Abstract
Objectives: The aim of this thesis was to evaluate the value of modern high-resolution transvaginal ultrasound for differential diagnosis of adnexal tumours. This was done by performing a series of studies: (1) comparison of risk of malignancy index (RMI) and ovarian crescent sign (OCS) for the diagnosis of ovarian malignancy; (2) assessment of the value of pattern recognition for the diagnosis of borderline ovarian tumours (BOT); (3) comparison of diagnostic accuracy using real-time and static images (4) assessment of the reproducibility of ultrasound pattern recognition for the diagnosis of BOT; (5) assessment of the effect of degree of operator's confidence on diagnostic accuracy; (6) examination of the effect of the quality of gynaecological ultrasound diagnosis on the management of patients with suspected ovarian cancer; and (7) determining the value of preoperative ultrasound examination for selection of women for laparoscopic surgery. Interpretation of findings: (1) The OCS proved to be a simpler and better method in diagnosing ovarian cancer when compared to the RMI. (2) Ultrasound diagnosis of BOT is highly specific but typical features are absent in one third of cases. (3) The diagnosis of an adnexal mass is more accurate when made on the basis of real-time ultrasound examination than on static ultrasound images. (4) Accuracy of ultrasound diagnosis of BOT is less in comparison to benign and invasive malignant lesions. (5) Accuracy of ultrasound pattern recognition in differentiating ovarian tumours depends on the degree of certainty with which the diagnosis is made. (6) Improved quality of ultrasound examination has a measurable positive effect on the management of women with suspected ovarian malignancy. (7) Detailed preoperative ultrasound examination of benign adnexal lesions is helpful for assessing feasibility of their removal by laparoscopic surgery.