Combined transvaginal B-mode and color Doppler sonography for differential diagnosis of ovarian tumors: results of a multivariate logistic regression analysis.
OBJECTIVE
Transvaginal sonography is limited in its ability to assess early stage cancers of the ovary as well as in distinguishing benign processes. As a method for characterization of tumor vascularization, color-coded Doppler sonography may be able to improve the diagnostic accuracy of B-mode sonography.


METHODS
Preoperative transvaginal B-mode and Doppler sonography was performed in 63 patients with unclear adnexal lesions prior to operation. Using multiple logistic regression, the independent variables of each procedure were selected and combined to yield a diagnostic flow chart. The diagnostic accuracy of this decision matrix was tested on 257 patients with unclear adnexal tumors.


RESULTS
In the 63 adnexal tumors investigated, the diagnostic impact of isolated sonomorphological assessment with evidence of a "solid area" was 78%. Using Doppler sonography, the best discrimination was achieved by displaying the vascular distribution ("central vascularization"). Combining these independent significant variables of the two procedures raised the diagnostic accuracy to 90% (sensitivity 86%, specificity 93%). The validity achieved by this combination was confirmed by the independent application of this method to the 257 adnexal tumors with unclear malignancy status (diagnostic accuracy 93%, sensitivity 92%, specificity 94%).


CONCLUSIONS
The combination of sonography and Doppler sonography achieves high and reproducible diagnostic accuracy in preoperative malignancy status assessment of adnexal tumors. The additional use of Doppler sonography can thus provide significant aid both for differential diagnostics of adnexal lesions and for the choice of surgical route in the case of an existing indication for operative therapy.
Schelling
M
M
Frauenklinik und Poliklinik der Technischen Universität München, Munich, Germany. Markus.Schelling@lrz.tum.de
Braun
M
M
Kuhn
W
W
Bogner
G
G
Gruber
R
R
Gnirs
J
J
Schneider
K T
KT
Ulm
K
K
Rutke
S
S
Staudach
A
A
D000291:Adnexal Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016015:Logistic Models; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D014621:Vagina / Q000000981:diagnostic imaging*