| 1. BackgroundWith the progress of the society and the develepment of the cause of health, the situation of aging population is severe and the situation is a increasing thrend. postmenopausal women in the proportion of the population is increasing and they are in a state of neglect of gynecological examination, which will influence the therapeutic effect and prognosis, ovarian tumor have a larger proportion than the other disease in postmenopausal women.Recent epidemiological show that Ovarian cancer incidence is after cervical cancer and in second malignant tumor in postmenopausal women. The mortality rate of ovarian cancer ranks first in gynecological malignant tumor, and the vast majority of patients is over the age of40.Now, ovarian cancer has become one of the major diseases threatening the health of postmenopausal women.Properties of ovarian tumors are benign, borderline and malignant points, and ovarian tissue composition is very complicated. The ovary is the most primary tumor types in every organ of the body organs. The ovary tumor occult stealthily, and it has a high proportion of malignant.At the same time the ovary tumor is lack of specific clinical symptoms and is difficult to diagnosis early.So, the ovary tumor has ofen been diagnosed at advanced stage, which brings a bad ending. Some people propose that the doctor shoud put on some screening for ovarian cancer, bur the existing screening practices have not been analysis comprehensive evaluation now, and ovarian cancer has the rapid progress. Screening intervals for one year or six months in dispute. Therefore, the early diagnosis of ovarian cancer has been paid more and more attention.The main method of ovarian cancer screening are CA-125and pelvicultrasound. The effects of CA-125in pelvic tumor examined can not be ignored. CA-125>35U/ml can be used as an index for predicting malignant ovarian tumors. But some scholars have pointed out that the increase of CA-125(>35IU/ml) specific co., It can also be seen in benign lesions. Such as ovarian cyst, endometriosis and pelvic infection. So the ultrasound examination can be used as an important method in the diagnosis of ovarian tumors. and it helps to improve the specificity With the combined application of CA-125, In this study, the research for the past6years in our hospital operation treatment of130cases of postmenopausal patients with ovarian tumors were retrospectively analyzed, analysising of postmenopausal clinical features and two-dimensional ultrasound, color Doppler ultrasound features of pelvic masses. The study is to evaluate the value of ultrasonography in the diagnosis of pelvic tumor in postmenopausal women.2. Objective1Discussion postmenopausal women with pelvic masses of the clinical features and pathological types2To evaluate the value of ultrasound in diagnosis of in the postmenopausal women.3To evaluate the preoperative diagnosic values of ultrasound in greater omentum and pelvic peritoneal metastasis from primary ovarian cancer and analyze the impact of factors.4To discuss the accurate rates of diagnosis for the pathological types of ovarian tumor in postmenopausal women by ultrasound3. Research data and methods 3.1Object of studyData of130patients of pelvic mass with postmenopausal primary operation treatment in our hospital were analysed. The age are46to82years, and the average age is65.8years old.The menopausal age are1-32years, and the average are12yearsThe inclusion criteria:1Inpatient medical records is complete(concluding are, age of menarche, age of menopause, the number of pregnancy, childbirth Views, Chief complaint, surgical approach, pathologic reports.2Natural menopause≥1year;3the patients with pelvic mass who were been found by physical examination or conscious mass were all confirmed by surgery.concluding pathological findings4there are abdominal or transvaginal pelvic ultrasound resultsThe exclude criteria:1.Data for inpatients with basic information is not complete;2The postmenopausal women are with the hysterectomy or bilateral oophorectomy3Because of pelvic tumor has line operation, patients with recurrent operation;4. The patients have been chemotherapy after operation;5The people with ovarian masses have been operated outside our hospital, and their postoperative pathology have been confirmed malignant in the next operation in our hospital or outside our hospital the people were diagnosed as malignant directly to our hospital6The patients have not been operated and have underwent pelvic chemotherapy or the patients discharged from hospital because some factors of untreated. 3.2Instrument and measuring methodThe TOSHIBA ISTYLE,Medison800Oand GE-E8colorful ultrasound equipment, witha3.5-to7.5-MHz, vaginal ultrasound and abdominal ultrasound have been used jointly, focus observing tumor volume, boundary echo, internal echo (solid and cystic papillary structures, separated), wall structure (wall thickness>3mm and rough wall structure abnormalities), and the amount of ascites nine sonographic indicators. Color Doppler ultrasonic examinations were conducted with Parameter of the flow indexes recorded.The resistance index (RI)<0.43, the pulsatility index(PI)<1.0were the diagnosis reference of the malignant ovarian tumors.AT the same time, uterus, dual attachments, and the entire pelvic circumstances should be observed, including the omentum and peritoneum dirty parietal metastasis of tumor, abdominal and pelvic