Characterization of papillary projections in benign versus borderline and malignant ovarian masses on conventional and color Doppler ultrasound.

OBJECTIVE: The purpose of our study was to evaluate on endovaginal ultrasound the morphologic and color Doppler characteristics of papillary projections in benign compared with borderline and malignant epithelial stromal ovarian tumors. MATERIALS AND METHODS: A total of 283 women (mean age, 52 years; age range, 20-85 years) with 343 operated adnexal masses comprising 167 epithelial stromal tumors of the ovary with 76 tumors containing papillary projections at pathology were retrospectively studied on ultrasound. We systematically evaluated the topography of the papillary projections, the morphologic features of the largest papillary projection, and the presence or absence of color Doppler findings. All these findings were correlated with macroscopic and microscopic features. RESULTS: Ultrasound detected papillary projections in 78% of tumors. Papillary projections were disseminated in 33% of malignant, 20% of borderline, and 0% of benign tumors (p = 0.0049). The mean size of the papillary projections was 9.6, 15.7, and 35.3 mm in benign, borderline, and malignant tumors, respectively (p = 0.0007). An acute angle was present in 68% of benign tumors and an obtuse angle in 40% of borderline and 89% of malignant tumors (p = 0.0001). The surface was regular in 77% of benign tumors and irregular in 50% of borderline and 88% of malignant tumors (p = 0.0000). Calcifications were present only in benign tumors (18%). For papillary projections ≥ 10 mm, color flow was present in all malignant, in 86% of borderline, and absent in all benign tumors. CONCLUSION: Association of morphologic and vascular ultrasound findings can highly suggest the diagnosis of benign or malignant papillary projection.