Which ultrasound findings are characteristic of malignant ovarian tumors?

Updated: Feb 27, 2019
  • Author: Arthur C Fleischer, MD; Chief Editor: Eugene C Lin, MD  more...
  • Print
Answer

Answer

Malignant ovarian tumors tend to have papillary excrescences, irregular walls, and/or thick septations. [5, 1, 24, 25, 26] The tumor can contain echogenic material arising from mucin or protein debris. The more solid the areas are, the greater the likelihood that a tumor is present. Typically, intraperitoneal fluid is present; this is a sign of peritoneal spread.

On color Doppler ultrasonograms, tumors tend to have vessels with low impedance because of the lack of muscular media in the vessel wall and arteriovenous shunts. The vessels tend to be clustered. 

(See the images and video below.)

Transvaginal ultrasonogram shows the right ovary, Transvaginal ultrasonogram shows the right ovary, which contains a cystic mass with a papillary excrescence (arrow). This finding is highly indicative of an ovarian neoplasm.
Transvaginal and color Doppler ultrasonograms of s Transvaginal and color Doppler ultrasonograms of stage I ovarian cancer. Top: Note the marked thickening and irregularity in the wall of this left adnexal cyst. Bottom: Color Doppler ultrasonogram shows very low impedance flow within the wall, which indicates an ovarian tumor.
Transvaginal, color Doppler ultrasonogram shows a Transvaginal, color Doppler ultrasonogram shows a solid mass in the left ovary. Low impedance flow is noted within this mass, which is a clear cell carcinoma of the ovary.
Note the marked thickening and irregularity of the Note the marked thickening and irregularity of the wall of this left adnexal cyst.
Color Doppler ultrasonogram shows low impedance fl Color Doppler ultrasonogram shows low impedance flow within the wall, which indicates an ovarian tumor.
Three-dimensional, color Doppler ultrasonogram shows a cystic mass containing a vascular papillary excrescence; this is indicative of ovarian cancer.

The ultrasonographic finding that is most indicative of ovarian cancer is papillary excrescence, which is present in more than 50% of ovarian malignancies. Low impedance and clustered vessels have a 70-80% diagnostic accuracy. [7]

Tubo-ovarian abscesses may mimic the ultrasonographic appearance of ovarian cancer, but patients with abscesses typically present with symptoms that are attributable to an inflammatory process.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!