Usg Intensif 5. Adnexa Normal & Pathology Jje 20090525

MATERI AJAR INI HANYA UNTUK DIPERGUNAKAN DALAM KEGIATAN PENDIDIKAN DAN KESEHATAN JJE-13/07/2009

Hanya untuk Pendidikan dan Kesehatan

JJE-13/07/2009

Hanya untuk Pendidikan dan Kesehatan

Motto :

• Jalani hidup ini dengan sabar, jujur dan ikhlas, • Mau mengerti dan melaksanakan tatacara (adab) yang benar, dan • Mempunyai kemauan untuk selalu berbuat baik memperbaiki diri dan lingkungan, serta

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Hanya untuk Pendidikan dan Kesehatan

Barang siapa mengamalkan apa-apa yang ia ketahui, maka Allah SWT akan mewariskan kepadanya ilmu yang belum diketahuinya, dan Allah SWT akan menolong dia dalam amalannya sehingga ia mendapatkan surga. Dan barang siapa yang tidak mengamalkan ilmunya, maka ia tersesat oleh ilmunya itu, dan Allah SWT tidak menolong dia dalam amalannya sehingga ia akan mendapatkan neraka (sabda Rasulullah Muhammad SAW) Ilmu lebih utama dari harta, ilmu adalah pusaka para Nabi, sedangkan harta adalah pusaka Karun atau Fir’aun. Ilmu lebih utama dari harta, karena ilmu akan menjagamu sementara harta malah engkau yang harus menjaganya. Ilmu lebih utama dari harta karena di akherat nanti pemilik harta akan dihisab, sedangkan orang berilmu akan memperoleh syafaat. Ilmu lebih utama dari harta karena pemilik harta bisa mengaku menjadi Tuhan akibat harta yang dimilikinya, sedangkan orang berilmu justru mengaku sebagai hamba Tuhan karena ilmunya. Harta itu jika engkau berikan menjadi berkurang, sebaliknya ilmu jika engkau berikan malahan semakin bertambah. Pemilik harta disebut dengan nama kikir dan buruk, tetapi pemilik ilmu disebut dengan nama keagungan dan kemuliaan. Pemilik harta itu musuhnya banyak, sedangkan pemilik ilmu temannya banyak. Harta akan hancur berantakan karena lama ditimbun zaman, tetapi ilmu tidak akan rusak dan musnah walau ditimbun zaman. Harta membuat hati seseorang menjadi keras, sedangkan ilmu malah membuat hati menjadi bercahaya. (hamba Allah) JJE-13/07/2009

Hanya untuk Pendidikan dan Kesehatan

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Mampu melakukan pemeriksaan USG adneksa Mampu menilai adneksa normal, lesi jinak dan curiga malignansi Mampu mengetahui kelainan adneksa yang sering terjadi Mampu memberikan informed consent dengan baik dan benar Mampu membuat laporan hasil pemeriksaan USG adneksa JJE-13/07/2009

Hanya untuk Pendidikan dan Kesehatan

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Ovarian cancer is the fourth leading cause of cancer deaths in American women today. About one in seventy women will be diagnosed with this cancer in their lifetime. The death rate (see table) from ovarian cancer is high, due in part to the fact that most women have advanced disease that has spread outside the ovaries at the time of diagnosis.

http://www.macgn.org/newsletter/nl27b.h JJE-13/07/2009

Hanya untuk Pendidikan dan Kesehatan

JJE-13/07/2009

Hanya untuk Pendidikan dan Kesehatan

http://library.med.utah.edu/WebPath/jpeg4/ FEM082.jpg http://www.femalehealthmadesimple.com/Ovariu mSewe.jpg http://labstend.ru/site/index/folies/univ/anatom y/p0077.gif Hanya untuk Pendidikan dan JJE-13/07/2009

Kesehatan

http://www.macgn.org/newsletter/nl27b.htm

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Hanya untuk Pendidikan dan Kesehatan

