Ovarian ultrasound is a primary imaging method used to assess masses or other abnormalities in the ovaries. It employs high-frequency sound waves to generate real-time images of the ovaries and adjacent pelvic structures. This non-invasive technique is favored as an initial diagnostic step because it is widely available and does not involve radiation.
The Ultrasound Procedure and What is Examined
An ovarian ultrasound can be performed using one of two methods: transabdominally or transvaginally. The transabdominal approach involves moving a handheld device called a transducer across the lower abdomen. This method provides a broad overview of the pelvic region. For a more detailed examination, a transvaginal ultrasound is often preferred. This technique uses a smaller, specialized transducer placed inside the vagina, allowing for closer proximity to the ovaries and yielding clearer, higher-resolution images.
During the examination, a sonographer or radiologist carefully assesses several aspects of the pelvic anatomy. The primary focus is on the ovaries, where their size, shape, and overall texture are evaluated. The specialist also examines the uterus and the surrounding pelvic area for any related findings. One such finding is the presence of ascites, which is an accumulation of fluid in the pelvic cavity that can sometimes be associated with ovarian conditions.
Interpreting Ultrasound Features of Ovarian Masses
Radiologists analyze specific characteristics of an ovarian mass to help determine its nature. These features, identifiable on the ultrasound image, provide insight into whether a mass is likely benign or requires more investigation.
A fundamental distinction is made between simple and complex masses based on their composition. A simple cyst is a fluid-filled sac with thin walls and no internal structures; these are almost always benign. In contrast, a complex mass contains both fluid and solid material. The presence of solid components within a mass is a significant feature that prompts careful evaluation by the radiologist.
Septations, which are thin walls that divide a cyst into multiple compartments, are another feature of interest. Thin, smooth septations are less concerning. However, if the septations are thick, measuring over 3 millimeters, and appear irregular, they can be an indicator of a more suspicious lesion.
Papillary projections are small, cauliflower-like growths that extend from the inner wall of a cyst into its center. The presence of these projections is considered a suspicious finding that merits closer examination. They represent areas of cellular growth that are not typical for simple cysts and can be associated with more complex processes.
To further assess a mass, a Doppler ultrasound may be used. This technology evaluates blood flow within the mass. A high amount of blood flow, especially within the solid parts of a tumor, can be a sign of increased cellular activity.
Common Types of Ovarian Findings
The features observed on an ultrasound help to classify ovarian masses into different types, each with a typical appearance. Many findings are benign and do not indicate cancer. Understanding these common types can provide context for the ultrasound results.
Functional cysts, such as follicular cysts, are common in premenopausal women and are simple, fluid-filled sacs that usually resolve on their own. Endometriomas, sometimes called “chocolate cysts,” are associated with endometriosis and have a distinct “ground-glass” appearance on ultrasound due to old blood inside them. Dermoid cysts, a type of teratoma, are another benign tumor that can contain various tissues like fat, hair, or even teeth, giving them a unique and complex look on the scan.
Conversely, certain features raise concern for a suspicious or malignant finding. Masses with thick, irregular walls, solid components, and papillary projections are more likely to be suspicious, as is increased blood flow detected by Doppler. It is the combination of these features, rather than a single one, that determines the level of suspicion and requires further evaluation.
Limitations and Next Steps
While ultrasound is a powerful imaging tool, it cannot definitively diagnose ovarian cancer. A definitive diagnosis requires histopathology, which is the microscopic examination of a tissue sample obtained through a biopsy. The ultrasound report is one part of a larger diagnostic process.
Following an ultrasound that shows a suspicious mass, several next steps are taken to gather more information. A blood test to measure the level of a protein called CA-125 may be ordered. CA-125 can be elevated in ovarian cancer, but it can also be raised by many benign conditions, so it is interpreted in conjunction with other findings.
Further imaging with an MRI or CT scan might be recommended. These scans can provide more detailed views of the mass and help determine if there is any evidence of spread to other parts of the body. Based on all this information, a referral to a gynecologic oncologist is often the next step. These specialists have expertise in cancers of the female reproductive system and can provide a comprehensive evaluation and plan for management.