Value of ultrasonography in the diagnosis of polycystic ovary syndrome – literature review

• Authors: Michał Bachanek , Nebil Abdalla , Krzysztof Cendrowski , Włodzimierz Sawicki

Title variants

PL

Wartość ultrasonografii w diagnostyce zespołu policystycznych jajników – przegląd piśmiennictwa

• Languages of publication: EN PL

Abstracts

EN

Polycystic ovary syndrome is a multi-factorial disease. Its etiopathogenesis has not been elucidated in detail. It is the most common endocrine disorder in women of child-bearing age. This disease entity is primarily characterized by disrupted ovulation and hyperandrogenism, but the clinical picture can be diversified and symptom intensity can vary. Currently, the sonographic assessment of ovaries is one of the obligatory criteria for the diagnosis of PCOS according to the Rotterdam consensus (2003) and Androgen Excess & PCOS Society (2006). This criterion is determined by the presence of ≥12 follicles within the ovary with a diameter of 2–9 mm and/or ovarian volume ≥10 cm3. Such an ultrasound image in one gonad only is sufficient to define polycystic ovaries. The coexistence of polycystic ovaries with polycystic ovary syndrome is confirmed in over 90% of cases irrespective of ethnic factors or race. However, because of the commonness of ultrasound features of polycystic ovaries in healthy women, the inclusion of this sign to the diagnostic criteria of polycystic ovary syndrome is still questioned. The development of new technologies has an undoubted influence on the percentage of diagnosed polycystic ovaries. This process has caused an increase in the percentage of polycystic ovary diagnoses since the Rotterdam criteria were published. It is therefore needed to prepare new commonly accepted diagnostic norms concerning the number of ovarian follicles and the standardization of the technique in which they are counted. The assessment of anti-Müllerian hormone levels as an equivalent of ultrasound features of polycystic ovaries is a promising method. However, analytic methods have to be standardized in order to establish commonly accepted diagnostic norms.

PL

Zespół policystycznych jajników jest chorobą wieloczynnikową. Szczegółowa jego etiopatogeneza wciąż nie została wyjaśniona. Jest to najczęstsze schorzenie endokrynologiczne kobiet w wieku reprodukcyjnym. Ta jednostka chorobowa charakteryzuje się przede wszystkim zaburzeniem przebiegu owulacji i hiperandrogenizacją, ale obraz kliniczny może być zróżnicowany, o różnym nasileniu symptomów. Obecnie sonograficzna ocena jajników należy do obowiązujących kryteriów rozpoznania zespołu według konsensusu z Rotterdamu (2003) oraz Androgen Excess & PCOS Society (2006). Kryterium to jest uwarunkowane obecnością w obrębie jajnika ≥12 pęcherzyków o średnicy 2–9 mm i/lub objętością jajnika ≥10 cm3. Opisany obraz ultrasonograficzny dotyczący tylko jednej gonady wystarczy do zdefiniowania policystyczności. Współistnienie policystyczności jajników z zespołem policystycznych jajników potwierdzane jest w ponad 90% przypadków, niezależnie od czynników etnicznych czy rasowych. Jednak ze względu na powszechną obecność ultrasonograficznych cech policystyczności jajników u kobiet zdrowych nadal kwestionuje się włączenie tego objawu do kryteriów diagnostycznych zespołu policystycznych jajników. Niewątpliwy wpływ na odsetek rozpoznań policystyczności jajników ma rozwój nowych technologii. Proces ten powoduje zwiększenie odsetka rozpoznań cech policystyczności jajników od czasu publikacji kryteriów rotterdamskich. Zatem istnieje potrzeba ustanowienia nowych, powszechnie akceptowanych norm diagnostycznych dotyczących liczby pęcherzyków jajnikowych, jak również standaryzacji techniki ich liczenia. Duże nadzieje wiązane są z oceną stężenia hormonu antymüllerowskiego jako równoważnego markera ultrasonograficznych cech policystyczności jajników, jednakże do wyznaczenia powszechnie akceptowanych norm diagnostycznych potrzebna jest standaryzacja metod analitycznych.