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Size, location, and characteristics

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Benign : < 5 cm, uniloculare

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Malignant : > 5 cm, complex mass, thick septum, papillary projections or nodule

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Less sensitive to differentiate the malignancy B. Karsono : Pemeriksaan ultrasonografi tumor ginekologik, 2006

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Hanya untuk Pendidikan dan Kesehatan

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Vary in size depending on age and menopausal status. Normal size is approximately 3 x 2 x 2 cm

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Almond shaped

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Contain follicles in women of childbearing age Arthur C Fleischer, 2004 JJE-13/07/2009

Hanya untuk Pendidikan dan Kesehatan

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↑ frequency → ↑ resolution → better image Sliding organs sign : adhesions Pelvic pain At the end of menstruation period DD : corpus luteum, lutein cyst Bilateral ovaries (60%), unilateral (80%) → atrophy, pelvic adhesion, compression by ovarium or pelvic tumor

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Hanya untuk Pendidikan dan Kesehatan

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Follicles are less than 10 mm when immature

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10 – 15 mm at intermediate maturity

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18 – 25 mm when mature Arthur C Fleischer, 2004

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Hanya untuk Pendidikan dan Kesehatan

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Corpora lutea : thick wall, vascular ring

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The main arterial supply of the uterus and ovaries arises from the aorta through the infundibulopelvic ligament;

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Other blood supply is from the adnexal branch of the uterine artery Arthur C. Fleischer, 2004

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Hanya untuk Pendidikan dan Kesehatan

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There is highimpedance arterial flow except around the mature follicle / corpora lutea, where lowimpedance highdiastolic flow can be seen Arthur C. Fleischer, 2004

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Hanya untuk Pendidikan dan Kesehatan

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History of ovarian cancer in the immediate family (More details).

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Age (over 50 years).

No children (pregnancies protect against ovarian cancer so that two or more pregnancies lower the risk for developing ovarian cancer).  Self history of breast cancer. 

http://www.geocities.com/HotSprings/Sauna/1913/SymptomsandRiskFactor

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Hanya untuk Pendidikan dan Kesehatan

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Race --- ovarian cancer appears to occur more frequently in Caucasian women than African American women, but African-American women that are socioeconomically similar to Caucasian women may take on the Caucasian risk due to smaller families and having children later.

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Jewish descent

http://www.geocities.com/HotSprings/Sauna/1913/SymptomsandRiskFactor

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Hanya untuk Pendidikan dan Kesehatan

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HRT in post-menopausal women may account for a very slight increase in ovarian cancer risk.

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Infertility drug use --- a nearly 3-fold increase in risk characterizes women who fail to conceive.

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However, this risk may be due to an underlying ovarian dysfunction in combination with a failure to gain a protective advantage from pregnancy.

http://www.geocities.com/HotSprings/Sauna/1913/SymptomsandRiskFactor

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Hanya untuk Pendidikan dan Kesehatan

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High fat diets have been reported to be associated with higher rates of ovarian cancer in industrialized nations.

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Talc-use in feminine hygiene sprays or in sanitary napkins has been suggested as a factor associated with some risk.

http://www.geocities.com/HotSprings/Sauna/1913/SymptomsandRiskFactor

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Hanya untuk Pendidikan dan Kesehatan

 the

risk of ovarian cancer is 1 in 55 (1.8%), but Age and Family history may increase this risk.

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Jemal A, Thomas A, Murray T, Thun M. Cancer statistics, 2002. CA Cancer J Clin. 2002;52:23-47.

Dr. Mohammed Abdalla Egypt / Domiat general hos

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Hanya untuk Pendidikan dan Kesehatan

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Hanya untuk Pendidikan dan Kesehatan

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Symptoms significantly associated with ovarian cancer when occurring more than 12 days a month:    

Pelvic / abdominal pain Frequent or urgent urination Increased abdominal size/ bloating Difficulty eating / feeling full

http://www.geocities.com/HotSprings/Sauna/1913/SymptomsandRiskFactor Goff et. al. Cancer 2007; 109:221-227.

