Specific features of ovarian lesions visualized on ultrasound can be used as effective predictors of ovarian cancer, according to new research published in Radiology.
Ovarian cancer causes around 15,000 deaths in the U.S. every year. It is considered the deadliest of all gynecologic cancers, mostly due to how the symptoms manifest—most women do not develop signs until the cancer has progressed, at which point disease management becomes challenging.
An important aspect of achieving diagnosis in the cancer’s earliest stages is monitoring adnexal lesions near the uterus via ultrasound imaging. Though most lesions are benign, some can progress into cancer, which makes characterizing and monitoring their features on imaging a critical component of patient care.
“When an adnexal lesion does not fit into one of the classic-appearing lesion categories, it can be challenging to assess the risk of cancer, particularly in the absence of metastatic disease, such as peritoneal implants or malignant ascites,” lead author Akshya Gupta, MD, from the Department of Imaging Sciences at the University of Rochester Medical Center, and co-authors explained. “In these isolated nonclassic lesions—which include multilocular cysts, cysts with solid components, and predominantly solid lesions—the radiologist must identify specific lesion features that would prompt surgical consultation versus additional imaging evaluation.”
Although there are several risk stratification systems in place for assessing adnexal lesions on ultrasound, the authors note that the multifaceted approaches and numerous subcategories make it difficult for busy practitioners to master. To simplify this process, Gupta and colleagues developed a system that classifies lesions into one of two categories: classic and nonclassic.
Classic lesions such as fluid-filled cysts carry minimal likelihood of malignancy. Nonclassic lesions have a solid component and blood-flow detected on Doppler ultrasound, and are considered more clinically suspicious.
To test their system, researchers analyzed 970 isolated adnexal lesions in 878 women at average risk of ovarian cancer. Of those lesions, 53 (6%) were found to be malignant. Less than 1% of lesions with classic ultrasound features were cancerous, while nonclassic features resulted in a malignancy rate of 32%. That rate increased to 50% for women older than 60.
The researchers observed a sensitivity of 92.5% and a specificity of 73.1% for diagnosing lesion malignancy using the classic versus nonclassic approach.
“If you have something that’s not classic in appearance, then the presence of solid components and particularly the presence of Doppler blood flow is really what drives the risk of malignancy,” Gupta said. “Ultimately, we’re hoping that by using the ultrasound features we can triage which patients need follow-up imaging with ultrasound or MRI and which patients should be referred to surgery.”
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.