Ovarian Cysts

Question 1

Describe the IOTA simple rules

Answer 1

• an approach to determine the likelihood that a cyst is malignant
• based on 10 ‘simple rules’
• 5 ultrasound features that are consistent with benign lesions
• 5 ultrasound features that are consistent with malignant lesions

Question 2

Describe the IOTA simple rules

Answer 2

• an approach to determine the likelihood that a cyst is malignant
• based on 10 ‘simple rules’
• 5 ultrasound features that are consistent with benign lesions
• 5 ultrasound features that are consistent with malignant lesions

Question 3

list the 5 ultrasound features associated with benign cysts

Answer 3

• unilocular cyst, any size
• solid components either not present, or less than 7mm in diameter
• presence of acoustic shadowing
• smooth multilocular cyst <10mm in size
• no blood flow

Question 4

List the 5 ultrasound features suggestive of a malignant tumour

Answer 4

• irregular, solid tumour
• ascites
• at least 4 papillary structures
• irregular, solid, multi-locular tumour, largest diameter over 10cm
• very strong colour flow

Question 5

List the 5 ultrasound features suggestive of a malignant tumour

Answer 5

• irregular, solid tumour
• ascites
• at least 4 papillary structures
• irregular, solid, multi-locular tumour, largest diameter over 10cm
• very strong colour flow

Question 6

Explain the ‘2 step strategy’

Answer 6

• some cysts can be defined instantly by their features e.g. endometrium, dermoid
• the 2 strep strategy incorporates this ‘instant’ detection, with the IOTA simple rules

Question 7

How sensitive and specific is the 2 step strategy?

Answer 7

• sensitivity of 98%
• specificity of 64%

Question 8

explain the 3 step strategy for risk stratifying cysts?

Answer 8

• 2 step
• 3rd step - expert sinologist further assesses a mass that is not otherwise classified by the two step strategy

Question 9

What are the typical features of a corpus luteum

Answer 9

• thickened wall
• circumferential colour doppler flow ‘ring of fire’
• small central lucency containing echoes

Question 10

what are the typical USS features of a dermoid cyst?

Answer 10

• markedly hyper echoic nodule within the cyst that casts shadows
• ‘distal acoustic shadowing’
• fluid - fluid level
• calcification may be present

Question 11

What are the typical features associated with an endometrioma?

Answer 11

• homogenous (ground glass) low to medium level echoes within a cystic mass in the absence of a solid component
• small echogenic foci in the inner wall of the cyst
• varying degrees of echogenicity in the locals

Question 12

What are the typical features associated with an endometrioma?

Answer 12

• homogenous (ground glass) low to medium level echoes within a cystic mass in the absence of a solid component
• small echogenic foci in the inner wall of the cyst
• varying degrees of echogenicity in the locules

Question 13

What are the typical USS features of a haemorrhage cyst?

Answer 13

• haemorrhage into a cyst - usually a follicle - can stimulate separations and nodules
• a fine network (fishnet appearance) of echoes in a reticular pattern
• the echoes do not span the full diameter of the cyst and therefore can be differentiated from true septae

Question 14

What are the typical USS features of a haemorrhage cyst?

Answer 14

• haemorrhage into a cyst - usually a follicle - can stimulate separations and nodules
• a fine network (fishnet appearance) of echoes in a reticular pattern
• the echoes do not span the full diameter of the cyst and therefore can be differentiated from true septae

Question 15

Describe the IOTA simple rules

Answer 15

• an approach to determine the likelihood that a cyst is malignant
• based on 10 ‘simple rules’
• 5 ultrasound features that are consistent with benign lesions
• 5 ultrasound features that are consistent with malignant lesions