Trans-vaginal ultrasound examination of ovarian masses in premenopausal women.
OBJECTIVE
Two scoring systems based on trans-vaginal sonographic findings of ovarian tumors were evaluated with respect to the prediction of ovarian malignancy.


METHODS
In this retrospective study, 64 premenopausal non-pregnant patients with an ovarian tumor underwent trans-vaginal sonography from 1991 to 1993. In each women a numerical score was calculated using two methods. Method A included four variables: inner wall structure, wall thickness, presence of septa and echogenicity. The point scale ranged from 4 to 15 points. Method B included three morphological characteristics: volume, wall structure and septal structure, the point scale ranging from 0 to 12 points. The threshold values for predictability of malignancy were 9 and 5 points for methods A and B, respectively.


RESULTS
The mean age of the patients was 32.2 years (range 22-44). The mean gravidity was 2.6 (range 0-5) in 45 women, 19 women being nulliparous. Fifty-five masses were surgically proven to be benign and 9 women had primary malignant tumors. Sensitivity and specificity for prediction of malignancy were 89% and 73%, respectively, for method A, and 89% and 70%, respectively, for method B. Positive predictive value and negative predictive value for malignancy were 35% and 97% for method A and 29% and 64% for method B. The mean morphology scores on benign and malignant masses, calculated by method A, were 6.94 +/- 2.36 S.D. and 12.0 +/- 2.4 S.D. (P < 0.01). The same scores, calculated by method B, were 4.16 +/- 1.16 S.D. and 9.44 +/- 2.96 S.D. (P < 0.01). We found a considerable overlap in the scores of different types of ovarian tumors.


CONCLUSIONS
Both methods are easy to apply and provided explicit data. Method A was shown to be more effective. The number of false positive results was relatively high. The most important single sonographic characteristic of the malignant masses are the wall structure abnormalities.
D000328:Adult; D018282:Cystadenocarcinoma, Mucinous / Q000000981:diagnostic imaging / Q000473:pathology; D018284:Cystadenocarcinoma, Serous / Q000000981:diagnostic imaging / Q000473:pathology; D004715:Endometriosis / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D010048:Ovarian Cysts / Q000000981:diagnostic imaging / Q000473:pathology; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D010298:Parity; D017697:Premenopause; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014621:Vagina