A new sonomorphologic scoring-system (Mainz score) for the assessment of ovarian tumors using transvaginal ultrasonography. Part II: A comparison between the scoring-system and the assessment by an experienced sonographer in postmenopausal women.
OBJECTIVE
The early and accurate detection of ovarian carcinomas continues to pose a problem. To what degree can the evaluation of a maximum number of sonographic tumor markers on the basis of a newly developed 10-item score improve the preoperative assessment of adnexal tumors in postmenopausal women?


METHODS
In a prospective study 195 postmenopausal women with an adnexal tumor were examined by transvaginal sonography. A score allowing the evaluation of 10 sonographic markers was used to predict the adnexal tumor status: 1. Total tumor structure, 2. tumor border, 3. wall thickness, 4. inner echoes in cystic component, 5. septa, 6. shape of echocomplex or of the completely solid tumor, 7. echogenicity of the echocomplex or of the completely solid tumor, 8. acoustic phenomena behind tumor, 9. ascites, 10. detection of liver metastases/peritoneal carcinosis. The different markers were rated on a scale from 0 to 2 points depending upon the degree of expression observed for the individual characteristics. The total score obtained after addition of the point number recorded for each marker served as the basis for the assessment of the sonographic tumor status. The adnexal tumor was then assessed by a second sonographer to confirm the validity of the score. After having been informed of all clinical parameters, this sonographer evaluated the preoperative tumor status assessment based on his previous experience. The preoperative tumor status assessment according to the score as well as that by the experienced sonographer were compared postoperatively with the results of the histological diagnosis.


RESULTS
All assessment criteria of the score with the exception of septal thickness showed p-values of < 0.05, thus demonstrating a statistically significant correlation between score point numbers and histological findings. A suitable scoring threshold for the sonographic differentiation between malignant and benign adnexal tumors was determined at > or = 10 points at a sensitivity of 96.8% and a specificity of 91.2%, a positive predictive value of 91.2% and a negative predictive value of 96.9%. Ninety of 93 malignant and 93 of 102 benign tumors were accurately identified. Compared with the tumor status assessment by the experienced sonographer, the score offers a clear advantage in the evaluation of ambiguous cases. In 24 of 38 neoplasms whose tumor status could not be determined definitely by the experienced sonographer, the accurate tumor status could be established on the basis of the score. Using the score a problem continues to exist, however, for a small number of false-positive assessments of benign tumors, which occurred in particular for dermoid cysts and fibromas.


CONCLUSIONS
The 10-item score provides even an inexperienced ultrasound sonographer with a valuable tool allowing the assessment of the tumor status of postmenopausal adnexal tumors with a high degree of diagnostic accuracy. For the experienced sonographer the score represents, in particular in the case of indistinct ultrasound findings, a refined and improved method for the prediction of tumor status.
Weber
G
G
Universitäts-Frauenklinik Klinikum Mannheim GmbH.
Merz
E
E
Bahlmann
F
F
Leber
A M
AM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D017698:Postmenopause; D011446:Prospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography / Q000379:methods*