YEŞİM BAYOĞLU TEKİN, ŞADIMAN KIYKAÇ ALTINBAŞ, F. Suat DEDE, Berna DİLBAZ

Dermoid kistlerde ultrasonografik tanı doğruluğunu etkileyen parametreler

Amaç: Ultrasonografinin dermoid kist tanısındaki yeterliliğini belirlemek ve histopatolojik olarak farklı tanı alan olgularda sonografik tanısal hata nedenlerini ortaya koymak. Yöntemler: Adneksiyal kitle tespit edilen ardışık 245 olgudan ultrasonografik ve histopatolojik olarak dermoid kist tanısı alanlar çalışmaya dahil edildi. Preoperatif ultrasonografi bulguları ile postoperatif patoloji sonuçları de- ğerlendirildi ve preoperatif ultrasonografik görüntüleme ile postoperatif patoloji sonuçları arasındaki ilişki araştırıldı. Bulgular: Dermoid kist tanısı ultrasonografi ile %81,8 sensitivite, %93,1 spesifite, %67,5 pozitif öngörü değeri, %96,7 negatif öngörü değeri ile tanımlandı. Ultrasonografi ile dermoid kist tespitinde kist duvar kalınlığının 3 milimetreden fazla olmasının (p=0,029), duvar iç konturunun düzensiz olması (p=0,001) ve hiperekojenik ince çizgilenmeye bağlı olarak karışık ekojenitenin izlenmesinin (p=0,003), solid komponent (p=0,001), akustik gölgelenme (p=0,001), kalsifikasyon (p=0.001) ve ekojenik mural nodül (p=0,001) saptanmasının istatistiksel olarak anlamlı oranda yüksek olduğu görüldü. Doppler sonografide vaskularite tespitinin dermoid kist tespitinde istatistiksel olarak anlamlı olmadığı görüldü (p=0,52). Sonuç: Adneksiyel kitlelerin ultrasonografi ile subjektif olarak değerlendirilerek tanı konulmasına patern tanıma yöntemi denilmektedir. Adneksiyal kitlelerin tanınmasında patern tanıma yöntemi, diğer yöntemlere oranla yüksek doğruluk oranına sahiptir ve spesifik tanıya gitmede daha güvenilirdir. Dermoid kistlerde hiperekojenik ince çizgilenme ve hiperekojenik solid yapı karakteristik özellik olmakla birlikte, bu parametrelerin aynı zamanda yanlış tanı konulmasına sebep olan parametreler olduğu görülmüştür.

The parameters affecting accuracy of e ultrasonographic diagnosis in dermoid cysts

Objective: To determine the adequacy of ultrasound in diagnosis of dermoid cysts and to demonstrate the causes of ultrasonographic failure in histopathologically misdiagnosed cases. Methods: Of 245 consecutive patients, whom an adnexal mass is determined and the preliminary ultrasonographic diagnosis of the cyst was a dermoid csyt, were included in the study. Preoperative ultrasonographic findings and postoperative pathology results were evaluated and the correlation with pre-operative ultrasound imaging and final pathologic results were analyzed. Results: The diagnosis of a dermoid cyst with ultrasonography was detected with the following rates of sensitivity 81.8%, specifity 93.1%, positive predictive value 67.5%, negative predictive value 96.7%. A wall thickness greater than 3 mm (p=0.029), inner wall irregularity (p=0.001), mixed echogenity according to hyperechogenic lines p=0.003), solid component (p=0.001), acoustic shadowing (p=0.001), calcification (p=0.001), echogenic mural nodule (p=0.001), were found to be statistically significant (p<0.001) in ultrasonographic diagnosis of dermoid cysts. Determination of vascularity in Doppler sonography was not found statistically significant in diagnosis of dermoid cysts (p=0.52). Conclusion: Pattern recognition method is a method that evaluates and diagnoses adnexal masses by ultrasonography subjectively. It was shown to be more reliable with high accuracy rates in specific diagnosis of adnexial masses when compared to that of other methods. Even though hyperechogenic lines and hyperechogenic solid masses were characteristic findings for dermoid cysts, these parameters were found to be the most frequent causes of misdiagnosis.

