Interactive Transcript
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Okay, so today we're going to talk about
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a few things in terms of ovarian masses.
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So firstly, we'll talk about the
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anatomy and normal physiology,
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that's important as radiologists.
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And then the clinical significance of
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ovarian lesions is also very important
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when we're interpreting our cases,
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because there is quite a spectrum of
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appearances of ovarian lesions and ovaries.
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In general, I like to think of them as
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little factories producing eggs over time.
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So there is a difference in appearance
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of the ovary in the pre-menopausal and
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the post-menopausal stage, depending
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on the physiology of the patient.
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So we can have a spectrum of
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appearances from physiologic to non-neoplastic
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to neoplastic lesions.
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And as radiologists, it's challenging for us
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to determine when to work up these lesions.
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So then we'll talk a little bit about O.
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Rads, which is a mechanism of characterizing
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and triaging lesions for further workup.
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We'll briefly go over imaging protocols,
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and then we'll spend some time talking
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about some common manifestations of
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ovarian and pelvic disease, including
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endometriosis and ovarian masses.
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So let's begin by talking about
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normal ovarian physiology.
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Now, there are several categories of
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adnexal lesions, ranging from a simple
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appearing cyst to a characteristic
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diagnosis to an uncertain diagnosis.
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And as radiologists, it's up to us to be
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able to kind of triage and differentiate
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between those broad categories.
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And one of the most challenging areas
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that we need to feel comfortable with is
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determining what actually needs workup.
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So in my experience over time, I've noticed
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that in general, radiologists, including
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myself, often work up too many ovarian lesions.
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So it's usually after several years of practice
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and experience that you start to refine
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your approach in terms of working up ovarian
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lesions, you get a bit of a different threshold
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as to what's normal and what's not normal.
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In the beginning, you may want to work up
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a lot of different appearances because your
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exposure and experience may not be very broad.
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And then slowly over time, we tend to kind of
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raise our threshold for working up lesions.
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And many of the different appearances
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that we see and sometimes work up are
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actually physiologic manifestations
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of the normal ovarian cycle.
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And it's important to keep in mind that even
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though we tend to work up a lot of these cystic
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lesions, over 99 percent of them in any age
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group, when they're greater than 10 centimeters,
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even at that size, they tend to be benign.
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So, That for me was really striking when I
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learned about that because it really gave me
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a little bit more comfort in trying to raise
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my threshold for what I was going to work up.
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So if you keep that in mind, and even in the
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postmenopausal age group, most of the cysts
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you're going to see are actually benign.
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So that's a little bit reassuring and makes
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you feel a little bit better about making
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your follow-up period of time a little bit
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longer, or maybe not working up certain things
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that really have no concerning features.
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Thanks.
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