title: Three-dimensional sonographic morphologic assessment in complex adnexal masses: preliminary experience.
abstract: OBJECTIVE
  To evaluate the role of three-dimensional transvaginal sonography in assessing complex adnexal masses.
  
  
  METHODS
  Forty-one women (mean age, 49.5 years; range, 23-75 years) with the diagnosis of complex adnexal masses on the basis of two-dimensional transvaginal sonography were reevaluated by three-dimensional transvaginal sonography. Two different sonologists evaluated the two- and three-dimensional transvaginal sonograms. Criteria indicative of malignancy included the presence of gross papillary projections, solid areas, and solid echogenicity for both techniques. Three women (7%) had bilateral masses, giving a total of 44 masses that were ultimately assessed. A definitive histologic diagnosis was obtained in every case after surgical tumor removal.
  
  
  RESULTS
  Twenty-one tumors (47.7%) were proved malignant, and 23 (52.3%) were benign. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for two- and three-dimensional transvaginal sonography were 90%, 61%, 68%, 87%, and 75% and 100%, 78%, 81%, 100%, and 89%, respectively. There were no statistical differences between two- and three-dimensional transvaginal sonography (McNemar test, P = .687). The agreement between both examiners was high (kappa index = 0.71).
  
  
  CONCLUSIONS
  The use of three-dimensional transvaginal sonography does not significantly improve the two-dimensional transvaginal sonographic morphologic assessment of complex adnexal masses; however, we found it useful for reinforcing initial diagnostic impressions.
authors.affiliation: Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Alcázar
authors.forename: María José
authors.initials: MJ
authors.lastname: Galán
authors.forename: Manuel
authors.initials: M
authors.lastname: García-Manero
authors.forename: Stefano
authors.initials: S
authors.lastname: Guerriero
mesh_terms: D000232:Adenofibroma / Q000175:diagnosis / Q000473:pathology; D000290:Adnexa Uteri / Q000000981:diagnostic imaging* / Q000473:pathology*; D000291:Adnexal Diseases / Q000175:diagnosis* / Q000473:pathology*; D000328:Adult; D000368:Aged; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000473:pathology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional; D016387:Women's Health