title: Contribution of power Doppler blood flow mapping to gray-scale ultrasound for predicting malignancy of adnexal masses in symptomatic and asymptomatic women.
abstract: OBJECTIVE
  To determine the contribution of power Doppler blood flow mapping to gray-scale ultrasound for predicting malignancy of adnexal masses in symptomatic and asymptomatic women.
  
  
  METHODS
  One thousand and ninety-four women with adnexal mass were included. Patients were divided into three groups according to clinical complaints: asymptomatic (group A), patients with symptoms non-suspicious of ovarian cancer (group B) and patients with symptoms suspicious of ovarian cancer (group C). All patients underwent transvaginal power Doppler ultrasound prior to surgery. Any mass in which the echo architecture at B-mode ultrasound was not highly suggestive of benign histology was categorized as questionable. In these cases power Doppler was performed as the second step. Definitive histological diagnosis was used as the standard reference. Sensitivity, specificity, positive likelihood ratio (+LR) and negative likelihood ratio (-LR) were calculated for B-mode diagnosis and B-mode plus Doppler in each group.
  
  
  RESULTS
  In group A, B-mode was significantly more sensitive (98.1%) than Doppler ultrasound (91.3%) (p<0.01). In group B Doppler ultrasound (97.0%) was more specific than B-mode ultrasound (92.2%) (p<0.001). In group C Doppler ultrasound (84.0%) was more specific than B-mode ultrasound (68.0%) (p<0.001). Positive LR was significantly higher after Doppler evaluation in all groups (30.5 vs 12.8 in group A, 33.2 vs 12.8 in group B and 6.0 vs 3.1 in group C).
  
  
  CONCLUSIONS
  The diagnostic performance of B-mode and power Doppler ultrasound is different depending on patients' complaints.
authors.affiliation: Department of Obstetrics and Gynecology, Clinica Universitaria de Navarra, University of Navarra, Pamplona, Spain. jlalcazar@unav.es
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Alcázar
authors.forename: Stefano
authors.initials: S
authors.lastname: Guerriero
authors.forename: Carmen
authors.initials: C
authors.lastname: Laparte
authors.forename: Silvia
authors.initials: S
authors.lastname: Ajossa
authors.forename: Matías
authors.initials: M
authors.lastname: Jurado
mesh_terms: D000291:Adnexal Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003663:Decision Trees; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D018608:Ultrasonography, Doppler / Q000379:methods*; D018617:Ultrasonography, Doppler, Pulsed / Q000379:methods*; D055815:Young Adult