PELVIC EXAMINATION, TUMOR-MARKER LEVEL, AND GRAY-SCALE AND DOPPLER SONOGRAPHY IN THE PREDICTION OF PELVIC CANCER

Objective: To determine the ability of pelvic examination, tumor marke r assessment, and transvaginal ultrasonography, with selected use of D oppler ultrasonography, to predict pelvic malignancy. Methods: Two hun dred twenty-six women scheduled for operative removal of a pelvic mass were entered in the study prospectively. Each woman underwent pelvic examination, tumor marker assessment, and transvaginal ultrasonography preoperatively. Women whose gray-scale findings were suspicious for m alignancy underwent Doppler ultrasonography. Suspicious findings inclu ded masses that were fixed or irregular on pelvic examination; CA 125 level greater than 35 U/ml; elevations in serum lactic dehydrogenase, alphafetoprotein, or hCG; and the presence of a substantial solid comp onent on gray-scale ultrasonography. Suspicious Doppler findings inclu ded intratumoral color flow, pulsatility index less than 1.0, or resis tance index 0.4 or lower. The findings were correlated with the presen ce of malignancy. Results: If all three indicators (examination, tumor marker assessment, and gray-scale ultrasound findings) were non-suspi cious, 99% of premenopausal women and 100% of postmenopausal women had benign masses. If all three indicators were suspicious, 77% of premen opausal women and 83% of postmenopausal women had malignant tumors. Lo gistic regression identified ultrasound impression and tumor size to b e significant predictors of malignancy in premenopausal women, whereas CA 125 level and ultrasound impression were significant in postmenopa usal women. In patients with suspicious gray-scale findings, recategor ization based on Doppler findings resulted in inferior diagnostic indi ces. Conclusions: Ultrasonographic tumor size and appearance are the b est predictors of pelvic malignancy in premenopausal women, whereas CA 125 level and ultrasonographic appearance are the best predictors in postmenopausal women. Neither color nor spectral Doppler is useful in this setting. (C) 1997 by The American College of Obstetricians and Gy necologists.