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2. With the increased use of transvaginal sonography more adnexal masses are being detected in postmenopausal patients. • Screening studies have indicated that approximately 3% to 5% of asymptomatic postmenopausal women will have an adnexal mass confirmed sonographically. • Pelvic examination is inadequate in assessing ovarian size. Therefore, ultrasound is often used in addition to clinical examination. דר' דפנה מיצד

3. Management of benign ovarian tumors and ovarian cancer is quite different. • Accurate preoperative assessment of the risk of malignancy in adnexal tumors is very important. • An effective system for predicting risk of malignancy in ovarian tumors will allow proper individualization of treatment. דר' דפנה מיצד

4. Ultrasound Evaluation More than 3000 postmenopausal women with unilocular ovarian cysts were monitored. The majority of which were less than 5 cm in diameter. During US follow up for an average of 6 years approximately 70% of these ovarian cysts resolved Spontaneously. No patient had ovarian cancer develop. The risk of malignancy in unilocular cystic ovarian tumors less than 5 cm in diameter was essentially nonexistent. דר' דפנה מיצד

5. 250 complex ovarian tumors were identified in the same screening population. Spontaneous resolution occurred in 135 (54%) of these tumors, but 115(45%) persisted and were removed surgically. 8 of them (3%) had ovarian or primary peritoneal cancers • All persisting complex ovarian tumors in postmenopausal women should be removed surgically as soon as possible. דר' דפנה מיצד

6. Morphology Index • Based on tumor volume, wall structure, and septal structure. • Wall structure was the most reliable morphologic criterion • A modified MI based on tumor volume and wall structure. • Tumor volume= length*width* height x0.523 • This MI was easy to interpret and interobserver variation was minimal. דר' דפנה מיצד

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10. MI ≥ 5 indicative of malignancy was associated with sensitivity 0.981, specificity 0.808, PPV 0.409, NPV 0.997. • Morphologic indexing, based on sonographically derived images, is a relatively accurate and cost-effective method to predict risk of malignancy in an ovarian tumor. דר' דפנה מיצד

11. Doppler Flow Studies • PI = S – D/A, • RI = S – D/S. • Benign ovarian tumors had high systolic flow, and a high PI (≥ 1.0) and RI (≥ 0.4) • Malignant ovarian tumors had a low PI (≥ 1.0) and RI(≥ 0.4). • Recent studies showed there is a significant overlap in Doppler flow indices between benign and malignant ovarian tumors. דר' דפנה מיצד

12. Contrast-enhanced power Doppler • Intravascular contrast agents are used to enhance depiction of tumor vessels by providing a stronger Doppler signal. • This method is time-consuming and require sophisticated ultrasound equipment and sonographer skill. דר' דפנה מיצד

13. Tumor Markers • Serum levels of CA 125 are elevated (>35 u/mL) in approximately 50% of patients with stage I epithelial ovarian cancer and in more than 90% of those with advanced disease. • CA 125 is also elevated in a number of benign gynecologic conditions, but these conditions occur less frequently in postmenopausal women. • CA 125 ≥135 u/mL was necessary to achieve 100% specificity in distinguishing ovarian cancer from benign ovarian neoplasms. דר' דפנה מיצד

14. Serum CA 125 values rise over time in patients with ovarian cancer, whereas they remain stable or decrease in patients with benign ovarian tumors. • Serial CA 125 values at 2 to 4-week intervals can be helpful in deciding whether a sonographically confirmed ovarian tumor can be monitored safely or should be removed surgically. דר' דפנה מיצד

15. Management Strategy • Ovarian tumor morphology and marker production often change with time, therefore the importance of adequate follow-up cannot be over emphasized דר' דפנה מיצד

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