±54.7mm (range: 50–210), most of them with a regular contour (n:9, 69.2%) and 5 with acoustic shadowing (38.5%). In 10 cases (76.9%) a solid part was found (mean size: 53.5 ±60.5mm range:12–210), 6 of them highly vascularized (score color 3–4) and 8 had a papillae (mean size: 22.6 ±11.2 mm, range: 12–45), 3 of them with score color 3–4. Most of them were uni-bilocular (n:9) and only two had more than 10 locules. Mean level of CA125 was 49.5 ±37.6 IU/ml (12–152). In all cases malignancy was suspected in SA. SRRA suspected malignancy in 10 cases (mean: 42.2% ±34.1, range:0.6–89.5), similar to ADNEX model with CA125 (mean: 38.4% ±26.3, range: 4.8–92.4). O-RADS classified all masses as suspicious (O-RADS 4: n:6, O-RADS 5 n:7).
Conclusion IOTA SRRA, ADNEX model and ORADS can help in the differentiation of adnexal borderline tumors that have certain ultrasound characteristics associated with malignancy.
Disclosures The use of different scores such as IOTA simple rules risk assessment, O-RADS and ADNEX model may help in the identification of borderline tumors as suspicious masses. They can present mixed characteristics of benignity (regular contour, acoustics shadows) or malignancy (vascularized solid areas or papillae). Levels of CA125 are not always elevated.