An ultrasound is a non-invasive imaging technique that uses sound waves to create pictures of the body’s internal structures. When symptoms like pelvic pain or bloating occur, or if a physical exam reveals a possible abnormality, an ultrasound is a safe and effective first step. This technology helps medical professionals investigate the cause of symptoms in the pelvic region, including the ovaries, without using radiation.
The Ovarian Ultrasound Procedure
Two primary methods are used for an ovarian ultrasound: the transabdominal and transvaginal approaches. The transabdominal ultrasound involves applying a clear gel to the lower abdomen. A handheld device called a transducer is moved across the skin to transmit sound waves and capture images. For this procedure, the patient is asked to drink water beforehand to ensure a full bladder, which provides a clearer view of the ovaries.
A transvaginal ultrasound offers a more detailed look at the ovaries. For this internal examination, the patient lies on an examination table, often with their feet in stirrups, similar to a pelvic exam. A small, thin transducer, about the size of a finger and covered with a protective sheath and lubricant, is gently inserted into the vagina. While it may cause a feeling of pressure, the procedure is often painless.
The sound waves from the transducer bounce off the ovaries and surrounding tissues, creating echoes that a computer processes into real-time images. The entire process for either type of ultrasound is completed within 30 minutes. Patients can resume their normal activities immediately following the examination.
What an Ultrasound Can Reveal About the Ovaries
An ultrasound provides visual information about the ovaries’ physical characteristics. The test allows a medical professional to measure the size and observe the shape of each ovary, identifying deviations from the norm. It is effective at distinguishing between different types of structures that may be present on or within an ovary.
The technology is adept at identifying ovarian cysts, which are fluid-filled sacs, and can differentiate between a simple cyst and a complex mass. A simple cyst appears as a smooth, thin-walled sac containing only clear fluid and is almost always benign. A complex mass has more concerning features, such as solid components, thick or irregular walls, or internal divisions known as septations.
To further assess a mass, a Doppler ultrasound may be used during the same examination. This technique evaluates the flow of blood to and within the ovarian mass. The presence of significant blood flow within the solid parts of a mass can be a feature of malignant tumors, as they often develop new blood vessels to support their growth.
Interpreting Ultrasound Findings
An ultrasound cannot definitively diagnose ovarian cancer. Its primary role is to identify and characterize pelvic masses, flagging those with features suspicious for malignancy. A radiologist or gynecologist analyzes the images to differentiate between findings that are likely benign and those that require further investigation.
The interpretation hinges on a careful assessment of the mass’s structure, size, and complexity. For instance, a large, solid, irregularly shaped mass with high blood flow detected on Doppler is more suspicious than a small, simple, fluid-filled cyst.
Conversely, many findings on an ultrasound are benign. Functional cysts, which develop as part of the normal menstrual cycle, are common in premenopausal women and typically resolve on their own. These appear as simple, thin-walled cysts on an ultrasound. A physician evaluates the visual evidence to categorize the finding and decide on the appropriate action.
Next Steps After an Abnormal Ultrasound
When an ultrasound reveals a suspicious mass, the findings guide the subsequent steps. The management plan is tailored to the individual and the specific characteristics of the mass. Not all abnormal findings lead to immediate action; sometimes, a “watchful waiting” approach is recommended.
For a mass with some concerning features but that is not highly suspicious, a follow-up ultrasound may be scheduled in a few weeks or months. This allows the doctor to see if the mass has changed in size or appearance. If the findings are more worrisome, the physician will likely order additional tests to gather more information.
A common next step is a CA-125 blood test. CA-125 is a protein that can be elevated in the blood of women with ovarian cancer, although it can also be raised by other, non-cancerous conditions. Other imaging tests, such as a CT scan or MRI, may be ordered to get a more detailed view of the pelvic region and check if a mass has spread. A definitive diagnosis of ovarian cancer requires a biopsy, where a tissue sample is examined under a microscope. This is most often accomplished through surgery to remove the entire mass or ovary.