Chairman, Division of Clinical Support Services Senior consultant radiologist Department of Diagnostic and Interventional Imaging KK Women’s and Children’s Hospital 1 How to assess an ovarian cyst for malignancy? <Insert cover image here> Adj A/Prof Ong Chiou Li
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How to assess an ovarian cyst for malignancy? objectives •The normal ovary •Types of adnexal masses •Ultrasound evaluation of adnexal masses •Features of physiological ovarian
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Chairman, Division of Clinical Support ServicesSenior consultant radiologist Department of Diagnostic and Interventional ImagingKK Women’s and Children’s Hospital
1
How to assess an ovarian cyst for malignancy?<Insert cover image here>
Adj A/Prof Ong Chiou Li
Learning objectives
• The normal ovary
• Types of adnexal masses
• Ultrasound evaluation of adnexal masses
• Features of physiological ovarian structures
and pathology
• Differentiating benign from malignant
Cyclical change in ovaries
• Follicular development
– Follicular phase• Antral follicles 2-4mm
• Dominant follicle 10mm (9-6 days prior to luteal surge)
– Ovulation• 20 – 24mm ( max diameter 15-30mm)
– Luteal phase
• Variation in ovarian volume
6 weeks
Corpus luteum
• Luteal phase
• Wall is slightly thicker and slightly
echogenic
• Hypervascular wall
• May haemorrhage and present with
complex appearances
• May simulate ectopic pregnancy
“Lace-like, fishnet appearance”
-Fibrin strands
Septa
Follow-up
“Solid-looking haemorrhagic cyst”
Functional ovarian “cysts”
• Women of child bearing age
• Usually unilocular and anechoic
• Thin-walled
• Less than 3cm, but can be larger
• Stimulated ovaries
• Resolves with ovulation
• May persist
Left ovary
Ovarian hyperstimulation syndrome
Adnexal masses
• Ovarian
– physiological/pathological
• Non-ovarian
– Uterus
– Bowel
– Lymph nodes
– Tubal
– Urinary tract
– Others – e.g. peritoneal inclusion “cyst”
Ovarian cysts
• Functional “cysts” – cyclical change
• Drugs
• Benign cysts
– Non-neoplastic cysts
– Neoplastic
• Malignant cysts
Seen on Day 2
Ultrasound follow-up
C - Fimbrial cyst
C
Simple cysts
• Up to 10 cm, any age ( risk of malignancy less
than 1%)
• Premenopausal, cysts up to 3cm considered
physiological, no follow-up required
• >3cm up to 5cm, likely benign, no follow-up
• Greater than 5cm, up to 7cm, annual follow-up
• More than 7cm, usually require further imaging
(MRI or surgery)
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Levine et al. Society of Radiologists consensus statement of Radiology 2010