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Hanya untuk Pendidikan dan Kesehatan

Diagnostic value of pelvic examination, ultrasound, and serum CA 125 in postmenopausal women with a pelvic mass. An international multicenter study 

Ninety-five malignant (41.7%) and 127 benign (55.7%) pelvic tumors were found in addition to 6 borderline ovarian tumors (2. 6%) in the 228 patients.

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Seventy-two patients had ovarian carcinoma, 49 of whom (68%) were International Federation of Gynecology and Obstetrics Stage III or IV.

http://www3.interscience.wiley.com/journal/112686925/abs

Eltjo M. J. Schutter, et al, JUOG, 199 JJE-13/07/2009

Hanya untuk Pendidikan dan Kesehatan

Diagnostic value of pelvic examination, ultrasound, and serum CA 125 in postmenopausal women with a pelvic mass. An international multicenter study

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Borderline tumors were excluded from the statistical calculations.

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The individual accuracy of pelvic examination, ultrasound, and serum CA 125 in discriminating between benign and malignant pelvic masses was approximately the same (76, 74, and 77%, respectively).

JJE-13/07/2009 JJE-20080821

Hanya untuk PendidikanEltjo dan Kesehatan

M. J. Schutter, et al, JUOG, 19 http://www3.interscience.wiley.com/journal/112686925/abs

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Benign : uniloculare, thin septum, thin wall, smooth internal surface, low echogenicity or sonoluscent

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Malignant : multiloculare, thick septum, thick wall, papillary projections from internal surface, high echogenicity or not homogenous B. Karsono : Pemeriksaan ultrasonografi tumor ginekologik, 2006 JJE-13/07/2009

Hanya untuk Pendidikan dan Kesehatan

Prospective assessment of simple rules to distinguish between malignant and benign adnexal masses prior to surgery 

Sunday, 24 August 2008

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D. Timmerman 1 *, L. Ameye 2, C. Van Holsbeke 3, R. Fruscio 4, A. Czekierdowski 5, S. Guerriero 6, A. C. Testa 7, V. Vandenbroucke 1, T. Bourne 8, B. Van Calster 2, G. Betsas 1, P. Neven 1, S. Van Huffel 2, L. Valentin 9

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1Dept Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium 2Electrical Engineering (ESAT-SISTA), Katholieke Universiteit Leuven, Leuven, Belgium 3Dept Obstetrics and Gynecology, UZ Leuven and ZOL Genk, Leuven and Genk, Belgium 4Dept Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy 5Dept Obstetrics and Gynecology, Medical University, Lublin, Poland 6Dept Obstetrics and Gynecology, Ospedale San Giovanni di Dio, Cagliari, Italy 7Dept Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy 8Dept Obstetrics and Gynecology, St George's Hospital and UZ Leuven, London and Leuven, United Kingdom 9Dept Obstetrics and Gynecology, University Hospital, Malmö, Sweden

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Hanya untuk Pendidikan dan *Correspondence to D. Timmerman, Dept Obstetrics and Gynecology, UZ Kesehatan JJE-13/07/2009 Leuven, Leuven, Belgium

The five simple rules to predict malignancy (Mrules) (Timmerman D, et al, JUOG, 2008)     

Irregular solid tumor; Ascites; At least four papillary structures; Irregular multilocular-solid tumor with a largest diameter of at least 100 mm; Very high color score using color Doppler.

http://www3.interscience.wiley.com/cgi-bin/fulltext/121375169/HTMLST

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Hanya untuk Pendidikan dan Kesehatan

http://www.femalehealthmadesimple.com/FileSevenFinal.

