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Ultrasound plays an important role in diagnostics of pelvic tumors and significantly contributes to their subsequent management. Ultrasound of pelvic tumors can be divided into basic and expert. The most important task of basic ultrasound is a distinction between normal and suspicious finding. A finding, which is suspicious of a severe adnexal pathology, is referred to an expert sonography. Using the IOTA criteria, this examination differentiates between benign or malignant findings. In case of a suspicion of an ovarian carcinoma, stage of the disease is determined. A detailed description of the extent of tumor affection in individual compartments of the pelvis and abdominal cavity further identifies patients with signs of suboptimal operability.
Signs of suboptimal operability (impossibility to achieve no residual disease after surgery) include suprarenal lymphadenopathy, multiple intraparenchymatous metastases, numerous metastatic nodules in the mesentery and diffuse visceral carcinomatosis.
Ultrasound in hands of experienced examiner reaches similar overall accuracy as CT or MRI in staging of advanced cancer, while it has the highest specificity compared to CT or MRI in assesment of the tumor spread in the abdominal cavity and in the prediction of metastases in the liver parenchyma or retroperitoneal lymph node involvement.
Approximately 30% of patients with ovarian carcinoma have any of the signs of inoperability at the time of diagnosis. Neoadjuvant chemotherapy is then initiated and followed by interval debulking surgery in case of a good effect of the treatment. However, histological verification of the tumor is necessary before initiation of this kind of therapy. Ultrasound-guided needle biopsy (tru-cut biopsy) is a reliable, minimally invasive and safe method to obtain a valid histological specimen. The basic indications for transvaginally or transabdominally conducted biopsies include primarily inoperable finding, identification of the tumor origin and differentiation between benign and malignant tumor. Biopsy is most often performed transvaginally from pelvic tumor or pelvic carcinomatosis, transabdominally from infiltrated omentum.