ACCURACY OF SONOGRAPHIC FEATURES TO DIAGNOSE MALIGNANCY IN OVARIAN CYSTS – IN A TERTIARY CARE HOSPITAL BAHAWALPUR – PAKISTAN

Introduction: Ovarian mass is a common clinical problem in reproductive age women, and ovarian malignancy presents late and thus at an advanced stage. That is the reason for its poor 5 year survival despite all advances in gynaecological surgery and oncological chemotherapeutics. It is extremely essential to estimate the risk of malignancy before deciding on the type of surgery for a patient with an ovarian cyst or mass. Objective was determine the sensitivity and specificity of individual sonographic features to predict malignancy in ovarian tumours. Methods: It was a cross – sectional study. Clinical and sonographic evaluation of 220 patients presenting with ovarian cysts to Department of Gynaecology, Bahawal Victoria Hospital Bahawalpur was followed by histological examination at Department of Pathology, Quaid-e-Azam Medical College Bahawalpur. Results: We analysed 220 cases of ovarian masses. Mean age of patients was 47.3 ± 3.8 years. Most common (57.3%) presenting complaint among these patients was abdominal pain followed by distension and palpable mass (21.8% and 19.1% respectively). On ultrasonography, ecogenicity, papillary projections and multilocularity were commonly observed in malignant cases. Colour Doppler was used to estimate the blood flow. On histopathology, 207 (94.1%) were diagnosed as benign and only 13 (5.9%) as malignant. Among benign, most common diagnoses were follicular / luteal cysts (34.8%) followed by serous cystadenoma (24.6%) and serous cysts (15.4%). Among malignant, 6 (46.2%) were serous cystadenocarcinoma, 3 (23.1%) were mucinous adenocarcinoma and 2 (15.4%) were granulose cell tumor. Conclusion: Most of ovarian masses are diagnosed as benign. Sonographic features especially increased ecogenicity, solid component, papillary projections, multilocularity and increased blood flow do predict malignant behavior but their sensitivity is low.