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Hanya untuk Pendidikan dan Kesehatan

The five simple rules to suggest a benign tumor (Brules)  

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Unilocular cyst; Presence of solid components where the largest solid component is < 7 mm in largest diameter; Acoustic shadows; Smooth multilocular tumor less than 100 mm in largest diameter; No detectable blood flow at Doppler examination.

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Hanya untuk Pendidikan dan Kesehatan

Sassone Morphology Scoring System for Ovarium and Pelvic Tumor Score

Internal Surface

Wall Thickness

Septum

Tumor Echogenicity

1

Smooth

≤ 3 mm

No-septum

Sonoluscent

2

Irregular ≤ 3 mm

> 3 mm

≤ 3 mm

Low echogenicity

3

Papil > 3 mmm

can’t be measurement > solid mass

> 3 mm

Low echogenicity Echogenic nodule

4

can’t be evaluation > solid mass

_

_

complex echogenic

5

_

_

_

High echogenicity

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Hanya untuk Pendidikan dan Kesehatan

B. Karsono : Pemeriksaan ultrasonografi

Which parameters could be useful to predict malignancy in sonographically solid adnexal masses? (Acazar JL, et al, JUOG, 2008) Symptoms suggestive Ovarian cancer Suspicious Physical exam Menopause Ascites Bilaterality Central blood flow Abundant blood flow High PSV/Low RI Median CA-125 (IU/mL)

5.4% 17.9% 39.3% 3.6% 3.6% 16.1% 12.5% 19.6% 19.6

49.5% 69.2% 69.2% 61.5% 23.4% 95.7% 67.6% 58.1% 312.1

< 0.0001 < 0.0001 < 0.0001 < 0.0001 < 0.0001 < 0.0001 < 0.0001 < 0.0001 0.005

tic regression analysis only central blood flow (odd ratio: 64.2, 95% CI: 17.07 to ence of ascites (odd ratio: 32.77, 95% CI: 5.38 to 199.72) were identified as inde s of malignancy. The presence of one of these two features correlated to malign cases. The absence of both was found in 82.1% of benign tumours. JJE-13/07/2009

Hanya untuk Pendidikan dan http://www3.interscience.wiley.com/cgi-bin/fulltext/121375594/HTMLST Kesehatan

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Cut-off value of RI ?? Malignancy ? CONTROVERSIAL !! (equipment, knowledge of Doppler, experience, and skills)

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RI : 0.30 – 0.60 PI : 0.30 – 1.50 Suspect malignancy : RI < 0.40 or PI < 1.0 Benign : RI > 0.70 or PI > 2.00

B. Karsono : Pemeriksaan ultrasonografi tumor gineko

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Hanya untuk Pendidikan dan Kesehatan

The clinical usefulness evaluation of new ultrasonographic method E-flow in Doppler index ovarian tumors malignancy prediction 

Ultrasound examinations was performed preoperatively in 53 patients with ovarian tumors. Malignant tumors were in 12 (22.6%) cases and 41 cases non malignant tumors.

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We estimated vascularisation as Doppler index (number of vessels, localization, regularity, vascular impedance and notch) of the tumors using Color Doppler (CD), Power Doppler (PD) and E-flow and compared this methods. JJE-13/07/2009

Hanya untuk Pendidikan dan Kesehatan

D. Szpurek et al, JUOG, 32,3, 200

The clinical usefulness evaluation of new ultrasonographic method E-flow in Doppler index ovarian tumors malignancy prediction 

Doppler index in occurrence of ovarian cancers has: sensitivity of 83.3%, 83.3% and 91.7% for CD, PD and Eflow, respectively; specificity of 90.2%, 87.8%, 92.7% and accuracy of 88.7%, 86.8% and 92.5% for CD, PD and e-flow, respectively.

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Negative and positive predictive values for e-flow estimation were 97.4% and 78.6%, respectively.

