title: Acoustic streaming cannot discriminate reliably between endometriomas and other types of adnexal lesion: a multicenter study of 633 adnexal masses.
abstract: OBJECTIVE
  To determine the ability of acoustic streaming to discriminate between endometriomas and other adnexal masses.
  
  
  METHODS
  We used data from 1938 patients with an adnexal mass included in Phase 2 of the International Ovarian Tumor Analysis (IOTA) study. All patients had been examined by transvaginal gray-scale and Doppler ultrasound following a standardized research protocol. Assessment of acoustic streaming was voluntary and was carried out only in lesions containing echogenic cyst fluid. Acoustic streaming was defined as movement of particles inside the cyst fluid during gray-scale and/or color Doppler examination provided that the probe had been held still for two seconds to ensure that the movement of the particles was not caused by movement of the probe or the patient. Only centers where acoustic streaming had been evaluated in > 90% of cases were included. Sensitivity, specificity, positive and negative likelihood ratios (LR+, LR-), and positive and negative predictive values (PPV and NPV) of acoustic streaming with regard to endometrioma were calculated.
  
  
  RESULTS
  460 (24%) masses were excluded because they were examined in centers where </= 90% of the masses with echogenic cyst fluid had been evaluated for the presence of acoustic streaming. Acoustic streaming was evaluated in 633 of 646 lesions containing echogenic cyst fluid. It was present in 19 (9%) of 209 endometriomas and in 55 (13%) of 424 other lesions. This corresponds to a sensitivity of absent acoustic streaming with regard to endometrioma of 91% (190/209), a specificity of 13% (55/424), LR+ of 1.04, LR- of 0.69, PPV of 34% (190/559) and NPV of 74% (55/74).
  
  
  CONCLUSIONS
  Acoustic streaming cannot discriminate reliably between endometriomas and other adnexal lesions, and the presence of acoustic streaming does not exclude an endometrioma.
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospitals Leuven, Belgium. caroline.van.holsbeke@skynet.be
authors.forename: C
authors.initials: C
authors.lastname: Van Holsbeke
authors.forename: Jingh
authors.initials: J
authors.lastname: Zhang
authors.forename: V
authors.initials: V
authors.lastname: Van Belle
authors.forename: D
authors.initials: D
authors.lastname: Paladini
authors.forename: S
authors.initials: S
authors.lastname: Guerriero
authors.forename: A
authors.initials: A
authors.lastname: Czekierdowski
authors.forename: H
authors.initials: H
authors.lastname: Muggah
authors.forename: W
authors.initials: W
authors.lastname: Ombelet
authors.forename: D
authors.initials: D
authors.lastname: Jurkovic
authors.forename: A C
authors.initials: AC
authors.lastname: Testa
authors.forename: L
authors.initials: L
authors.lastname: Valentin
authors.forename: S
authors.initials: S
authors.lastname: Van Huffel
authors.forename: T
authors.initials: T
authors.lastname: Bourne
authors.forename: D
authors.initials: D
authors.lastname: Timmerman
mesh_terms: D000291:Adnexal Diseases / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D003937:Diagnosis, Differential; D004715:Endometriosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D015203:Reproducibility of Results; D014463:Ultrasonography; D055815:Young Adult