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Predictive value and prevalence of refractive edge shadow in diagnosis of ovarian dermoids

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Abstract

Objective

To evaluate the diagnostic performance of refractive edge shadow in evaluation of ovarian dermoids compared to other benign adnexal masses.

Methods

Ultrasound images of 139 patients with 154 dermoids, endometriomas, and hemorrhagic cysts were retrospectively reviewed by 3 radiologists blinded to final diagnosis. Ultrasound and clinical features were compared to pathology or follow-up ultrasound results as reference standard. Inter-reader agreements with free-marginal kappa and diagnostic performance were evaluated. The former was compared using Fisher’s exact test or Mann–Whitney test with p < 0.05 to determine statistical significance.

Results

The study sample consisted of 154 lesions: 50 dermoids, 50 endometriomas, and 54 hemorrhagic cysts. Refractive edge shadow, homogeneous echogenic appearance, tip of the iceberg sign, mural echogenic nodule, echogenic shadowing focus, and dot-dash sign all were statistically significant across all readers for the diagnosis of dermoid. Prevalence of each feature in dermoids compared to other entities were as follows: refractive edge shadow (70% vs 8%; p < 0.001), homogeneously echogenic appearance (34% vs 2%; p < 0.001), tip of the iceberg sign (16% vs 1%; p < 0.001), mural echogenic nodule (38% vs 2%; p < 0.001), echogenic shadowing focus (13% vs 1%; p < 0.001), and dot-dash sign (44% vs 1%; p < 0.001). Refractive edge shadow had the highest sensitivity, negative predictive value, and accuracy among all ultrasound features associated with dermoids (70%, 86%, and 85%, respectively).

Conclusion

Refractive edge shadow is a promising ultrasound feature for diagnosis of dermoids, with the highest diagnostic accuracy and prevalence compared to other previously described features associated with dermoids.

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Authors and Affiliations

  1. Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA

    Luyao Shen, Justin R. Tse, Lindsey M. Negrete, Edward Lo, Luke Yoon & Aya Kamaya

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  1. Luyao Shen
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  2. Justin R. Tse
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Correspondence to Luyao Shen.

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Aya Kamaya: Book royalties from Elsevier and research grant from Canon, Inc. Luyao Shen, Justin Tse, Lindsey Negrete, Edward Lo, and Luke Yoon have no disclosures to report.

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Shen, L., Tse, J.R., Negrete, L.M. et al. Predictive value and prevalence of refractive edge shadow in diagnosis of ovarian dermoids. Abdom Radiol 47, 4227–4236 (2022). https://doi.org/10.1007/s00261-022-03666-3

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