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Prognostic values of analyzed methods in our group of patients based on the area under ROC was: 0.940, 0.945 and 0.960 respectively D. Szpurek et al, JUOG, 32,3, 200 JJE-13/07/2009

Hanya untuk Pendidikan dan Kesehatan

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Hanya untuk Pendidikan dan Kesehatan

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↑ Accuracy of the location, volume, and morphology (tumor and vascular)

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Contrast- enhanced 3D power Doppler

B. Karsono : Pemeriksaan ultrasonografi tumor gineko

JJE-13/07/2009

Hanya untuk Pendidikan dan Kesehatan

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Functional Cysts : Follicular cysts, Corpus luteum cysts, corpus luteum of pregnancy, theca lutein cysts

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Surface Epithelium Inclusion Cysts Rete Cysts Hyperreactio Luteinalis Ovarian Hyperstimulation Syndrome Polycystic Ovarian Syndrome Ovarian Remnant Syndrome Neonatal Ovarian Cysts Paratubal, Paraovarial Cysts Endometriosis PID Peritoneal Inclusion Cysts

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Hanya untuk Pendidikan dan Kesehatan

Marcus J. Dill-Macky et al, 2000

Tabel 17.1. Jumlah kasus baru dan lama neoplasma jinak ovarium tahun 2005 di RSPAD Gatot Soebroto BULAN

KASUS LAMA

KASUS BARU

Januari

16

8

Februari

31

8

Maret

22

4

April

38

3

Mei

12

3

Juni

27

3

Juli

14

7

Agustus

20

September

23

6

Oktober

15

4

November

8

5

Disember

11

5

237

63

Jumlah

Hanya untuk Pendidikan dan Kesehatan

7

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neoplasma ovarium Pemeriksaan standar

Risiko Malignansi

Pemeriksaan Lanjutan

Anamnesis •

Data reproduksi (paritas, abortus), riwayat haid, KB pil, terapi infertilitas, terapi sulih hormon, riwayat operasi (ovarium).

Umur • Premanopause • Pascamenopause

Rendah Tinggi

Riwayat Keluarga kanker ovarium dan atau payudara • Ada • Tidak ada

Tinggi Rendah

Konseling genetik

Keluhan (bila ada) •

Pembesaran perut, rasa penuh atau penekanan didaerah perut atau pelvik, nyeri perut atau pinggang bagian bawah, sering berkemih, lekas lelah, nafsumakan berkurang, dan penurunan berat badan

Tinggi

Singkirkan kelainan yang bukan berasal dari ovarium (Rontgent, CT-scan, MRI)

Palpasi bimanual • •

Halus, bundar, mobilitas baik, unilateral, diameter < 10 cm Ada bagian padat/padat, tidak bergerak (ada perlekatan), bilateral, batas tidak tegas, dan diameter > 10 cm

Rendah Tinggi

USG Transvaginal 2D : volume • • • •

< 20 cm3 – premenopause < 10 cm3 – postmenopause > 20 cm3 – premenopause > 10 cm3 – postmenopause

Rendah Rendah Tinggi Tinggi

USG Transvaginal 2D : morfologi • •

dinding halus, sekat tipis, tidak ada bagian padat, dan anekhoik ada pertumbuhan intrakista, papil-papil, sekat tebal, bagian padat, dan ekhogenitas campuran

USG Transvaginal Doppler berwarna dan Power Doppler, parameter arus darah : • PI > 1,0 , RI > 0,42 • PI < 1,0 , RI ≤ 0,42 Lokasi arus darah Hanya untuk Pendidikan dan • Perifer Kesehatan • Sentral Petanda tumor • Ca 125 < 35 U/ml • Ca 125 > 35 U/ml

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USG 3D lebih superior dari 2D dalam hal : • tampilan karakteristik dinding dalam massa • Identifikasi infiltrasi tumor pada kapsul kista • Pengukuran volume

Rendah Tinggi

Rendah Tinggi

Pemeriksaan kualitatif arus darah tumor dengan USG 3D Power Doppler • Posisi • Struktur • Pola

