Value of ultrasonographic detection of normal ovarian tissue in the differential diagnosis of adnexal masses in pediatric patients

Abstract

Objective The aim of the study was to evaluate whether the presence of normal ovarian tissue, the 'ovarian crescent sign' (OCS), could assist in the differential diagnosis between benign and malignant adnexal masses in young patients. Methods This was a prospective observational study, from March 2004 to January 2006, which included 98 patients younger than 20 years of age (including two with bilateral tumors) with an ultrasonographic diagnosis of an adnexal mass. Morphological assessment using the Ueland index was performed in each case. Patients were also systematically examined for the presence of the OCS and a comparison was made with the Ueland index. All findings in surgically treated patients were compared with the final histological diagnosis. Results There were 100 adnexal masses:90 were benign and 10 were malignant. Forty-eight were managed expectantly and 52, including 17 cases of adnexal torsion, underwent surgical treatment. The OCS was found in 65 (72%) benign adnexal masses and in one (10%) noninvasive malignant tumor. A Ueland index score of <7 was found in 85 (94%) benign masses and in one (10%) non-invasive malignancy. The OCS was seen in 15 (45%) of 33 masses in premenarchal patients and in 51 (76%) of 67 masses in postmenarchal patients. The OCS was absent in 15 (88%) of the torsioned adnexal masses. Conclusions The presence of normal ovarian tissue adjacent to an ovarian mass is a useful morphological feature that can assist exclusion of a malignant tumor in pediatric and adolescent patients. When compared with the Ueland index, diagnostic sensitivity of the OCS is similar, but specificity is lower. The presence of the OCSis significantly less frequent in premenarchal patients thanin postmenarchal patients. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.