Color Doppler ultrasound in the preoperative assessment of adnexal masses

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Abstract
To differentiate benign from malignant ovarian tumors preoperatively by means of transvaginal color Doppler ultrasound and to compare the sensitivity and specificity of this technique with that of conventional transvaginal ultrasound and CA 125 serum levels. Different indicators of blood flow resistance (pulsatility index and resistance index) within intratumoral vessels were evaluated preoperatively in 80 adnexal masses by means of color Doppler ultrasound. Results were compared to CA 125 levels, conventional ultrasound and histopathologic findings. Forty-seven benign, 29 malignant and four borderline masses were studied. Mean PI and RI were significantly higher in benign than in malignant masses but an overlap was observed. Sensitivity, specificity and accuracy of color Doppler in predicting malignancy were 85%, 91% and 89% by using a cut-off value of 0.56 for resistance index and 97%, 87%, 91% by using a cut-off value of 1.0 for pulsatility index. The accuracy of both indexes in differentiating benign from malignant tumors was superior to that obtained by using conventional ultrasound and CA 125. In eight of nine masses where disagreement existed between color Doppler ultrasound and conventional ultrasound, pathologic examination confirmed the nature suggested by color Doppler ultrasound. Compared to conventional ultrasound and CA 125, color Doppler ultrasound was more accurate in discriminating malignancies from benign tumors. The best use for this technique seems in giving further preoperative information about masses with uncertain sonographic characteristics, allowing better timing and tailoring of surgery.

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