Can a transvaginal ultrasound miss ovarian cancer?

Transvaginal ultrasound (TVUS) is a commonly used imaging technique for evaluating the female reproductive organs, including the ovaries. While TVUS is generally considered a reliable method for diagnosing ovarian cancer, it is possible for the test to miss some cases. This can occur for several reasons:

Limitations of the technique: TVUS provides a relatively limited field of view, and some ovarian tumors may be located in areas that are difficult to visualize with this technique. Additionally, tumors that are very small or have certain characteristics may not be easily detectable on TVUS.

Operator dependency: The accuracy of TVUS is dependent on the skill and experience of the healthcare professional performing the examination. An inexperienced or less skilled practitioner may miss or misinterpret subtle signs of ovarian cancer.

Tumor characteristics: Some ovarian tumors, such as mucinous tumors or certain types of borderline tumors, may have a cystic or benign appearance on TVUS, making them difficult to differentiate from normal ovarian tissue.

Coexisting conditions: The presence of other conditions, such as uterine fibroids or bowel loops, can sometimes obstruct the view of the ovaries during TVUS, making it more difficult to detect abnormalities.

Stage of cancer: TVUS may be less sensitive in detecting early-stage ovarian cancer, when the tumors are small and confined to the ovaries.

It is important to note that TVUS is often used in conjunction with other diagnostic tests, such as transabdominal ultrasound, CA-125 blood test, and pelvic examination, to improve the accuracy of ovarian cancer diagnosis. If there is a high suspicion of ovarian cancer based on symptoms or other findings, additional imaging studies, such as a CT scan or MRI, may be recommended to further evaluate the ovaries and surrounding structures.