From the Guidelines
Transabdominal ultrasound can detect ovarian lesions, but its effectiveness is limited by factors such as lesion size, patient obesity, and bowel gas, and transvaginal ultrasound is generally superior for evaluating ovarian pathology. The visibility of ovarian lesions on transabdominal ultrasound is affected by patient factors, and this imaging technique may identify larger ovarian lesions (typically greater than 2-3 cm), but smaller lesions might be missed 1. Transvaginal ultrasound is widely accepted as the initial imaging modality of choice for assessing adnexal pathology, with a sensitivity of over 90% 1. For optimal assessment of suspected ovarian lesions, a combination of both transabdominal and transvaginal approaches is often recommended, as the transvaginal component allows for detailed evaluation and the transabdominal component is helpful for larger lesions that may be suboptimally seen transvaginally 1.
Some key points to consider when evaluating ovarian lesions with ultrasound include:
- The use of contrast-enhanced ultrasound (CEUS) can be a useful real-time technique to demonstrate the presence of internal vascular soft tissue component in an indeterminate ovarian lesion that increases the risk of malignancy 1
- The International Ovarian Tumor Analysis (IOTA) simple rules can be applied to CEUS to reduce indeterminate masses and improve diagnostic accuracy 1
- Transvaginal ultrasound is superior for evaluating ovarian pathology, but transabdominal ultrasound can be useful for larger lesions or when transvaginal ultrasound is not possible 1
It is essential to discuss the most appropriate imaging technique with a healthcare provider for accurate diagnosis, as the choice of imaging modality depends on various factors, including patient symptoms, medical history, and the suspected location and size of the ovarian lesion 1. The most recent and highest quality study recommends a combination of transvaginal and transabdominal ultrasound for optimal assessment of suspected ovarian lesions 1.
From the Research
Tranabdominal Ultrasound for Ovary Lesions
- Tranabdominal ultrasound can be used to detect ovary lesions, but its accuracy may vary compared to other imaging methods like transvaginal ultrasound or computed tomography (CT) 2, 3.
- A study from 1991 outlined the sonographic appearances of most ovarian tumors using both transabdominal and transvaginal sonography, suggesting that transabdominal sonography can be useful in detecting ovarian masses 3.
- However, another study from 1997 found that transvaginal ultrasonography has a closer accuracy in the diagnosis of serous cysts, serous cystadenoma, ovarian carcinoma, and endometrioma compared to CT, even when CT is associated with clinical and biochemical parameters 2.
- A more recent study from 2022 compared the performance of transvaginal and transabdominal ultrasound with CT and whole-body diffusion-weighted MRI in the assessment of peritoneal involvement, lymph-node staging, and prediction of non-resectability in patients with suspected ovarian cancer, finding that ultrasound performed better than CT in the assessment of overall peritoneal carcinomatosis 4.
Limitations and Comparisons
- Transabdominal ultrasound may have lower sensitivity and specificity compared to transvaginal ultrasound or other imaging methods in certain cases, such as the detection of carcinomatosis in the pelvis or the evaluation of deep rectosigmoid wall infiltration 4.
- A study from 1994 found that transabdominal and transvaginal ultrasound had similar prevalence rates for polycystic ovaries in a population of randomly selected women, but almost 20% of the women declined a transvaginal ultrasound examination 5.
- The role of transvaginal ultrasound in screening for ovarian cancer has been investigated in several trials, with mixed results regarding its effectiveness in reducing mortality 6.