Interactive Transcript
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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.
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