ADNEXAL MASS ULTRASOUND – HOW ACCURATE ARE REPORT DESCRIPTIONS AND IMAGE INTERPRETATION?
By Sarah Natas, Guy’s and St. Thomas’ NHS Foundation Trust
Objective:
Adnexal masses are common during gynaecological ultrasound and may cause symptoms or represent an incidental finding. Accurate assessment of benign findings or potential malignancy is vital for optimal patient outcomes. Adnexal morphology may be varied which makes sonographic assessment challenging. For this reason, standardised descriptors and classification systems have been produced to assist diagnostic accuracy. This audit aimed to assess the accuracy of interpretation of adnexal masses, by comparing results with local departmental guidelines based upon standard IOTA classification and RCOG referral guidelines. Local target for compliance is 85%.
Method:
PACS reports were reviewed for patients undergoing gynaecological ultrasound between March-May 2022. Reports were reviewed for standard description of benign pathologies (simple and haemorrhagic cysts, endometriomas and dermoid cysts) or more complex abnormalities, using standard IOTA descriptors/classification and RCOG guidelines for gynaecological referral.
Results:
Total number of ultrasound reports = 2797
185 cysts diagnosed in 160 patients Median age: 38 years Benign cysts with standard descriptors: 133 (72%), other/complex cysts: 52 (28%) Adequacy of reports with standard descriptors: 94% Gynaecology referrals: 45 (25%) 35 (19%) subsequent ultrasound demonstrating resolution/benign features, 10 (5%) persistent masses with borderline/malignant features.
MRI performed: 18 (10%), of which 8 (4%) were borderline/malignant.
Unnecessary referrals mostly for haemorrhagic cysts/endometriomas (9%). 2 unnecessary referrals were made for simple cysts based on menopausal status and size. 4 simple cysts and 5 complex cysts should have been referred (5%). Guidance on follow up imaging in dermoid cysts not followed in 1. Referrals meeting guidance = 84%
Conclusion:
Overall compliance was very good for report adequacy indicating thorough understanding of IOTA descriptors allowing accurate diagnosis, highlighted by the relatively low number of MRI scans performed, allowing efficient use of imaging resources. Adequacy of compliance with referral guidelines was marginally below target, suggesting the need for education to reinforce local knowledge.