Adneksiyel kitlelerin pre-operatif değerlendirilmesinde manyetik rezonans görüntülemenin ultrasonografiye olan üstünlüğünün araştırılması

Objective: The aim of this study was to compare the benign/malign distinction of Magnetic Resonance Imaging (MRI) and Ultrasonography (USG) in preoperative evaluation of patients with adnexal masses who applied to our clinic. At the end of the study, the specificity and sensitivity of USG and MRI in detecting malignant masses were compared, and the most effective imaging method for patient and physician management was discussed for future clinical use. Materials and Methods: In our retrospective single-center multidisciplinary study, 171 patients aged between 16 and 80 years who were hospitalized and operated on due to adnexal masses at the Adnan Menderes University Faculty of Medicine Department of Obstetrics and Gynecology between January 2014 and September 2023 were included. In this study, the sensitivity and specificity of MRI and USG in the preoperative diagnosis of malignancy were compared. In USG scoring, the presence of free fluid, the presence of septation and its thickness (>3mm), wall structure, regular or irregular mass borders, hypoechoic-hyperechoic area presence, mass localization, and mass size were included. In MRG scoring, contrast uptake, solid area presence, ascites, omental cake, lymphadenopathy presence, other organ involvement, localization, and mass size were included. When classifying MRG findings, additional findings such as ascites, omental cake, lymphadenopathy presence, and other organ involvement were placed under the additional findings heading. NCSS (Number Cruncher Statistical System) 2020 (Kaysville, Utah, USA) program was used for statistical analysis. Student t-test was used for comparing parameters showing normal distribution in two groups, and Mann Whitney U test was used for comparing parameters that did not show normal distribution in two groups. Pearson Chi-Square test and Fisher's Exact test were used for comparing qualitative data. Significance was evaluated at p<0.01 and p<0.05 levels. Results: According to the pathology results, 80.7% of the cases were benign, and 19.3% were malignant. A significant relationship was found between menopause, age, and malignancy in patients with malignancy .The ROC curve area was evaluated for the predicted probability levels that could predict malignancy obtained from both models, and the area under the ROC curve for the USG prediction model was found to be 86.1% with a standard error of 3.9. The area under the ROC curve for MRG was found to be 88.9% with a standard error of 3.3, and no significant difference was found between them (p=0.902; p>0.05). Conclusion: The most important prognostic factor in ovarian cancer is accurate surgical staging, and therefore, masses suspected of malignancy should be referred to tertiary-competent centers, and the maximum life span that the patient can gain should be provided after primary debulking surgery . According to the results of our study, USG parameters such as the presence of free fluid, wall thickness >3 mm, irregular border parameters, and MRG parameters such as contrast uptake, solid area presence, additional findings, and mass size did not show superiority of MRG over USG. Based on our findings, USG should be recommended as the first choice for making an operation decision, and additional imaging methods should not be needed except for cases where there is uncertainty .