Role of sonography in the assessment of pelvic masses in women and its histopathological correlation
DOI:
https://doi.org/10.18203/2320-6012.ijrms20222360Keywords:
Pelvic masses, Diagnostic modality, Ultrasonography, Histopathology, Benign, MalignantAbstract
Background: Abnormal growth of tissues in gynecologic pelvic organs like uterus, cervix or uterine adnexa are termed as female pelvic masses. Pelvic masses can be benign or malignant in nature. An efficient non-invasive treatment modality is essential for effective management and efficient treatment of pelvic masses. Current investigation is aimed towards estimating the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ultrasonography in diagnosing pelvic masses and differentiating benign and malignant pelvic masses.
Methods: A descriptive study was conducted on 100 volunteers for 12 months at ultrasound department of radio-diagnosis in a tertiary care center. Patients were examined through transabdominal ultrasonography, covering entire pelvis. Morphology of pelvic lesions were examined in longitudinal and transverse planes through Doppler coupled with ultrasonography. Post-surgery histopathological examination reports were correlated with pre-operative imaging findings.
Results: Majority of patients included in current study belonged to <40 years of age group and exhibited benign pelvic masses. Sensitivity and specificity of ultrasound in diagnosing benign masses was observed to be 87.5 and 70 respectively with PPV of 92.1 and NPV of 58.3. Majority of benign lesions were hypoechogenic, whereas malignant lesions were of mixed echogenicity. Most of the malignant lesions showed echogenic focus significantly different from malignant lesions.
Conclusions: Ultrasonography was concluded to be primary modality and best screening tool for evaluation of pelvic masses with high sensitivity and specificity for correctly diagnosing and differentiating benign and malignant pelvic lesions. Ultrasonography coupled with color Doppler was efficient in determining the morphological characteristics of pelvic masses.
References
Killackey MA, Neuwirth RS. Evaluation and management of the pelvic mass: a review of 540 cases. Obstet Gynecol. 1988;71(3):319-22.
Hernandez E, Miyazawa K. The pelvic mass. Patients' ages and pathologic findings. J Reprod Med. 2008;33(4):361-4.
Bast RC, Skates S, Lokshin A, Moore RG. Differential diagnosis of a pelvic mass: improved algorithms and novel biomarkers. Int J Gynecol Cancer. 2012;22(1):S5-8.
Shaha PR, Khetawat R, Sahoo K, Garg A, Ilyas MA, Khairnar G, Garg S, Budgemwar SH. Pelvic mass lesions in females: tissue characterization capability of MRI. J Clin Diagn Res. 2017;11(7):TC01-5.
Dodge JE, Covens AL, Lacchetti C, Elit LM, Le T, Devries-Aboud M. Gynecology cancer disease site group. management of a suspicious adnexal mass: a clinical practice guideline. Curr Oncol. 2012;19(4):e244-57.
Stabile G, Zinicola G, Romano F, Laganà AS, Pozzolo CD, Ricci G. Pelvic mass, ascites, hydrothorax: a malignant or benign condition? Meigs syndrome with high levels of CA 125. Prz Menopauzalny. 2021;20(2):103-7.
Engelen MJ, Bongaerts AH, Sluiter WJ, de Haan HH, Bogchelman DH, Tenvergert EM et al. Distinguishing benign and malignant pelvic masses: the value of different diagnostic methods in everyday clinical practice. Eur J Obstet Gynecol Reprod Biol. 2008;136(1):94-101.
Haggerty AF, Hagemann AR, Chu C, Siegelman ES, Rubin SC. Correlation of pelvic magnetic resonance imaging diagnosis with pathology for indeterminate adnexal masses. Int J Gynecol Cancer. 2014;24(7):1215-21.
Funt SA, Hann LE. Detection and characterization of adnexal masses. Radiol Clin North Am. 2002;40(3):591-608.
Franchi M, Beretta P, Ghezzi F, Zanaboni F, Goddi A, Salvatore S. Diagnosis of pelvic masses with transabdominal color Doppler, CA 125 and ultrasonography. Acta Obstet Gynecol Scand. 1995;74(9):734-9.