Rendah Tinggi Generasi kedua Ca 125, Ca 15-3, Ca 19-9 Rendah Tinggi

Ovarian Torsion  Massive Ovarian Edema  Ovarian Vein Thrombosis 

Marcus J. Dill-Macky et al, 2000

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Hanya untuk Pendidikan dan Kesehatan

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Surface Epithelial Stromal Tumors : Serous tumors, Mucinous tumors, Endometrioid tumors, Clear cell tumors, Transitional cell (Brenner) tumors

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Germ Cell Tumors : Mature cystic teratomas

(ovarian dermoid cysts), mature solid teratomas, Immature teratomas, Struma ovarii, dysgerminoma, Yolk sac tumors 

DYSGERMINOMA

Sex Cord Stromal Tumors : Fibroma,

Thecoma, Granulosa cell tumors, Sertoli-Leydig cell tumors 

Metastatic Tumors

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Ovarian Lymphoma Marcus J. Dill-Macky et al, 2000

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Hanya untuk Pendidikan dan Kesehatan

FIBROMA OVARII

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Thin walled Unilocular 3 – 8 cm Smooth & thin wall Contents : from serous or serosanguineous fluid to clotted blood

Marcus J. Dill-Macky et al, 2000

JJE-13/07/2009

http://www.femalehealthmadesimple.com/FileSevenFinal.html

Hanya untuk Pendidikan dan Kesehatan

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Commonly complicated by hemorrhage (corpus rubrum hemorrhagicum)

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Thick hyperechoic, occasionally crenulated wall, echogenic content

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Contents : from serous or serosanguineous fluid to clotted blood Marcus J. Dill-Macky et al, 2000

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Hanya untuk Pendidikan dan Kesehatan

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Enlarged and cystic

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Kobayashi et al (1997) : monitored as a functional cyst if the cysts gradual diminution and without complication Marcus J. Dill-Macky et al, 2000

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Hanya untuk Pendidikan dan Kesehatan

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Frequently multilocular

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The largest of the functional cysts

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Overstimulation by hCG

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Trophoblastic disease or iatrogenic hyperstimulation

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Often bilateral

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Persist for days to weeks after withdrawal of the stimulus Marcus J. Dill-Macky et al, 2000

://library.med.utah.edu/kw/human_reprod/mml/hrot_ot_1.html

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Hanya untuk Pendidikan dan Kesehatan

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TAS : Adams criteria (1985) → ≥ 10 cysts, 2 - 18 mm, single plane, peripherally, ↑ central stroma or small cysts 2 - 4 mm

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TVS : Fox criteria (1991) : ≥ 15 cysts, 2 – 10 mm

Marcus J. Dill-Macky et al, 2000 JJE-13/07/2009

http://www.femalehealthmadesimple.com/FileEightFinal. Hanya untuk Pendidikan dan Kesehatan

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Hanya untuk Pendidikan dan Kesehatan

JJE-20080821

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Hanya untuk Pendidikan dan Kesehatan

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Mesonephric (Wolffian), paramesonephric (Mullerian), or mesothelial structures

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Indistinguishable from simple functional cysts

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Normal ipsilateral ovary close to, but separate from the cyst Marcus J. Dill-Macky et al, 2000

ariety of appearance nechoic cysts to diffuse low level echoes w / wo solid components to a solidappearing mass Marcus J. Dill-Macky et al, 2000

D : functional hemorrhage cysts

or other echogenic cysts Hanya untuk Pendidikan dan JJE-13/07/2009

Kesehatan

JJE-20080821

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25% benign ovarian neoplasms

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50 – 70% of all ovarian serous tumors

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Sharply marginated, anechoic masses, may be large, and usually unilocular

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Internal thin walled septation

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Occasionally papillary projections Marcus J. Dill-Macky et al, 2000

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Hanya untuk Pendidikan dan Kesehatan

