Pelvic imaging for ovarian pathology
Transvaginal ultrasound (TVUS) remains the primary imaging modality for detecting and characterising ovarian lesions with the aim to categorise ovarian masses as likely benign or malignant, in order to triage to appropriate treatment pathways.
Most ovarian lesions are benign and can either be managed expectantly or by minimally invasive techniques, while lesions with a high suspicion for malignancy require referral to a cancer centre for specialist surgery.
Ultrasound can be used to accurately discriminate between benign and malignant ovarian lesions in the majority of cases. For an experienced examiner, the most effective technique is the subjective or so-called ‘pattern recognition’ approach, although up to 20% of lesions will remain indeterminate. In recent years, the International Ovarian Tumour Analysis (IOTA) group has developed ‘Simple Rules’ in an attempt to standardise the ultrasound reporting of benign and malignant adnexal masses. For masses that remain indeterminate at ultrasound, MRI is used as a problem-solving technique.
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