A STUDY OF CLINICAL, SONOLOGICAL AND HISTOPATHOLOGICAL CORRELATION OF OVARIAN TUMOURS
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 30
Abstract
BACKGROUND Ovarian cancer is the second most common of all gynaecological cancers and accounts for 10-15% of gynaecological malignancies in developing countries including India. Of all gynaecological cancers, ovarian malignancies represent the greatest clinical challenge because of greater range and variety of tumours with uncertain origin with no known premalignant lesion and variability in the rate of disease progression. Around 70% of patients with ovarian tumours are diagnosed only at advanced stages due to unavailability of effective screening methods, and lack of specific clinical presentations at early stage of the disease. In premenopausal women 7% of tumours are frankly malignant, while in postmenopausal women 30% are malignant. Sonography is considered to be the investigation of choice for the evaluation of ovarian tumours due of its high sensitivity, acceptability and low cost. Morphology indexing is an inexpensive and accurate method in differentiating benign ovarian tumours and malignant ovarian tumours and can be used as an effective tool to plan the management of ovarian tumours. The use of Doppler flow studies along with this morphological indexing have not shown to improve the diagnostic accuracy of morphological indexing. The objectives of this study are 1. to analyse the sensitivity and specificity of a morphological scoring system in differentiating benign and malignant tumours of the ovary and 2. to study the epidemiology of ovarian tumours. MATERIALS AND METHODS 136 patients with an ovarian tumour confirmed by transabdominal ultrasound examination were evaluated during this study period. Transabdominal sonography was performed on all patients using a 3.5-5 MHz transducer. Morphology indexing was performed using volume of tumour and morphologic features of the tumour. The ovary was measured in all its three dimensions and the volume of the ovary was calculated with the use of ellipsoid formula (length x width x height x 0.523). Morphological features include papillary projections, solid areas, echogenicity, presence of septum and the presence or absence of free fluid in the extratumoral space. A score from 0-5 was assigned for each of the component. A total score ranging from 0 to 10 for every tumour. Following morphology indexing, each tumour was surgically removed and was histologically classified according to the WHO system of classifying ovarian tumours. RESULTS Of the 136 ovarian tumours, 92 cases were benign (67.6%), 3 were borderline (2.2%) and 41 were malignant (30.2%). The mean age for benign tumours was 36.7, borderline tumours was 49.7 and malignant tumours was 48.1 respectively. Benign tumours were common in 2nd parity women and malignant tumours were common in women with parity 4 and above. The most common presenting feature in both benign and malignant ovarian tumours was pain abdomen with an incidence of 84.7% and 82.9% respectively. Most benign tumours were cystic in consistency (93.4%) and malignant tumours were hard in consistency (40.5%) and around 23.8% of malignant tumours have a variable consistency. Most ovarian tumours were unilateral (80.9%). 92.3% of benign tumours were unilateral and 53.6% of malignant tumours were unilateral. Based on the tumour volume by ultrasound, most benign tumours have a score of ≤ 4 and most of the malignant tumours have a score of ˃ 4. Based on the tumour structures by ultrasound, most benign tumours have a structural score of ˂ 2 and most malignant tumours have a structural score of ˃3. Based on morphological score which includes both volume score and structural score, most of the benign tumours have a score of ˂5 and score of ˃5 suggests malignancy. In the present study, epithelial tumours (117) were the most common ovarian tumours followed by germ cell tumours (11). CONCLUSION Morphological scoring system is helpful in identifying women with ovarian tumours who are at risk for malignancy. Morphological scoring system also effectively decreases the need for unwanted surgery in benign ovarian tumour.
Authors and Affiliations
S. Valarmathy, J. Josephine Hema
Keywords
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- EP ID EP538870
- DOI 10.14260/jemds/2018/768
- Views 120
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