Dermoid kistlerde ultrasonografik tanı doğruluğunu etkileyen parametreler

Amaç: Ultrasonografinin dermoid kist tanısındaki yeterliliğini belirlemek ve histopatolojik olarak farklı tanı alan olgularda sonografik tanısal hata nedenlerini ortaya koymak. Yöntemler: Adneksiyal kitle tespit edilen ardışık 245 olgudan ultrasonografik ve histopatolojik olarak dermoid kist tanısı alanlar çalışmaya dahil edildi. Preoperatif ultrasonografi bulguları ile postoperatif patoloji sonuçları de- ğerlendirildi ve preoperatif ultrasonografik görüntüleme ile postoperatif patoloji sonuçları arasındaki ilişki araştırıldı. Bulgular: Dermoid kist tanısı ultrasonografi ile %81,8 sensitivite, %93,1 spesifite, %67,5 pozitif öngörü değeri, %96,7 negatif öngörü değeri ile tanımlandı. Ultrasonografi ile dermoid kist tespitinde kist duvar kalınlığının 3 milimetreden fazla olmasının (p=0,029), duvar iç konturunun düzensiz olması (p=0,001) ve hiperekojenik ince çizgilenmeye bağlı olarak karışık ekojenitenin izlenmesinin (p=0,003), solid komponent (p=0,001), akustik gölgelenme (p=0,001), kalsifikasyon (p=0.001) ve ekojenik mural nodül (p=0,001) saptanmasının istatistiksel olarak anlamlı oranda yüksek olduğu görüldü. Doppler sonografide vaskularite tespitinin dermoid kist tespitinde istatistiksel olarak anlamlı olmadığı görüldü (p=0,52). Sonuç: Adneksiyel kitlelerin ultrasonografi ile subjektif olarak değerlendirilerek tanı konulmasına patern tanıma yöntemi denilmektedir. Adneksiyal kitlelerin tanınmasında patern tanıma yöntemi, diğer yöntemlere oranla yüksek doğruluk oranına sahiptir ve spesifik tanıya gitmede daha güvenilirdir. Dermoid kistlerde hiperekojenik ince çizgilenme ve hiperekojenik solid yapı karakteristik özellik olmakla birlikte, bu parametrelerin aynı zamanda yanlış tanı konulmasına sebep olan parametreler olduğu görülmüştür.

The parameters affecting accuracy of e ultrasonographic diagnosis in dermoid cysts

Objective: To determine the adequacy of ultrasound in diagnosis of dermoid cysts and to demonstrate the causes of ultrasonographic failure in histopathologically misdiagnosed cases. Methods: Of 245 consecutive patients, whom an adnexal mass is determined and the preliminary ultrasonographic diagnosis of the cyst was a dermoid csyt, were included in the study. Preoperative ultrasonographic findings and postoperative pathology results were evaluated and the correlation with pre-operative ultrasound imaging and final pathologic results were analyzed. Results: The diagnosis of a dermoid cyst with ultrasonography was detected with the following rates of sensitivity 81.8%, specifity 93.1%, positive predictive value 67.5%, negative predictive value 96.7%. A wall thickness greater than 3 mm (p=0.029), inner wall irregularity (p=0.001), mixed echogenity according to hyperechogenic lines p=0.003), solid component (p=0.001), acoustic shadowing (p=0.001), calcification (p=0.001), echogenic mural nodule (p=0.001), were found to be statistically significant (p<0.001) in ultrasonographic diagnosis of dermoid cysts. Determination of vascularity in Doppler sonography was not found statistically significant in diagnosis of dermoid cysts (p=0.52). Conclusion: Pattern recognition method is a method that evaluates and diagnoses adnexal masses by ultrasonography subjectively. It was shown to be more reliable with high accuracy rates in specific diagnosis of adnexial masses when compared to that of other methods. Even though hyperechogenic lines and hyperechogenic solid masses were characteristic findings for dermoid cysts, these parameters were found to be the most frequent causes of misdiagnosis.

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