Keywords

EN

PCOS; ovarian follicles; polycystic ovarysyndrome; pęcherzyki jajnikowe; ultrasonografia; ultrasound; zespół policystycznychjajników

Discipline

• MEDICINE: MEDICINE

• Publisher: Medical Communications
• Journal: Journal of Ultrasonography
• Year: 2015
• Volume: 15
• Issue: 63
• Pages: 410-422

Contributors

author

Michał Bachanek

• Department of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland

author

Nebil Abdalla

• Department of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland

author

Krzysztof Cendrowski

• Department of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland

author

Włodzimierz Sawicki

• Department of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland

References

• Stein IF, Leventhal ML: Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 1935; 29: 181–191.
• Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO: The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004; 89: 2745–2749.
• Asunción M, Calvo RM, San Millán JL, Sancho J, Avila S, Escobar-Morreale HF: A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 2000; 85: 2434–2438.
• Abbott DH, Tarantal AF, Dumesic DA: Fetal, infant, adolescent and adult phenotypes of polycystic ovary syndrome in prenatally androgenized female rhesus monkeys. Am J Primatol 2009; 71: 776–784.
• Oberfield SE, Sopher AB, Gerken AT: Approach to the girl with early onset of pubic hair. J Clin Endocrinol Metab 2011; 96: 1610–1622.
• Zhang HY, Guo CX, Zhu FF, Qu PP, Lin WJ, Xiong J: Clinical characteristics, metabolic features, and phenotype of Chinese women with polycystic ovary syndrome: a large-scale case-control study. Arch Gynecol Obstet 2013; 287: 525–531.
• March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ: The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 2010; 25: 544–551.
• Szydlarska D, Grzesiuk W, Bar-Andziak E: Kontrowersje wokół patogenezy zespołu policystycznych jajników. Endokrynologia, Otyłość i Zaburzenia Przemiany Materii 2010; 6: 141–146.
• Bachanek M, Sawicki W: Zespół metaboliczny a zespół policystycznych jajników. In: Mamcarz A: Zespół metaboliczny. Medical Education, Warszawa 2008: 567–577.
• Zawadski JK, Dunaif A: Polycystic ovary syndrome. Blackwell Scientific, Boston 1992.
• Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group: Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81: 19–25.
• The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group: Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19: 41–47.
• Pache TD, Wladimiroff JW, Hop WC, Fauser BC: How to discriminate between normal and polycystic ovaries: transvaginal US study. Radiology 1992; 183: 421–423.
• van Santbrink EJ, Hop WC, Fauser BC: Classification of normogonadotropic infertility: polycystic ovaries diagnosed by ultrasound versus endocrine characteristics of polycystic ovary syndrome. Fertil Steril 1997; 67: 452–458.
• Jonard S, Robert Y, Cortet-Rudelli C, Pigny P, Decanter C, Dewailly D: Ultrasound examination of polycystic ovaries: is it worth counting the follicles? Hum Reprod 2003; 18: 598–603.
• Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W et al.; Androgen Excess Society: Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab. 2006; 91: 4237–4245.
• Adams J, Polson DW, Franks S: Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism. Br Med J (Clin Res Ed) 1986; 293: 355–359.
• Broekmans FJ, de Ziegler D, Howles CM, Gougeon A, Trew G, Olivennes F: The antral follicle count: practical recommendations for better standardization. Fertil Steril 2010; 94: 1044–1051.
• Lujan ME, Brooks ED, Kepley AL, Chizen DR, Pierson RA, Peppin AK: Grid analysis improves reliability in follicle counts made by ultrasonography in women with polycystic ovary syndrome. Ultrasound Med Biol 2010; 36: 712–718.
• Deb S, Campbell BK, Clewes JS, Raine-Fenning NJ: Quantitative analysis of antral follicle number and size: a comparison of two-dimensional and automated three-dimensional ultrasound techniques. Ultrasound Obstet Gynecol 2010; 35: 354–360.
• Jayaprakasan K, Walker KF, Clewes JS, Johnson IR, Raine-Fenning NJ: The interobserver reliability of off-line antral follicle counts made from stored three-dimensional ultrasound data: a comparative study of different measurement techniques. Ultrasound Obstet Gynecol 2007; 29: 335–341.
• Scheffer GJ, Broekmans FJM, Bancsi LF, Habbema JD, Te Velde ER: Quantitative transvaginal two- and three-dimensional sonography of the ovaries: reproducibility of antral follicle counts. Ultrasound Obstet Gynecol 2002; 20: 270–275.
• Battaglia C, Battaglia B, Morotti E, Paradisi R, Zanetti I, Meriggiola MC, Venturoli S: Two- and three-dimensional sonographic and color Doppler techniques for diagnosis of polycystic ovary syndrome. The stromal/ovarian volume ratio as a new diagnostic criterion. J Ultrasound Med 2012; 31: 1015–1024.
