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Dear Editor, dear Dr. Xi,
Thank you for commenting on our review article concerning the special role of ultrasound for the detection of ovarian cancer [1]. In the letter by Xi et al. [2] the authors propose to consider and rule out Meigs syndrome before applying the simple rules for ultrasound features suggestive of malignant or benign tumors [3] as proposed by the International Ovarian Tumor Analysis (IOTA) group. The authors refer to a rare syndrome associated with ovarian fibroma that typically shows malignant features on ultrasound [4]. We agree that Meigs syndrome will not be considered benign according to the “simple rules” [3]. It certainly is one of the “false positives” that are important to keep in mind when counseling the patient. However, the proposed ultrasound features were developed as triage criteria for preoperative planning and are not used for diagnosing the adnexal mass. The classification of ovarian masses therefore directs the triage of the vast majority of malignant ovarian tumors to a gynecologic-oncologic specialist in order to optimize the therapy and ultimately the prognosis. Therefore, all cases of suspected malignancy including the benign cases of Meigs syndrome will be triaged to a gynecologic-oncologic specialist. However, Meigs syndrome cannot be diagnosed without a histopathologic report of the ovary and therefore a surgical intervention cannot be prevented.
In conclusion, the simple ultrasound features [3] can be used as a preoperative triage of adnexal masses and will correctly triage masses with suspected malignancy accepting that in the rare case of Meigs syndrome this triage will be “false positive”.
References
Manegold-Brauer G, Bellin AK, Tercanli S, Lapaire O, Heinzelmann-Schwarz V (2014) The special role of ultrasound for screening, staging and surveillance of malignant ovarian tumors: distinction from other methods of diagnostic imaging. Arch Gynecol Obstet 289(3):491–498
Zeng X, Liao G-D, Xi M-R (2014) The mass cannot be classified as malignant. doi:10.1007/s00404-014-3556-2
Timmerman D, Testa AC, Bourne T, Ameye L, Jurkovic D, Van Holsbeke C et al (2008) Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound Obstet Gynecol 31(6):681–690
Meigs C, Cass J (1937) Fibroma of the ovary with ascites and hydrothorax: with a report of seven cases. Am J Obstet Gynecol. 33:249–267
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Manegold-Brauer, G., Heinzelmann-Schwarz, V. Comment on the letter: The mass cannot be classified as malignant. Arch Gynecol Obstet 291, 475 (2015). https://doi.org/10.1007/s00404-014-3558-0
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DOI: https://doi.org/10.1007/s00404-014-3558-0