title: Differentiation of small adnexal masses based on morphologic characteristics of transvaginal sonographic imaging: a multicenter study.
abstract: OBJECTIVE
  The purpose of this study was to assess the diagnostic accuracy of transvaginal sonographic examination of small adnexal masses by simple descriptive sonographic scoring.
  
  
  METHODS
  In a prospective multicenter study, 4 teaching hospitals and 2 regional hospitals with homogeneous standard sonographic equipment and operator experience recruited 677 consecutive patients with small adnexal masses of less than 5 cm. Morphologic scoring was obtained for each mass and recorded. The management of the mass was based on local protocols. The minimal requirement was that surgery had to be performed for complex masses scoring 8 or higher, and follow-up of at least 12 months had to be performed and recorded for patients not admitted to surgery. Sonographic results were compared with pathologic reports and follow-up findings.
  
  
  RESULTS
  Fifty-two malignant tumors (19 borderline, 15 stage I-II, 15 stage III-IV, 2 tubal carcinomas, and 1 ovarian lymphoma), 243 benign tumors at pathologic examination, and 382 masses defined as benign according to follow-up findings were observed. Malignant tumors had a significantly higher mean +/- SD morphologic score (11.2 +/- 2.7) than benign masses (6.2 +/- 2.5) (P = .001). No difference was observed in the scoring assignment of malignant masses in different centers (P = .56). With a score of 8 or higher, the likelihood ratio was 3.61 (95% confidence interval, 3.09-4.21); sensitivity, 92%; specificity, 76.9%; and positive predictive value, 25.6%.
  
  
  CONCLUSIONS
  Our results provide evidence that descriptive morphologic scoring may overcome the subjectivity of interpretation of morphologic characteristics in small masses, and, at the same time, it can incorporate criteria to avoid simplistic description of a complex mass.
authors.affiliation: Department of Obstetrics and Gynecology, Dipartimento di Scenze Cliniche Sacco Milano, University of Milan, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferrazzi
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Lissoni
authors.forename: Danilo
authors.initials: D
authors.lastname: Dordoni
authors.forename: Diego
authors.initials: D
authors.lastname: Trio
authors.forename: Laura
authors.initials: L
authors.lastname: Redaelli
authors.forename: Costantino
authors.initials: C
authors.lastname: Rusconi
authors.forename: Patrizia
authors.initials: P
authors.lastname: Sanpaolo
authors.forename: Irene
authors.initials: I
authors.lastname: Floriani
authors.forename: Valter
authors.initials: V
authors.lastname: Torri
authors.forename: Silvano
authors.initials: S
authors.lastname: Zaglio
authors.forename: Adriana
authors.initials: A
authors.lastname: Valcamonico
authors.forename: Francesca
authors.initials: F
authors.lastname: Piol
authors.forename: Nicola
authors.initials: N
authors.lastname: Berlanda
authors.forename: Gerardo
authors.initials: G
authors.lastname: Zanetta
mesh_terms: D000290:Adnexa Uteri; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005833:Genital Neoplasms, Female / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D014463:Ultrasonography / Q000379:methods; D014621:Vagina