title: Diagnosis of adnexal malignancies by using color Doppler energy imaging as a secondary test in persistent masses.
abstract: The purpose of this prospective study was to compare the accuracy of B-mode transvaginal ultrasonography alone and in combination with color Doppler energy (or power Doppler) imaging in differentiating benign from malignant adnexal masses. A total of 192 consecutive persistent adnexal masses (159 benign, 33 malignant) were studied before surgery by B-mode transvaginal ultrasonography with and without color Doppler energy. In addition, CA-125 plasma levels were determined and spectral Doppler analysis was performed. By color Doppler energy imaging, a mass was considered malignant when arterial flow was visualized in an echogenic portion of a mass defined as malignant by B-mode. Intratumoral arterial blood flow could be readily detected by color Doppler energy imaging in all malignant tumors and in 94% of the benign tumors. The combined use of transvaginal B-mode ultrasonography and color Doppler energy imaging has greater accuracy in the diagnosis of ovarian malignancies than transvaginal ultrasonography alone (value of kappa: 0.81 and 0.63, respectively), reducing the number of false-positive results. The use of spectral Doppler analysis was of limited diagnostic value, with a kappa value of 0.17 for the pulsatility index (< 1) and of 0.41 for the resistance index (< 0.4). Also, the association with CA-125 increased the number of false-negative results. In conclusion, the use of color Doppler energy imaging seems to be a useful secondary test when a mass is suspected to be malignant by B-mode ultrasonography.
authors.affiliation: Department of Obstetrics and Gynecology, University of Cagliari, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Guerriero
authors.forename: S
authors.initials: S
authors.lastname: Ajossa
authors.forename: A
authors.initials: A
authors.lastname: Risalvato
authors.forename: M P
authors.initials: MP
authors.lastname: Lai
authors.forename: V
authors.initials: V
authors.lastname: Mais
authors.forename: M
authors.initials: M
authors.lastname: Angiolucci
authors.forename: G B
authors.initials: GB
authors.lastname: Melis
mesh_terms: D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging*; D017698:Postmenopause; D011237:Predictive Value of Tests; D017697:Premenopause; D011446:Prospective Studies; D012039:Regional Blood Flow; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color / Q000379:methods*