Varras M. Benefits and limitations of ultrasonographic evaluation of uterine adnexal lesions in early detection of ovarian cancer. Clin Exp Obstet Gynecol. 2004;31(2):85-98.
Chu LC, Coquia SF, Hamper UM. Ultrasonography evaluation of pelvic masses. Radiol Clin North Am. 2014;52(6):1237-52.
Voss SC, Lacey CG, Pupkin M, Degefu S. Ultrasound and the pelvic mass. J Reprod Med. 1983;28(12):833-7.
Nevin J, Denny L, Soeters R, Dehaeck K, Bloch B. Ultrasonography of pelvic masses. Br J Obstet Gynaecol. 2008;105(2):137-9.
Testa AC, Bourne TH. Characterising pelvic masses using ultrasound. Best Pract Res Clin Obstet Gynaecol. 2009;23(5):725-38.
Kozawa E, Inoue K, Yano M, Yasuda M, Hasegawa K, Tanaka J et al. An unusual ovarian mucinous borderline tumor with a large solid component. Case Rep Radiol. 2019;2019:1402736.
Wasnik AP, Menias CO, Platt JF, Lalchandani UR, Bedi DG, Elsayes KM. Multimodality imaging of ovarian cystic lesions: Review with an imaging based algorithmic approach. World J Radiol. 2013;5(3):113-25.
Rehn M, Lohmann K, Rempen A. Transvaginal ultrasonography of pelvic masses: evaluation of B-mode technique and Doppler ultrasonography. Am J Obstet Gynecol. 1996;175(1):97-104.
Schiller VL, Grant EG. Doppler ultrasonography of the pelvis. Radiol Clin North Am. 2002;30(4):735-42.
Yashi A, Singh S. Correlation of ultrasound findings with histopathology of pelvic masses in a tertiary care hospital. Int J Health Sci Res. 2019;9(1):46-52.
Anant M, Khushboo D, Raj N, Yadav N, Sinha HH. Evaluation of adnexal masses: A correlation of clinical, ultrasound and histopathological findings. Pain. 2015;117:73-12.
Usmani Y, Bhartiya P, Shukla MK. Role of USG and MRI in female pelvic masses with histological correlation in post-operative patients. J Evol Med Dent Sci. 2020;9(46):3439-44.
Mishra SK, Pradhan R, Pokharel HP. Evaluation of female pelvic mass-correlation of clinical and histopathological findings in female patients attending at Birat Medical College and Teaching Hospital, Morang, Nepal. Birat J Health Sci. 2019;4(3):845-9.
Hartman CA, Juliato CR, Sarian LO, Barreta A, de Toledo MC, Derchain S. Inclusion of symptoms in the discrimination between benign and malignant adnexal masses. Obstetr. 2012;34(11):511-7.
Brown DL, Dudiak KM, Laing FC. Adnexal masses: US characterization and reporting. Radiology. 2010;254:342-54.
Munir SS, Sultana M, Amin D. The evaluation of pelvic mass. Biomedica. 2010;26(14):70-5.
Madan R, Narula MK, Chitra R, Bajaj P. Sonomorphological and color doppler flow imaging evaluation of adnexal masses. Indian J Imaging. 2004;14(4):365-74.
Priya MH, Kirubamani NH. Clinical correla on of ovarian mass with ultrasound findings and histopathology report. Int J Reprod Contracept Obstet Gynecol. 2017;6:5230-4.
Radhamani S, Akhila MV. Evaluation of adnexal masses-correlation of clinical, sonological and histopathological findings in adnexal masses. Int J Sci Stud. 2017;4(11):88-92.
Sohaib SA, Mills TD, Sahdev A, Webb JA, Vantrappen PO, Jacobs IJ et al. The role of magnetic resonance imaging and ultrasound in patients with adnexal masses. Clin Radiol. 2005;60(3):340-8.
Granberg S, Wikland M, Jansson I. Macroscopic characterization of ovarian tumors and the relation to the histological diagnosis: criteria to be used for ultrasound evaluation. Gynecol Oncol. 1989;35(2):139-44.
