KU Leuven, Department of Development and Regeneration, Leuven, Belgium; KU Leuven, Department of Obstetrics and Gynecology and Leuven Cancer Institute, University Hospital KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
Department of Radiology, University Hospitals Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
Best Pract Res Clin Obstet Gynaecol. 2014 Jul;28(5):683-95. doi: 10.1016/j.bpobgyn.2014.03.013. Epub 2014 Apr 13.
A correct diagnosis of any adnexal mass is essential to triage women to appropriate treatment pathways. Several imaging techniques are available that may be used to provide an assessment of a mass before treatment, such as transvaginal ultrasonography, magnetic resonance imaging, computed tomography, and positron emission tomography combined with computed tomography. In this chapter, we focus in depth on the role of transvaginal ultrasonography, as current evidence suggests it is the most appropriate initial imaging investigation to identify and characterise any mass if present in women suspected of having adnexal pathology. Subjective assessment by an experienced ultrasound examiner is the optimal approach to diagnose masses, followed by risk models and rules developed by the International Ovarian Tumor Analysis study. A group of tumours has proven difficult to classify with transvaginal ultrasound, and remain a diagnostic challenge for which accurate second-stage tests would be of value. Some studies suggest that magnetic resonance imaging (MRI), compared with other imaging modalities, may play a role in the assessment of this cohort of 'difficult to classify' adnexal masses. These studies, however, did not report quality of transvaginal ultrasonography (i.e. experience level of the examiner) and lacked uniformity in describing the criteria used to define such 'difficult' masses. On the basis of standardised terminology developed by the International Ovarian Tumor Analysis study to describe adnexal masses, as well as prediction models and rules developed in the course of the study, we propose new criteria that we can use to clearly define complex or 'difficult to classify' adnexal masses to focus the role for second-line imaging tests, such as conventional magnetic resonance imaging combined with dynamic contrast-enhanced or diffusion-weighted sequences on masses where further tests other than ultrasonography would be of value.
正确诊断任何附件包块对于将女性分诊到适当的治疗途径至关重要。有几种成像技术可用于在治疗前评估包块，例如经阴道超声、磁共振成像、计算机断层扫描和正电子发射断层扫描结合计算机断层扫描。在本章中，我们深入探讨了经阴道超声的作用，因为目前的证据表明，如果怀疑女性患有附件病理学，经阴道超声是识别和特征化任何包块的最合适的初始成像检查。有经验的超声检查者的主观评估是诊断肿块的最佳方法，其次是国际卵巢肿瘤分析研究制定的风险模型和规则。一组肿瘤已被证明难以用经阴道超声进行分类，并且仍然是诊断挑战，准确的第二阶段测试将具有价值。一些研究表明，与其他成像方式相比，磁共振成像（MRI）可能在评估这组“难以分类”的附件包块中发挥作用。然而，这些研究并未报告经阴道超声的质量（即检查者的经验水平），并且在描述用于定义此类“困难”包块的标准方面缺乏一致性。根据国际卵巢肿瘤分析研究制定的描述附件包块的标准化术语，以及该研究过程中制定的预测模型和规则，我们提出了新的标准，我们可以使用这些标准来明确定义复杂或“难以分类”的附件包块，以集中二线成像测试的作用，例如常规磁共振成像结合动态对比增强或弥散加权序列，对那些除超声检查外还需要进一步测试的包块。
