Intra-operative Ultrasonography Evaluation of Risk of Malignancy Index in Ovarian Cysts

Authors: Fariba Behnia-Willison, FRANZCOG, MRANZCOG, MBBS, Peter J. Hewett, MBBS, FRACS, Mehrnoush Sarmadi, MD, Amirreza Jourabchi, MD, AFCHSM


The aim of the study was to compare intra-operative, Laparoscopic/Laparotomic Ultrasonography with pre-operative Transvaginal or Abdominal Ultrasonography for the evaluation of the Risk of Malignancy Index (RMI) in the ovarian cysts. We expected to have a more accurate and sensitive intraoperative RMI and more accurate estimation of the ovarian cyst size which could result in more appropriate surgical approach and reduction of Intraoperative Frozen Section sampling.

Methods and Materials

5 women who underwent surgical management of their ovarian cysts were included. An ultrasonic probe was placed over the surface of ovarian cyst and pictures were captured and saved for later evaluation. The results of intra-operative and pre-operative RMI were compared and the accuracy of the two methods was evaluated with final histopathology result.


Of 7 patients 5 had intraoperative ultrasonography at the time of the procedure. One woman with moderate RMI, was found to have borderline ovarian cyst at the time of frozen section and histopathology examination while intra-operative RMI was higher than preoperative one. One of them had low RMI pre and intra-operative with histopathology of benign cystadenoma. Three of them had moderate RMI pre-operatively and intra-operatively. It was noted that in the ovarian cyst more than 9 cms the accuracy of vaginal ultrasound was less than intra-operative ultrasound.


The intra-operative ultrasound is undervalued and not readily used in ovarian cysts evaluation. As vaginal ultrasound has a limitation when the cyst is more than 5 cm.Intraoperative ultrasound can accurately evaluate the cysts more than 5 cm in terms of abnormal features. As well as the limitation of BMI can be overcome by intra-operative ultrasound. It appears that intra-operative ultrasound has a place in the management of ovarian cyst but more studies are needed to confirm its usefulness in ovarian cysts management.

This research certified as Master of Minimally Invasive Surgery for Dr Fariba Behnia-Willison.



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