Age-related differences in the sonographic characteristics of endometriomas.
Do sonographic characteristics of ovarian endometriomas vary with age in premenopausal women?



With increasing age, multilocular cysts and cysts with papillations and other solid components become more common whereas ground glass echogenicity of cyst fluid becomes less common.



Expectant or medical management of women with endometriomas is now accepted. Therefore, the accuracy of non-invasive diagnosis of these cysts is pivotal. A clinically relevant question is whether the sonographic characteristics of ovarian endometriomas are the same irrespective of the age of the woman.



This is a secondary analysis of cross-sectional data in the International Ovarian Tumor Analysis (IOTA) database. The database contains clinical and ultrasound information collected pre-operatively between 1999 and 2012 from 5914 patients with adnexal masses in 24 ultrasound centres in 10 countries.



There were 1005 histologically confirmed endometriomas in adult premenopausal patients found in the database and these were used in our analysis. The following ultrasound variables (defined using IOTA terminology) were used to describe the ultrasound appearance of the endometriomas: tender mass at ultrasound, largest diameter of lesion, tumour type (unilocular, unilocular-solid, multilocular, multilocular-solid, solid), echogenicity of cyst content, presence of papillations, number of papillations, height (mm) of largest papillation, presence and proportion of solid tissue and number of cyst locules, as well as vascularity in papillations and colour content of the tumour scan (colour score) on colour or power Doppler ultrasounds. Results are reported as median difference or odds ratio (OR) per 10 years increase in age.



Maximal lesion diameter did not vary substantially with age (+1.3 mm difference per 10 years increase in age, 95% confidence interval (CI) -1.4 to 4.0). Tender mass at scan was less common in the older the woman (OR 0.75, 95% CI 0.63-0.89), as were unilocular cysts relative to multilocular cysts (OR 0.70, 95% CI 0.57-0.85) and to lesions with solid components (OR 0.61, 95% CI 0.48-0.77), and ground glass echogenicity relative to homogeneous low-level echogenicity (OR 0.74, 95% CI 0.58-0.94) and other types of echogenicity of cyst contents (OR 0.64, 95% CI 0.50-0.81). Papillations were more common the older the woman (OR 1.65, 95% CI 1.24-2.21), but their height and vascularization showed no clear relation to age.



It is a limitation that we have little clinical information on the women included, e.g. previous surgery or medical treatment for endometriosis. It is important to emphasize that we do not know the age of the endometrioma itself and that our study is not longitudinal and so does not describe changes in endometriomas over time. The differences in the ultrasound appearance of endometriomas between women of different ages might be explained by previous surgery or medical treatment and might not be an effect of age per se.



Awareness of physicians that the ultrasound appearance of endometriomas differs between women of different ages may facilitate a correct diagnosis of endometrioma.



This study was supported in part by the Regione Autonoma della Sardegna (project code CPR-24750). B.V.C., A.C. and D.T. are supported by the Fund for Scientific Research Flanders, Belgium (FWO). The authors declare that there is no conflict of interest.
Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy gineca.sguerriero@tiscali.it.
Stefano
S
Guerriero
Department of Development and Regeneration, KU Leuven, Herestraat 49, Box 7003, 3000 Leuven, Belgium.
Ben
B
Van Calster
Department of Obstetrics and Gynecology, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Edgardo
E
Somigliana
Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy.
Silvia
S
Ajossa
Department of Obstetrics and Gynecology, KU Leuven, Leuven, Belgium.
Wouter
W
Froyman
Department of Obstetrics and Gynecology, KU Leuven, Leuven, Belgium.
Bavo
B
De Cock
Department of Obstetrics and Gynecology, KU Leuven, Leuven, Belgium Department of Oncology, ImmunOvar Research Group, Leuven Cancer Institute, KU Leuven, Leuven, Belgium.
An
A
Coosemans
Department of Obstetrics and Gynecology, Oncogynecological Center, Charles University in Prague, First Faculty of Medicine and General University Hospital, Prague, Czech Republic.
Daniela
D
Fischerová
Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium.
Caroline
C
Van Holsbeke
Department of Obstetrics and Gynecology, University of Navarra, Pamplona, Spain.
Juan Luis
JL
Alcazar
Clinica Ostetrica Ginecologica, University Catholic of Sacred Heart, Rome, Italy.
Antonia C
AC
Testa
Skåne University Hospital Malmö, Lund University, Lund, Sweden.
Lil
L
Valentin
Department of Development and Regeneration and Department of Oncology, KU Leuven, Leuven, Belgium; Department of Gynaecology and Obstetrics and Leuven Cancer Institute, University Hospitals KU Leuven, Leuven, Belgium; Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK.
Tom
T
Bourne
Department of Obstetrics and Gynecology, KU Leuven, Leuven, Belgium.
Dirk
D
Timmerman
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D004715:Endometriosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010048:Ovarian Cysts / Q000000981:diagnostic imaging*; D010049:Ovarian Diseases / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D055815:Young Adult
age; diagnosis; ovarian endometrioma; sonographic characteristics; ultrasound