Diagnosis of paraovarian cysts using transvaginal sonography combined with CA 125 determination

Paraovarian cysts arise from the broad ligament between the Fallopian tube and the ovary and they appear sonographically as thin-walled, smooth-margined, usually unilocular cysts. We wish to add to the literature on paraovarian cyst diagnosis by reporting our findings on the diagnostic accuracy of transvaginal sonography alone or in combination with serum cancer antigen (CA 125) determination. A total of 315 adnexal masses in 313 non-pregnant women were included in this prospective study. One or 2 days prior to surgery all women underwent a detailed transvaginal ultrasound examination by an experienced operator and, on the same day, CA 125 was determined. At surgery, all adnexa were examined carefully and all adnexal masses removed. Seventeen of 313 women were found to have paraovarian cysts (prevalence, 5.4%). In eight paraovarian cysts suspected on transvaginal sonography, the diagnosis was confirmed by surgery. In the nine false-negative cases, the presence of paraovarian cysts was missed because the sonographic appearance resembled that of a simple ovarian cyst. Our study suggests the important role in the diagnosis of paraovarian cysts of transvaginal ultrasound performed by an experienced sonographer, showing good specificity with a good kappa value, but relatively low sensitivity.