title: Differentiating between benign and malignant adnexal lesions with contrast-enhanced transvaginal ultrasonography.
abstract: OBJECTIVE
  To analyze the relationship between contrast kinetics in tumorous vessels and lesion histologic type in an attempt to differentiate between malignant and benign disease.
  
  
  METHODS
  In a single-center prospective study, patients who had been referred for elective surgery because of a diagnosis of unilateral and/or bilateral adnexal masses were enrolled at Dr Jan Biziel University Hospital, Bydgoszcz, Poland, between January 2012 and September 2013. Participants underwent contrast-enhanced ultrasonography examination (CEUS). Contrast kinetics were obtained and compared with the neovascularization of the tumor. Accuracy, and positive and negative predictive values were calculated.
  
  
  RESULTS
  Among 160 enrolled patients, 84 underwent CEUS examination and 51 lesions were studied. Baseline and maximum color Doppler intensities were significantly higher in malignant than in benign tumors (P < 0.001 for both). Similarly, the absolute and relative increases in color Doppler intensity were significantly higher in malignant tumors (P < 0.001). The estimated positive predictive value was 97.1%, the negative predictive value was 100%, and the accuracy was 100%. Peak enhanced intensity of fractional color Doppler Area and area under the time-intensity curve (S-parameter) correlated significantly with the histology of the lesion (P < 0.001). Probability curves demonstrated that higher S-parameter values were correlated with a higher risk of malignancy.
  
  
  CONCLUSIONS
  Transvaginal CEUS is a reliable and reproducible way to differentiate between benign and malignant adnexal lesions.
authors.affiliation: Department and Clinic of Obstetrics, Gynecology, and Oncological Gynecology, Dr Jan Biziel University Hospital, Bydgoszcz, Poland; Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Szymanski
authors.affiliation: Department and Clinic of Obstetrics, Gynecology, and Oncological Gynecology, Dr Jan Biziel University Hospital, Bydgoszcz, Poland; Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland.
authors.forename: Maciej W
authors.initials: MW
authors.lastname: Socha
authors.affiliation: Department and Clinic of Obstetrics, Gynecology, and Oncological Gynecology, Dr Jan Biziel University Hospital, Bydgoszcz, Poland. Electronic address: mg.kowalkowska@gmail.com.
authors.forename: Magdalena E
authors.initials: ME
authors.lastname: Kowalkowska
authors.affiliation: Department of Obstetrics and Gynecology, District Hospital, Wyrzysk, Poland.
authors.forename: Izabela B
authors.initials: IB
authors.lastname: Zielińska
authors.affiliation: Department of Regenerative Medicine and Immunoregulation, Medical University of Bialystok, Bialystok, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Eljaszewicz
authors.affiliation: Department and Clinic of Obstetrics, Gynecology, and Oncological Gynecology, Dr Jan Biziel University Hospital, Bydgoszcz, Poland; Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland.
authors.forename: Wieslaw
authors.initials: W
authors.lastname: Szymanski
mesh_terms: D000291:Adnexal Diseases / Q000000981:diagnostic imaging* / Q000378:metabolism; D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000493:pharmacokinetics*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging; D010051:Ovarian Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000378:metabolism; D011044:Poland; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color / Q000379:methods* / Q000706:statistics & numerical data; D014621:Vagina / Q000000981:diagnostic imaging
chemical_list: D003287:Contrast Media
keywords: Adnexal lesion; Contrast-enhanced ultrasonography; Differential diagnosis; Ovarian cancer; Pelvic mass