It is of utmost importance to use complementary imaging methods in questionable cases and/or to be present in the operating theater in order to maximize one's knowledge of the tumor's characteristics and spread. To become an ultrasound expert in gynecological oncology requires adequate practical expertise, which is developed through exposure to abnormal findings. The accuracy of ultrasound is largely dependent on three variables: operator, equipment and patient. Ultrasound also enables the targeted biopsy of advanced tumors or metastatic lesions, allowing fast and minimally invasive establishment of the tumor histology 1. In this way we can make maximum therapeutic impact with minimal patient morbidity. Using ultrasound to evaluate important prognostic parameters makes the individualization of oncology treatment possible. When performed by an experienced diagnostician, it can play an invaluable role in the primary diagnosis of gynecological cancers, the assessment of tumor extent in the pelvic and abdominal cavity and the evaluation of treatment effects as well as follow-up after treatment. Ultrasound is a non-invasive, commonly available, affordable imaging method associated with minimal risk and discomfort to the patient. contrast-enhanced ultrasound, computed tomography, magnetic resonance imaging, positron emission tomography) is indicated. If, however, less characteristic findings are encountered, especially when the examination result radically affects subsequent therapeutic management, an additional examination using a complementary imaging method (e.g. In the investigation of distant metastases, if a normal visceral organ or characteristic diffuse or focal lesions (such as a simple cyst, hepatic hemangioma, renal angiomyolipoma, fatty liver (steatosis)) are identified on ultrasound, additional examinations using complementary imaging methods are not required. The presence of peripheral or mixed vascularity or displacement of vessels seems to be the sole criterion in the diagnosis of metastatic or lymphomatous nodes. Vascular patterns are particularly well visualized in peripheral nodes using high resolution linear array probes or in the pelvis using high-frequency probes. Ultrasound can be used to assess changes in infiltrated lymph nodes, including demonstration of characteristic sonomorphologic and vascular patterns.

Furthermore, it is specific for the detection of extrapelvic tumor spread to the abdominal cavity in the form of parietal or visceral carcinomatosis, omental and/or mesenteric infiltration. In cases of ureteric involvement, ultrasound is also helpful in locating the site of obstruction. Ultrasound can be used to detect early as well as locally advanced cancers that extend from the vagina, cervix or other locations to the paracolpium, parametria, rectum and sigmoid colon, urinary bladder and other adjacent organs or structures. Ultrasound is established as the method of choice for evaluating local extent of endometrial cancer and is the most important imaging method for the differential diagnosis of benign and malignant ovarian tumors. Other complementary imaging techniques, such as computed tomography and magnetic resonance imaging, can be used as an adjunct to ultrasound in specific cases, but are not essential to tumor staging if sonography is performed by a specialist in gynecological oncology.

With increased technical quality, sonography has become an accurate staging method for early and advanced gynecological tumors. The methodology of gynecological cancer staging, including assessment of local tumor extent, lymph nodes and distant metastases, is described. This Review documents examination techniques, sonographic features and clinical considerations in ultrasound assessment of gynecological tumors.

Sonogram abdomen