PDF

___

1. Talerman A. Germ cell tumors of the ovary. Curr Opin Obstet Gynecol 1997;9:44-47.
2. Talerman A. Germ cell tumors of the ovary. In:Kurman RJ, ed. Blausteins pathology of the female genital tract 5th edition. Newyork: Springer; 2002. 997.
3. Serafini G, Quadri PG, Gandolfo NG, et al. Sonographic Features of Incidentally Detected, Small, Nonpalpable Ovarian Dermoids. J Clin Ultrasound 1999;27:369-373.
4. Momtahen AJ, Zawin J. Mature ovarian cystic teratoma (dermoid cyst). Ultrasound Q 2012;28:175-177.
5. Patel MD, Feldstein VA, Lipson SD, et al. Cystic teratoma of the ovary: diagnostic value of sonography. Am J Roentgenol 1998;171:1061-1065.
6. Hertzberg BS, Kliewer MA. Sonography of benign cystic teratoma of the ovary: pitfalls in diagnosis. Am J Roentgenol 1996;167:1127-1133.
7. Sokalska A, Timmermen D, Testa AC, et al. Diagnostic accuracy of transvaginal ultrasound examination for assigning a specific diagnosis to adnexal masses. Ultrasound Obstet Gynecol 2009;34:462470.
8. Valentin L. Use of morphology to characterize and manage common adnexal masses. Best Pract Res Clin Obstet Gynaecol 2004;18:71-89.
9. Hoo W, Yazbek J, Holland T, et al. Expectant management of ultrasonically diagnosed ovarian dermoid cysts: is it possible to predict outcome? Ultrasound Obstet Gynecol 2010;36:235240.
10. Timmerman D, Valentin L, Bourne TH, et al. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol 2000;16:500-505.
11. Jacobs I, Oram D, Fairbanks J, et al. A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynaecol 1990;97:922929.
12. Lerner JP, Timor-Tritsch IE, Federman A, et al. Transvaginal ultrasonographic characterization of ovarian masses with an improved, weighted scoring system. Am J Obstet Gynecol 1994;170:8185.
13. Tailor A, Jurkovic D, Bourne TH, et al. Sonographic prediction of malignancy in adnexal masses using multivariate logistic regression analysis. Ultrasound Obstet Gynecol 1997;10:4147.
14. Timmerman D, Bourne T, Tailor A, et al. A comparison of methods for preoperative discrimination between malignant and benign adnexal masses: The development of a new logistic regression model. Am J Obstet Gynecol 1999;181:5765.
15. Timmerman D, Verrelst H, Bourne TH, et al. Artificial neural network models for the preoperative discrimination between malignant and benign adnexal masses. Ultrasound Obstet Gynecol 1999;13:1725.
16. Tailor A, Jurkovic D, Bourne TH, et al. Sonographic prediction of malignancy in adnexal masses using an artificial neural network. Br J Obstet Gynaecol 1999;106:2130.
17. Timmerman D, Schwarzler P, Collins WP, et al. Subjective assesment of adnexal masses with the use of ultrasonography: an analysis of interobserver variability and experience. Ultrasound Obstet Gynecol 1999;13:11-16.
18. Caspi B, Appelman Z, Rabinerson D, et al. Pathognomic echo patterns of benign cystic teratomas of the ovary: classification, incidence and accuracy rate of sonographic diagnosis. Ultrasound Obstet Gynecol 1996;7:275-279.
19. Guerriero S, Alcazar JL, Pascual MA, et al. Diagnosis of the most frequent benign ovarian cysts: Is ultrasonography accurate and reproducible? J Womens Health 2009;18:519- 27.
20. Mais V, Guerriero S, Ajossa S, et al. Transvaginal sonography in the diagnosis of cystic teratoma. Obstet Gynecol 1995;85:48-52.
21. de Kroon CD, van der Sandt HA, van Houwelingen JC, et al. Sonographic assesment of non-malignant ovarian cysts: does sonohistology exist? Hum Reprod 2004;19:2138- 2143.
22. Malde HM, Kedar RP, Chadha D, et al. Dermoid mesh: a sonographic sign of ovarian teratoma. Am J Roentgenol 1992;159:349-1350.
23. Tongsong T, Wanapirak C, Khunamornpong S, et al. Numerous intracystic floating balls as a sonographic feature of benign cystic teratoma: report of five cases. J Ultrasound Med 2006;25:1587-1591.
24. Guerriero S, Mais V, Ajossa S, et al. The role of endovaginal ultrasound in differantiating endometriomas from the other ovarian cysts. Clin Exp Obstet Gynecol 1995;22:20-22.
25. Aybar MD, Barut YA, Öztürk A, et al. Matur Kistik Teratomların Görüntüleme Özellikleri: US, BT, MRG Bulguları. İstanbul Tıp Dergisi 2010;1:24-28.
26. Kurjak A, Kupesic S, Babic MM, et al. Preoperative evaluation of cystic teratoma: What does color Doppler add? J Ultrasound Med 1997;25:309-316.
27. Patel MD. Practical approach to the adnexal mass. Radiol Clin North Am 2006;44:879-899.