Preoperative diagnosis of the primary Fallopian tube carcinoma by three-dimensional static and power Doppler sonography

Authors


Professor A. Kurjak, MD, PhD, Department of Obstetrics and Gynecology, Medical School, University of Zagreb, Sveti Duh Hospital, Sveti Duh 64, HR-10000 Zagreb, Croatia

Abstract

Objective To investigate whether three-dimensional static and power Doppler ultrasound improves the diagnosis of primary Fallopian tube carcinoma.

Methods During a 2-year period five cases of primary Fallopian tube carcinoma were selected from a cohort of 520 patients with a previous scan suggestive of an adnexal tumor.

Results Tubal malignancy occurred in patients between 49 and 64 years, with presenting symptoms such as pain, vaginal bleeding and leukorrhea. CA 125 was elevated in three cases of tubal carcinoma with stages II and III, while in two patients with stage I, CA 125 was within the normal limits. Two-dimensional ultrasound demonstrated sausage shaped cystic masses with papillary projections in two patients and a complex adnexal mass in one patient. Three-dimensional ultrasound revealed sausage shaped cystic and/or complex masses with papillary projections in all five cases of tubal malignancy. In one patient preoperative 3-D ultrasound correctly predicted bilateral tumors, while 2-D transvaginal sonography found only unilateral changes. Additional 3-D power Doppler examination depicted vascular geometry typical for malignant tumor vessels such as arteriovenous shunts, microaneurysms, tumoral lakes, blind ends and dichotomous branching in each of the cases with Fallopian tube carcinoma.

Conclusions Three-dimensional ultrasound allows precise depiction of tubal wall irregularities such as papillary protrusions and pseudosepta. Improved understanding of anatomical relationships may aid in distinguishing ovarian from tubal pathology. Multiple sections of the tubal sausage like structures enable determination of local tumor spread and capsule infiltration. Study of the vascular architecture in cases of Fallopian tube malignancy is further enhanced using 3-D power Doppler imaging.

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