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20 – 25% of all benign ovarian neoplasms 75 – 85% of all ovarian mucinous tumors

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Thicker & more numerous septations

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Frequently contains fine, gravitydependent echoes produced by the thick contents

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Gentle tapping on the cyst wall Marcus J. Dill-Macky et al, 2000 JJE-13/07/2009

Hanya untuk Pendidikan dan Kesehatan

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Ovarian dermoid cysts

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5 – 25% of all ovarian neoplasms

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Reproductive years

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Regional diffuse bright echoes w / wo posterior acoustic shadowing, hyperechoic lines and dots, shadowing echodensity, and fluidfluid level Marcus J. Dill-Macky et al, 2000

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Hanya untuk Pendidikan dan Kesehatan

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Peritoneal inclusion cysts, inflammatory cysts of the peritoneum

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Trapping by peritoneal adhesions

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A history of trauma, abdominal surgery, PID, endometriosis, or combinations

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May measure up to 20 cm, lined by mesothelial cells

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Spider-web pattern Marcus J. Dill-Macky et al, 2000

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Hanya untuk Pendidikan dan Kesehatan

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The current tests available to us are not “routine,” unless you have a family history of ovarian cancer or have several relatives with early-onset breast cancer.

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Unfortunately, 75 percent of women with ovarian cancer are diagnosed after the disease has reached an advanced stage.

Judith R at http://www.msnbc.msn.com/id/203596

JJE-13/07/2009

Hanya untuk Pendidikan dan Kesehatan

Is ovarian cancer screening a routine test? 

These results were not considered by statisticians to meet the "we should routinely screen with these tests" criteria.

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For a test to be cost-effective (in simple terms, worth doing on a large basis), it should have a PPV of 10 percent. This means that 10 surgeries are necessary to detect one cancer.

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In this study the PPV was 4 percent for an abnormal CA125 result and 1.6 percent for an abnormal transvaginal ultrasound.

Judith R at http://www.msnbc.msn.com/id/203596

JJE-13/07/2009

Hanya untuk Pendidikan dan Kesehatan

Is ovarian cancer screening a routine test? 

When both tests were abnormal, this value was 23.5 percent (meaning approximately four surgeries were needed to detect one cancer), but in women where one or both tests were not abnormal, 12 out of 20 invasive cancers were missed (60%).

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That's an awful lot of cancers to miss in women who were reassured that their tests were fine.

Judith R at http://www.msnbc.msn.com/id/203596 JJE-13/07/2009

Hanya untuk Pendidikan dan Kesehatan

Role of US in Ovarian Cancer Screening 

Long-term survival : minimal

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If 25% stage I → 75% → the number of women dying would be ↓ 50% (Van Nagell Jr JR, 1991)

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The best studied technique for ovarian cancer screening : Ca 125 + Ultrasound examination

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Ultrasound : TAS, TVS Problems with Screening Population to be screened

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Marcus J. Dill-Macky et al, 2000

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Hanya untuk Pendidikan dan Kesehatan

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Only about 85% of all women with ovarian cancer have raised CA125

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Only 50% of women with early stage ovarian cancer have raised CA125

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Women with other conditions can also have raised CA125

http://www.cancerhelp.org.uk/help/default.asp?page=307

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Tabel 17.3. Hubungan diagnostik neoplasma ovarium secara sonografis dan patologi anatomi di RSPAD Gatot soebroto NO.