• Dewailly D, Lujan ME, Carmina E, Cedars MI, Laven J, Norman RJ et al.: Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update 2014; 20: 334–352.
• Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W et al.: The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 2009; 91: 456–488.
• Dewailly D, Gronier H, Poncelet E, Robin G, Leroy M, Pigny P et al.: Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Hum Reprod 2011; 26: 3123–3129.
• Lujan ME, Jarrett BY, Brooks ED, Reines JK, Peppin AK, Muhn N et al.: Updated ultrasound criteria for polycystic ovary syndrome: reliable thresholds for elevated follicle population and ovarian volume. Hum Reprod 2013; 28: 1361–1368.
• Balen AH, Laven JS, Tan SL, Dewailly D: Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update 2003; 9: 505–514.
• Chen Y, Li L, Chen X, Zhang Q, Wang W, Li Y et al.: Ovarian volume and follicle number in the diagnosis of polycystic ovary syndrome in Chinese women. Ultrasound Obstet Gynecol 2008; 32: 700–703.
• Köşüş N, Köşüş A, Turhan NÖ, Kamalak Z: Do threshold values of ovarian volume and follicle number for diagnosing polycystic ovarian syndrome in Turkish women differ from western countries? Eur J Obstet Gynecol Reprod Biol 2011; 154: 177–181.
• Deb S, Campbell BK, Clewes JS, Pincott-Allen C, Raine-Fenning NJ: Intracycle variation in number of antral follicles stratified by size and in endocrine markers of ovarian reserve in women with normal ovulatory menstrual cycles. Ultrasound Obstet Gynecol 2013; 41: 216–222.
• Bentzen JG, Forman JL, Johannsen TH, Pinborg A, Larsen EC, Andersen AN: Ovarian antral follicle subclasses and anti-mullerian hormone during normal reproductive aging. J Clin Endocrinol Metab 2013; 98: 1602–1611.
• Lujan ME, Chizen DR, Peppin AK, Dhir A, Pierson RA: Assessment of ultrasonographic features of polycystic ovaries is associated with Modest levels of inter-observer agreement. J Ovarian Res 2009; 2: 6.
• Carmina E, Orio F, Palomba S, Longo RA, Lombardi G, Lobo RA: Ovarian size and blood flow in women with polycystic ovary syndrome and their correlations with endocrine parameters. Fertil Steril 2005; 84: 413–419.
• Pavlik EJ, DePriest PD, Gallion HH, Ueland FR, Reedy MB, Kryscio RJ et al.: Ovarian volume related to age. Gynecol Oncol 2000; 77: 410–412.
• Fulghesu AM, Angioni S, Frau E, Belosi C, Apa R, Mioni R et al.: Ultrasound in polycystic ovary syndrome – the measuring of ovarian stroma and relationship with circulating androgens: results of a multicentric study. Hum Reprod 2007; 22: 2501–2508.
• Pascual MA, Graupera B, Hereter L, Tresserra F, Rodriguez I, Alcázar JL: Assessment of ovarian vascularization in the polycystic ovary by three-dimensional power Doppler ultrasonography. Gynecol Endocrinol 2008; 24: 631–636.
• Iliodromiti S, Kelsey TW, Anderson RA, Nelson SM: Can anti-Mullerian hormone predict the diagnosis of polycystic ovary syndrome? A systematic review and meta-analysis of extracted data. J Clin Endocrinol Metab 2013; 98: 3332–3340.
• Pigny P, Merlen E, Robert Y, Cortet-Rudelli C, Decanter C, Jonard S, Dewailly D: Elevated serum level of anti-mullerian hormone in patients with polycystic ovary syndrome: relationship to the ovarian follicle excess and to the follicular arrest. J Clin Endocrinol Metab 2003; 88: 5957–5962.
• Laven JS, Mulders AG, Visser JA,Themmen AP, DeJong FH, Fauser BC: Anti-Müllerian hormone serum concentrations in normoovulatory and anovulatory women of reproductive age. J Clin Endocrinol Metab 2004; 89: 318–323.
• Govind A, Obhrai MS, Clayton RN: Polycystic ovaries are inherited as an autosomal dominant trait: analysis of 29 polycystic ovary syndrome and 10 control families. J Clin Endocrinol Metab 1999; 84: 38–43.
• Dewailly D, Pigny P, Soudan B, Catteau-Jonard S, Decanter C, Poncelet E et al.: Reconciling the definitions of polycystic ovary syndrome: the ovarian follicle number and serum anti-Müllerian hormone concentrations aggregate with the markers of hyperandrogenism. J Clin Endocrinol Metab 2010; 95: 4399–4405.
• Johnstone EB, Rosen MP, Neril R, Trevithick D, Sternfeld B, Murphy R et al.: The polycystic ovary post-Rotterdam: a common, age-dependent finding in ovulatory women without metabolic significance. J Clin Endocrinol Metab 2010; 95: 4965-4972.
• Mortensen M, Ehrmann DA, Littlejohn E, Rosenfield RL: Asymptomatic volunteers with a polycystic ovary are a functionally distinct but heterogeneous population. J Clin Endocrinol Metab 2009; 94: 1579–1586.
• Catteau-Jonard S, Bancquart J, Poncelet E, Lefebvre-Maunoury C, Robin G, Dewailly D: Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome? Ultrasound Obstet Gynecol 2012; 40: 223–229.

• Document Type: review