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Ultrasound Features of Ovarian Lesions

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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,

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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.

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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

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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.

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All cysts should really be evaluated

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

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

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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.

Report

Faculty

Zahra Kassam, MD, FRCPC

Associate Professor of Medical Imaging, Division Head of Body Imaging

Western University

Tags

Ultrasound

Ovaries

Non-infectious Inflammatory

Idiopathic

Gynecologic (GYN)

Body

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