OP21.03: Inversion image analysis and Doppler: a novel technique to differentiate between malignant and benign ovarian masses during ultrasound examination

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To simplify the preoperative diagnosis of ovarian masses identified during ultrasound examination. Women with at least one ovarian mass were included (n = 363) and underwent preoperatively transvaginal ultrasound, based on IOTA protocol. Doppler images and 3D-volumes were stored The masses were categorized based on their histological pattern: SC/Serous cysts: 45, E/Endometrioma: 79, C/Cystadenoma: 43, T/Teratoma: 40, I/Inothecoma: 16, He/Hemorrhagic: 18, H/Hydrosalpinx: 35, SiC/Simple cysts: 32, B/Borderline: 2, M/Malignant: 53. We created the main 3D rotation image applying Voluson software. Using the magic cut tool, the mass was outlined and inverted. The signals produced by the resulting images were calculated as a percentage of their difference. Doppler images were divided into 3 groups based on the location of the pulse beat compared to the horizontal axis: a/ the pulse beat is limited above the axis b/ the pulse beat barely traceable is observed beneath and c/ the pulse beat is situated on both sides. The % of difference between the magic cut and the inverted volume was significantly different between benign and malignant groups (SC: 214 ± 21, E: 80 ± 7, C: 158 ± 20, T: 91 ± 15, I: 157 ± 37, He: 131 ± 28, H: 87 ± 9, SiC: 136 ± 23, B: 182 ± 105, M: 60 ± 3; P < 0.01). Most of the benign masses (91% of the cases) changed almost totally after inversion. In the malignant group, 30 lesions altered by > 50%. In these masses, the pulse beat was situated on both sides (23) or beneath the horizontal axis (7), while the majority of the benign masses showed pulse beat pattern limited above it (P = 0.01). Although these are preliminary data, we propose that in suspicion of malignancy of ovarian lesion during ultrasound, combination of the comparison between the 3D magic cut and inverted image with Doppler appearance could delineate the nature of the mass. Pulse beat situated on both sides of the horizontal axis enhances the possibility of malignancy.

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