Evaluating Ovarian Masses on Ultrasound Part I

In this series of articles, I will discuss ovarian masses, and how I think you should evaluate them if you’re shown an ovarian mass on the Boards which needs to be evaluated using ultrasound.

First, it’s important to remember that 70% of excised ovarian neoplasms are 6 cm in diameter or larger. This is indeed the origin of the so-called clinical 6 cm rule. So, generally speaking, if you’re looking at an ovarian neoplasm, it will likely be large.

That doesn’t mean that smaller masses won’t be identified and might not be clinically surgically excised, but generally, we are going to only do that when symptomology or the age of the patient, her being post-menopausal for example, makes us more suspicious.

Obviously lesions that are discovered during surgery for other reasons, or the mass has a highly suspicious sonographic appearance which we’ll be talking about momentarily, need to be looked at.

What I would like to discourage you from doing is to have the first words that come out of your mouth be, let me see, do I think this is benign or malignant.

Because that really isn’t the first thing you should think about when you look at an ovarian mass.

The first thought that should come to mind is might not this be a mass that will simply go away by itself if I’m only smart enough to recognize that that will happen.

The reason for that is the vast majority of masses that are found in the ovaries of women of child bearing age are non neoplastic cysts. These are overwhelmingly the most common ovarian masses, and they will virtually always spontaneously regress.

Key to this is the fact that they’re seen in both pre- and post-menopausal women. So, just because you happen to know that it’s a post-menopausal woman should not mean that you exclude the notion that this may not be a neoplasm at all.

In Part II we will discuss the main non neoplastic cysts we will encounter most often.

–
Author: Roy A. Filly, MD
Excerpted from:
Diagnostic Imaging Review: For Residents, Fellows and Radiologists
Female Pelvis Section