Evaluation of adnexal masses using three‐dimensional ultrasonographic technology: preliminary report

The purpose of the current study was to demonstrate the ability of three‐dimensional ultrasonographic technology to enhance the morphologic scoring system and further improve the ability to differentiate benign from malignant ovarian masses. We performed conventional two‐dimensional and three‐dimensional transabdominal and transvaginal ultrasonography on eight women with adnexal masses. All patients underwent exploratory laparotomy or diagnostic laparoscopy. The three‐dimensional ultrasonographic findings were compared with the two‐dimensional ultrasonograms, the intraoperative observations, and gross and histopathologic findings. The morphologic scoring system as described by Sassone and coworkers was adopted, with scores of less than 9 suggestive of benign lesions, and this system was applied in both the two‐dimensional and three‐dimensional ultrasonographic examinations. The morphologic scores were subsequently compared. The images were dissected in the XYZ planes, and the areas suggestive of malignancy, as suggested by two‐dimensional ultrasonography, were determined to be either negative or positive and confirmatory. In each of the eight adnexal masses, three‐dimensional ultrasonography confirmed the preoperative diagnoses. The morphologic scores did not differ between two‐dimensional and three‐dimensional ultrasonograms for the benign cysts. In one case of benign solid fibroma, both the two‐dimensional and three‐dimensional gray scale morphologic scores were falsely positive at greater than 9. In one case of malignant serous papillary cystadenocarcinoma the two‐dimensional morphologic score was a 9, where‐ as the three‐dimensional score was 13. This difference in scores can be attributed to the additional views available with three‐dimensional volume scanning, which allowed better characterization of the pathologic conditions. In addition, three‐dimensional sonographic technology had the added advantage of high‐speed image acquisition and recording to decrease the time of scanning to improve patient comfort. Furthermore, three‐dimensional ultrasonography allowed the real‐time analysis of the acquired image data to be conducted at a later time when the patient is off the examination table. Our preliminary results suggest that three‐dimensional transvaginal ultrasonographic technology can enhance and facilitate the morphologic evaluation of both benign and malignant adnexal masses.