effusion.and compared What we had seen in the operation to the ultrasonic performance.4.Statistical methodThe samples count data were expressed as a percentage, ane groups were compared using the x2test. The study is to evaluate the effect of ultrasound in diagnosing of benign and malignant Pelvic tumor, For the blood flow parameters of the statistical results between benign and malignant ovarian tumor, the standard deviation of mean soil said, between the two groups were compared by t test. In SPSS13.0, P<0.05for statistical significance difference5. ResultThe overall sample. Benign tumor are in94cases (72.3%).malignant tumors are36cases of (27.7%),(including9cases of borderline tumors).Tumor diameter is3cm-30cm. Distribution of different histological types are:epithelial tumors accounted for60.7%(79/130), sex cord-stromal tumor accounted for13%(10/130), germ cell tumor accounted for20.7%(27/130), other tumors accounted for10.7%(14/130)Clinical manifestations of pelvic benign and malignant tumors in the abdominal pain, bloating, vaginal bleeding and urinary urgency difference was not statistically significant (P>0.05). No symptoms of ovarian tumors are benign rate higher. Inadvertently abdominal palpable bag from malignant tumor block patients was significantly higher than that in benign tumor.The unilateral lesions are in109cases, including21cases of malignant lesions (19.2%);21cases are bilateral lesions, including15cases of malignant lesions (71.4%).The malignant rate of bilateral lesions was higher than that of unilateral lesions; the malignant rate of unilateral ovarian tumor with the maximum diameter>10cm was higher than that of unilateral ovarian tumor with the maximum diameter≤10cm. The9two-dimensional sonogram between pelvic benign and malignant tumor display that Irregular wall structure, cystic, solid, ascites<500and the amount of ascites>1000aspects of group difference was significant (P<0.05). Volume, nipple wall, solid and cystic separated aspects differences are no statistically significant (P>0.05). the sensitivity was93.9%, specificity of94.8%.94cases of benign tumors, there were48cases of blood flow signal could be detected, the detection rate was51%(48/94),36cases of malignant tumor blood flow signal could be detected, the detection rate was100%.In the CDFI, Benign tumor blood flow signals are scarce, mainly distributed in separate around or inside; the malignant ovarian tumors showed a rich, a large number of strips, semi-annular flow, diffusion and distribution blood flow signal within the tumor center or papillary processes on the interval.RI<0.43, and Pl<1.0of the flow indexes are associated With the malignancy of ovarian tumors. the accuracy of PI is higher than RI, and the positive predictive value is less than RI.22cases of36cases of metastatic omentum in patients with primary ovarian cancer, ultrasound was found in18cases, the positive rate was81.8%.36cases of primary ovarian carcinoma confirmed by operation in13cases of pelvic peritoneal metastasis, transvaginal sonography was found in6cases, the sensitivity was42.9%, specificity was97.5%. The detection rate of pelvic effusion were larger and higher metastatic nodules.Results of ultrasonography and pathological findings in line with the99cases,76.1%accuracy rate. Postmenopausal pelvic tumor are most benign. Serous cystadenoma and cystic teratoma is the most common benign tumor. Serous papillary adenocarcinoma is the most common malignancy in postmenopausal women. By contrasting preoperative ultrasound diagnosis with pathologic results of various types of ovarian tumor, the study display that serous cystadenoma, chocolate cysts, malignant teratoma have a higher rate of diagnosis. The lower rates are mixed cystadenoma, clear cell carcinoma, granulosa cell tumor.14cases of misdiagnosis, misdiagnosis rate was10.7%.Differentiating benign and malignant The error seven cases of ovarian fibroma misdiagnosed as three cases of subserosal uterine fibroids, teratoma misdiagnosed simple cyst, appendiceal mucinous adenocarcinoma one cases misdiagnosed as ovarian malignancies, fallopian tube cancer misdiagnosed as ovarian cancer two cases.6. Conclusions6.1There are some characteristics such as fast, noninvasivea and high accuracy when pelvic masses were diagnosed by ultrasonography. The ultrasonography is the first method to detect pelvic mass in the postmenopausal women and it is a reliable method in identifying the nature of the tumor.6.2Transabdominal ultrasound is great value in detection o f greater omentum Metastasis from Primary ovarian cancer.TVS in preoperative diagnosis was dissatisfied and the detection depends on the lesion’s morphous, size and the presence of pelvic fluid.6.3Ovarian serous cystdenoma, Teratoma and Endometriosis of the postmenopausal women has been diagnosised with higher accurate rates than that of the before menopausal women. Lose ovary as a reference, the Source judgment on the part of the ovarian tumor deviate from the rite by ultrasound;The accurate rates of diagnosis for the rare ovarian tumor need to be futher improved.6.4The ovarian cancer incidence with Postmenopausal women is highthan menopause.non-specific clinical symptoms, rapid progression, found more than an advanced stage, which show that we should pay more attention to the prevention and treatment of postmenopausal women with ovarian tumors. |
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