Can transabdominal shear wave elastography play a role in solving the dilemma of complex cystic and solid ovarian tumors by ultrasound?

Abstract

Purpose: We aimed to assess the role of shear wave elastography in better characterizing complex cystic and solid ovarian tumors in correlation with other ultrasound features and histopathology.

Materials and methods: The study included 40 patients with 40 unilateral complex cystic or solid ovarian lesions with a mean age of 43.2 ± 13.27 (mean ± SD). All patients were subjected to history taking, tumor markers assessment, ultrasound with Doppler assessment giving an ORADS score, and shear wave elastography assessment. (qualitatively and quantitatively). Correlation was done with the final histopathology.

Results: According to the final histopathological results of the 40 lesions, 14 (35%) were benign, four were borderline (10%), and 22 (55%) were malignant. Ultrasound and Doppler assessments revealed a higher frequency of irregular margins and Doppler score 4 in borderline/malignant patients compared to benign patients. ORADS ultrasound scoring system of the examined lesions showed a statistically significantly higher frequency of ORADS 5 in the malignant group, with ORADS sensitivity, specificity, and Diagnostic accuracy of 96.2%, 57.1, and 82.5%, respectively. Elastographic color mapping scores and elastographic readings were higher in borderline/malignant patients compared to benign patients and it significantly correlated with the Doppler score, ORADS score, color mapping score, and tumor markers.

Conclusion: The study detected significant associations between malignancy and higher tumor markers, marginal irregularity, higher Doppler, and higher ORADS scores. Shear wave elastography positively correlated with tumor markers, Doppler score, and ORADS score. This supports the utility of elastography in discriminating malignant from benign ovarian tumors.