Comparación de los diferentes scores ecográficos en la clasificación de las masas anexiales

Resumen

Ultrasound is an essential tool in the characterization of the adnexal masses. Different international societies have agreed the terms and definitions for their description helping the sonographer to define the study protocol. The opinion of an experienced sonographer (Subjective Assessment) has the greatest diagnostic validity in the differentiation between benignity and malignancy of this lesions. However, given the impossibility of general access to expert sonographers, different ultrasound scores have been designed to help other less experienced sonographers. The IOTA group (International Ovarian Tumor Analysis) initially published the IOTA Simple Rules, which, using simple descriptors and application rules, differentiated between benign lesions, malignant or unclassified, with good accuracy. In addition, an on-line application was added that allowed a quantitative calculation of the probability of malignancy (IOTA SRRA, International Ovarian Tumor Analysis Simple Rules Risk Assessment). The same group also introduced the ADNEX model (Assessment of Different Neoplasms in the Adnexa), that included the assessment of some clinical predictors (age, CA125) in addition to certain ultrasound characteristics. It is also an on-line calculator and the results include the probability in percentages and bar diagrams of the risk of benignity, malignancy or borderline of an adnexal lesion including the different stages of malignancy was detected (stage I, II-IV, ovarian metastasis). Subsequently, the ACR (American College of Radiology), based on the terminology described by the IOTA group, published the O-RADS (Ovarian Adnexal Reporting and Data System) which differentiates, according to the ultrasound characteristics, between 6 groups (O-RADS 0-5) assigning each group to a probability of malignancy and including a management suggestion. Different aspects of these classifications have been assessed in this assay. First of all (Article 1), the different ultrasound scores (IOTA Simple Rules, Simple Rule Risk Assessment, O-RADS, ADNEX-Model with and without CA125) as well as the subjective impression of the experienced sonographer (Subjective Assessment) were evaluated. We concluded that they can effectively be used in the differentiation of benign and malignant masses and are similar to the subjective evaluation of an experienced sonographer. Secondly (Article 2), we tried to identify which ultrasound characteristics included in the ultrasound scores were associated with benignity or malignancy. We found that there are certain items related to malignancy such as irregular contour, absence of acoustic shadowing, presence of vascularized solid areas, detection of papillae, vascularized septum, or moderate-severe ascites. Finally (Article 3), the adnexal masses that were not classified correctly using ultrasound scores were analysed. Ultrasound features were studied and the application of the scores was evaluated. We concluded that some malignant masses (borderline ovarian tumors, serous carcinoma, clear cell carcinoma, endometrioid carcinomas) are not always classified as malignant according to some ultrasound scores. Other lesions (fibroids, cystoadenofibromas, some mucinous cystadenomas and most Brenner tumors) could have characteristics associated with malignancy (solid components/papillae) and could be confused with malignant lesions. In conclusion, we have studied the application of ultrasound scores to adnexal masses, their characterization, as well as the identification of certain features that can help in the differentiation between benignity and malignancy.