NAMA PASIEN

DATA USG

TEMUAN SAAT OPERASI

PATOLOGI ANATOMI

1

SG (47 th)

Kistik, ekhointernal halus, 102x70 mm. D/: NOK, DD : kista simpleks

Kista paraovarial kiri

Kista hidatid Morgagni paratubae

2

EA (44 th)

Kistik,

Kista endometriosis. Ca 125 : 29,8

Tidak ditemukan

3

LK (60 th)

Kistik, > 200 mm, partikel halus bergerak, sekat 4 mm, neovaskularisasi (-), asietes (-). Hidronefrosis dekstra. D/ : NOK permagna

Kistadenoma ovarium musinosum multilokular papiliferum Ca 125 : 118,4

Kistadenoma musinosum papiliferum multilokular ovarium

4

NL (27 th)

Kistik, multilokular, 224x86 mm, berisi ekhointernal halus, RI : 0,4. D/: NOK multilokular kiri suspek musinosum. DD : kista endometriosis

Kista musinosum. Ca 125 : 1258,18

Kistadenoma musinosum papiliferum multilokular ovarium

5

MN (38 th)

Kistik, 137x108x167 mm, ekhointernal, RI : 0,489. D/ : NOK suspek malignansi

VC : kista endomet-riosis dengan sel atipik Ca 125 : 961,5

Kista endometriosis, tidak ditemukan sel ganas

6

DW (29 th)

Padat, di posterior uterus, mengisi rongga abdomen, arus darah arteri sulit dinilai, asites berisi partikel kasar. D/: NOP suspek malignan. DD : mioma uteri

VC : karsinoma dengan diferensiasi buruk. Ca. Ovarium III-C Ca 125 : 273,72

Karsinoma ovarium berdiferensiasi buruk

7

IR (28 th)

Kistik, multilokular, mengisi rongga pelvik dan abdomen (asal massa tak jelas), RI : 0,513. D/: kista ovarium permagna, keganasan belum dapat disingkirkan

Kista musinosum Ca 125 : 15

Kistadenoma musinosum papiliferum ovarium dengan bagian borderline

8

RN (44 th)

Ovarium kanan : kista simpleks, 34x25,4x29,6 mm. Ovarium kiri : D/ : NOK dgn bagian padat, 60x56x67 mm, multi lokular, RI : 0,536

Kista

9

SN (40 th)

Kistik, ekhointernal, 46x46 mm, melekat pd dinding belakang uterus. D/: suspek kista endometriosis kanan

Kista coklat bilateral Ca 125 : 20,5

Kista endometriosis kanan dan kista lutein kiri yang disertai perdarahan

10

TN (28 th)

Kistik, 44x43 mm, ekho-internal kasar dengan bercakbercak hiperekhoik. D:/ Kista dermoid kiri

Kista dermoid kiri. Ca 125 : 10,2

Kista dermoid ovarium

11

NR (44 th)

Kistik, ekhointernal kasar, batas tegas, dinding tebal, nyeri tekan, tidak tampak neovaskularisasi pada dinding. D/ : suspek NOK terinfeksi

Kista ovarium terinfeksi Ca 125 : 25,35

Kista

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unilokular, 170x131 mm, asites(-), kularisasi (-). D/ : Kista endometriosis

neovas-

endometriosis kiri ovarium kanan. Ca 125 : 68,42

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dan

kista

Kista endometriosis bilateral

endometriosis dan mengesankan adanya abses tubo-ovarial

http://www.sah.org.au/SUW/hycosy.html

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. Transvaginal Doppler sonogram of a large projection showing internal vascular flow.

Figure 3. Transvaginal spectral sonogram showing a relatively low resisti with the mural projection, indicative of a tumor.

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http://www.jultrasoundmed.org/cgi/content/full/21/10/1171

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Choosing the appropriate techniques and equipments

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From normal to pathological conditions, and from benign to malignant

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Knowing the frequent cases

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Good Informed consent, reporting & archiving

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CPD JJE-13/07/2009

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Perhaps the biggest obstacle to effective screening, early detection, and (ultimately) the prevention of ovarian cancer, is our lack of understanding of exactly how and why this disease develops.

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For the time being, women who are concerned about their ovarian cancer risk should be sure to have regular gynecologic checks and maintain an open and ongoing dialogue with their health care providers about appropriate ways to address their health concerns.

http://www.macgn.org/newsletter/nl27b.h JJE-13/07/2009

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