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Ultrasound, macroscopic and histological features of malignant ovarian tumors
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  1. Francesca Moro1,
  2. Valeria Verdecchia1,2,
  3. Paola Romeo1,
  4. Francesca Ciccarone1,
  5. Gian Franco Zannoni1,
  6. Lil Valentin3,4,
  7. Dirk Timmerman5,
  8. Tom Bourne6,7,
  9. Wouter Froyman5,
  10. Giovanni Scambia1,8 and
  11. Antonia Carla Testa

    Professor Antonia Carla Testa is a member of the IOTA steering committee. She is director of a School of Ultrasound in Gynecology at Policlinico Universitario Agostino Gemelli, IRCCS in Rome.


    1,8
  1. 1Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
  2. 2Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche, Università Politecnica delle Marche, Ancona, Italy
  3. 3Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
  4. 4Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
  5. 5Department of Obstetrics and Gynecology, Multidisciplinary Breast Centre and Leuven University Centre for Cancer Prevention (LUCK), University Hospitals Leuven, Leuven, Belgium
  6. 6Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
  7. 7Department of Development & Regeneration, KU Leuven, Leuven, Belgium
  8. 8Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
  1. Correspondence to Dr Francesca Moro, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; morofrancy{at}gmail.com

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Summary

Ultrasound examination is considered to be the first line imaging method to diagnose an ovarian mass with a high degree of accuracy, discriminating between benign and malignant ovarian masses in the hands of experienced examiners.

The International Ovarian Tumor Analysis (IOTA) group provided a standardized terminology of ovarian masses1 and suggested simple ultrasound rules that can be used to classify adnexal masses as benign or malignant.2 The IOTA group has also created logistic regression models (ie, ADNEX (Assessment of Different NEoplasias in the adneXa) model), including clinical and ultrasound information to calculate the likelihood of malignancy in adnexal masses. The IOTA ADNEX model estimates the likelihood not only of an adnexal mass being benign or malignant but also the likelihood that the mass is benign, borderline malignant, stage I primary invasive malignant, stage II–IV primary invasive malignant or a metastasis in the ovary from another primary tumor.3

Recently, a consensus meeting including European and North American professionals developed a new risk model for the pre-operative assessment of adnexal masses, called O-RADS (Ovarian-Adnexal Reporting and Data System). The O-RADS ultrasound risk stratification and management system was designed to provide consistent interpretations, to decrease or eliminate ambiguity in ultrasound reports resulting in a higher probability of accuracy in assigning risk of malignancy to ovarian and other adnexal masses, and to provide a management recommendation for each risk category.4

Moreover, during the past 15 years authors of the IOTA group have described the typical ultrasound appearance of several different adnexal pathologies, including various histotypes of malignancy, collected in the series of “Imaging in gynecology” papers.5–10 Indeed, ovarian cancer includes several histological entities which can be grouped into four histological groups: epithelial tumors, germ cell tumors, stromal tumors and metastatic tumors. Each histopathological category is often characterized by some morphological typical features, as described in the textbooks of pathologists.

In the pre-operative phase, ultrasound examination can enable assessment of these macroscopic aspects, thus providing a presumptive histological diagnosis.

We present a video describing how to apply the simple ultrasound rules, the IOTA ADNEX model and the O-RADS model, and provides explanatory examples for each model.

Video 1.

Professor Antonia Carla Testa is a member of the IOTA steering committee. She is director of a School of Ultrasound in Gynecology at Policlinico Universitario Agostino Gemelli, IRCCS in Rome.


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References

Footnotes

  • Contributors We present a video describing how to apply the simple ultrasound rules, the IOTA ADNEX model and the O-RADS model, and explanatory examples for each model.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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