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The preoperative evaluation of ovarian tumors can be improved?

        To the Editors: We read with interest the article by Osmers et al. (Osmers RGW, Osmers M, von Maydell B, Wagner B, Kuhn W. Preoperative evaluation of ovarian tumors in the premenopause by transvaginosonography. Am J Obstet Gynecol 1996;175:428-34) who investigated the use of simple sonomorphologic criteria. We appreciate the interest of the authors on the crucial role of persistence of the mass to reduce unnecessary surgery in premenopause but, in our opinion, the conclusion that, with the exception of simple ovarian cysts, the cancer should be encountered in all other ultrasonographic groups is misleading, also because it is not supported by an adequate statistical analysis. As a matter of fact, with use of the suggested criteria in a premenopausal population that is characterized by a high rate of endometriomas and dermoid cysts (33% and 14%, respectively),
        • Guerriero S
        • Ajossa S
        • Paoletti AM
        • Mais V
        • Angiolucci M
        • Melis GB.
        Tumor markers and transvaginal ultrasonography in the diagnosis of endometrioma.
        a safe laparoscopy could be never performed. On the contrary, these benign ovarian masses are characterized by very simple ultrasonographic findings not described by Osmers et al. In fact, the presence of a round homogeneous hypoechoic "tissue" of low-level echoes with a clear demarcation from the parenchyma and without papillary proliferations is characteristic of endometrioma,
        • Mais V
        • Guerriero S
        • Ajossa S
        • Angiolucci M
        • Paoletti AM
        • Melis GB.
        The efficiency of transvaginal ultrasonography in the diagnosis of endometrioma.
        and areas of focal or diffuse dense echogenicity frequently associated with posterior shadowing were present in dermoid cysts.
        • Mais V
        • Guerriero S
        • Ajossa S
        • Angiolucci M
        • Paoletti AM
        • Melis GB.
        Transvaginal ultrasonography in the diagnosis of cystic teratoma.
        These ultrasonographic findings demonstrated a strong agreement between test result and surgery with both κ values of 0.84.
        • Guerriero S
        • Ajossa S
        • Paoletti AM
        • Mais V
        • Angiolucci M
        • Melis GB.
        Tumor markers and transvaginal ultrasonography in the diagnosis of endometrioma.
        • Mais V
        • Guerriero S
        • Ajossa S
        • Angiolucci M
        • Paoletti AM
        • Melis GB.
        Transvaginal ultrasonography in the diagnosis of cystic teratoma.
        Ovarian cancer in premenopause showed ultrasonographic aspects different from those described as characteristic of endometriomas and dermoid cysts. With these two simple and reproducible findings we never misdiagnosed an ovarian cancer in the published studies
        • Guerriero S
        • Ajossa S
        • Paoletti AM
        • Mais V
        • Angiolucci M
        • Melis GB.
        Tumor markers and transvaginal ultrasonography in the diagnosis of endometrioma.
        • Mais V
        • Guerriero S
        • Ajossa S
        • Angiolucci M
        • Paoletti AM
        • Melis GB.
        The efficiency of transvaginal ultrasonography in the diagnosis of endometrioma.
        • Mais V
        • Guerriero S
        • Ajossa S
        • Angiolucci M
        • Paoletti AM
        • Melis GB.
        Transvaginal ultrasonography in the diagnosis of cystic teratoma.
        and >500 persistent ovarian masses undergoing surgery in our department from 1991. A very low risk of misdiagnosis should be always present but can be further reduced by thorough inspection at laparoscopy characterized by a high sensitivity and by selecting a population with a low risk of ovarian malignancy, such as patient <39 years old. Operative laparoscopy is demonstrated to be safe and to have benefits for the patient undergoing surgery for simple cysts, ovarian endometrioma, and dermoid cyst in the form of reduced postoperative pain, shorter hospital stay, and faster recovery. For these reasons, in premenopausal women with a persistent ovarian mass it is correct to perform operative laparoscopy on those patients in whom preoperative transvaginal ultrasonography identifies the characteristic findings of endometriomas and dermoid cysts.
        Stefano Guerriero, MD, Silvia Ajossa, MD, Gian Benedetto Melis, MD, Department of Obstetrics and Gynecology of the University of Cagliari, Ospedale S. Giovanni di Dio, Via Ospedale 46, 09124, Cagliari,
        6/8/82731
        NO LABEL6/8/82731

        References

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          • Ajossa S
          • Paoletti AM
          • Mais V
          • Angiolucci M
          • Melis GB.
          Tumor markers and transvaginal ultrasonography in the diagnosis of endometrioma.
          Obstet Gynecol. 1996; 88: 403-407
          • Mais V
          • Guerriero S
          • Ajossa S
          • Angiolucci M
          • Paoletti AM
          • Melis GB.
          The efficiency of transvaginal ultrasonography in the diagnosis of endometrioma.
          Fertil Steril. 1993; 60: 776-780
          • Mais V
          • Guerriero S
          • Ajossa S
          • Angiolucci M
          • Paoletti AM
          • Melis GB.
          Transvaginal ultrasonography in the diagnosis of cystic teratoma.
          Obstet Gynecol. 1995; 85: 48-52