title: Three-dimensional power Doppler vascular network assessment of adnexal masses: intraobserver and interobserver agreement analysis.
abstract: OBJECTIVE
  The purpose of this study was to assess intraobserver and interobserver agreement for tumor vascular network evaluation as assessed by 3-dimensional (3D) power Doppler sonography for discriminating benign from malignant adnexal masses.
  
  
  METHODS
  Stored 3D power Doppler angiographic volume data from 39 women with a diagnosis of a vascularized adnexal mass who were evaluated and treated at our institution were retrieved from our database for analysis. Two different examiners (observer A, with 6 years of experience in 3D sonography; and observer B, with 1 year of experience) reviewed 3D sonograms blinded to each other. Three-dimensional vascular network reconstruction was done with surface rendering in the color mode. Malignancy was considered in the presence of at least 2 of the following: irregular branching, vessel caliber changes, microaneurysms, and vascular lakes. A definitive histologic diagnosis was obtained in all cases. Intraobserver and interobserver agreement rates were estimated by calculating the kappa index.
  
  
  RESULTS
  Twenty (51%) tumors were malignant, and 19 (49%) were benign. Intraobserver agreement was good for observer A (kappa = 0.69) and moderate for observer B (kappa = 0.54). Interobserver agreement was moderate (kappa = 0.49).
  
  
  CONCLUSIONS
  We found intraobserver and interobserver agreement to be moderate for 3D power Doppler assessment of the vascular network in adnexal masses.
authors.affiliation: Department of Obstetrics and Gynecology, Clinica Universitaria de Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain. jlalcazar@unav.es
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Alcázar
authors.forename: Cristian
authors.initials: C
authors.lastname: Cabrera
authors.forename: Rosendo
authors.initials: R
authors.lastname: Galván
authors.forename: Stefano
authors.initials: S
authors.lastname: Guerriero
mesh_terms: D000290:Adnexa Uteri / Q000098:blood supply* / Q000000981:diagnostic imaging*; D000291:Adnexal Diseases / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D010051:Ovarian Neoplasms / Q000098:blood supply* / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult