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Alright, so some of the ultrasound

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features of ovarian lesions in general are important to keep in mind.

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So, we're probably all aware of what

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a benign lesion looks like with typically a simple cyst.

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So simple fluid within unilocular thin

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smooth wall and there's also a range of appearances.

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So sometimes you can have more complex

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looking cysts with hyperechoic regions, and sometimes you have cysts with uniform

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hypoechoic texture like I showed you with the endometrioma.

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Then when we get into malignant lesions,

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there's more complexity. So we might see some solid elements. On doppler, you'll see

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some flow, septations, thickened walls, more complex fluid, more locules.

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So when we start getting into that part of the spectrum, that's when the alarm

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bells start to go off for possible malignancy.

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So one of the cardinal rules for evaluating ovarian cysts on ultrasound,

0:56

are keeping in mind what is the definition of a simple cyst.

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So a simple cyst has to be round or oval,

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it needs to be anechoic with smooth thin walls, posterior acoustic enhancement,

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no evidence of a solid component or septation and no internal flow.

1:16

So those are the ultrasound features of a simple cyst.

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Now, we need to keep in mind that in order

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to call something simple, there are a few things we should really do.

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So first of all, we have to visualize the entire cyst.

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And sometimes on ultrasound that can be a challenge, particularly for larger cysts.

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If we're at the point where we're imaging a cyst that's greater than 8cm or 9cm

1:40

or 10cm, and we're not really confident we've seen the whole cyst,

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that's when you need to go to another modality like MRI.

1:48

All cysts should really be evaluated

1:50

with color or power doppler to make sure that there is no blood flow.

1:55

Malignant cysts are rare, as we talked about, particularly if they're mainly

2:00

composed of fluid and they're usually large, at least 10cm or more.

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And even though it's malignant at the time

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that we catch it, usually they start out as complex cysts, even when they're small.

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So it's very rare for a simple cyst

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that we saw, you know, a few months ago or a couple of years ago, to then become malignant.

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So usually they start out being complex.

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And then again, that mantra of the fact

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that over 99% of simple cysts up to 10cm, in a patient of any age, are benign.

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So just keep that in mind.

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And again, it does provide us with a little bit of reassurance,

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but at the same time, we have to keep our guard up.

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We don't want to not work up something that really is of concern.