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Hum. Reprod. Advance Access published online on June 10, 2004
Human Reproduction, doi:10.1093/humrep/deh353
© 2004 by European Society of Human Reproduction and Embryology
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Received October 27, 2003
Accepted May 11, 2004

Article

Sonographic assessment of non-malignant ovarian cysts: does sonohistology exist?

C.D. de Kroon 1, H.A.G.M. van der Sandt 1, J.C. van Houwelingen 2, F.W. Jansen 1*

1 Department of Gynaecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
2 Department of Medical Statistics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands

* To whom correspondence should be addressed. E-mail: f.w.jansen{at}lumc.nl.


  Abstract

BACKGROUND: Transvaginal ultrasound (TVU) is feasible and accurate in the differentiation between non-malignant and malignant ovarian abnormalities. However, despite the clinical relevance, the accuracy of TVU in the differentiation between the many different non-malignant cysts is unknown. METHODS: Between 1992 and 2002, all women who had surgery at our centre because of a non-malignant ovarian cyst were included prospectively in this study. The sonographic characteristics as well as the expected histological diagnosis (the ‘sonohistological diagnosis’) were evaluated pre-operatively. This diagnosis was compared with the histopathological diagnosis, and diagnostic parameters [with 95% confidence interval (CI)] of the sonohistological diagnosis were calculated. Logistic models, with the sonographic characteristics as variables, were constructed for each histopathological diagnosis. RESULTS: A total of 406 women were included consecutively. The overall diagnostic accuracy of the sonohistological diagnosis was 60% (95% CI 0.56-0.65). Only in cases of simple ovarian cysts did the diagnostic accuracy of the respective logistic model exceed that of the sonohistological diagnosis (0.88 versus 0.81 , P<0.01). The diagnostic accuracy of the sonohistological diagnosis for endometriotic and dermoid ovarian cysts was significantly better compared with the respective logistic model (0.84 versus 0.71, P<0.01 and 0.87 versus 0.82, P=0.03, respectively). CONCLUSION: In approximately half of the non-malignant ovarian cysts, TVU is capable of distinguishing between the different histopathological diagnoses of non-malignant ovarian masses. Only in the diagnosis of simple ovarian cysts might use of the logistic models be helpful.

Key words: adnexal disease, differential diagnosis, logistic regression, sensitivity and specificity, ultrasonography


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