To diagnose ovarian disorders, which of the following diagnostic studies is most helpful?
A. Transvaginal ultrasound
B. Pelvic CT scan
C. Pelvic MRI scan
D. Pap smear
ANS: A
Pelvic examination has been shown to have a low sensitivity and specificity for ovarian cancer, with many tumors smaller than 10 cm being missed. Several diagnostic studies are useful for detecting ovarian cancer. The CA-125 blood test by immunoassay is used as a tumor marker for treatment decisions but can also be used as a diagnostic tool. False-positive elevations in CA-125 do occur with endometriosis and pelvic surgeries; therefore, tests should be interpreted with caution and followed up with transvaginal ultrasound. Transvaginal ultrasound will show a solid, irregular mass that may be adhered to adjoining structures. A Pap smear may contain malignant cells. X-rays may show metastatic lung or bone lesions. Transvaginal ultrasound will give the best information for differentiating a blood- or fluid-filled ovarian cyst from a solid mass.
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