BLOOD-FLOW CHARACTERISTICS OF OVARIAN-TUMORS - IMPLICATIONS FOR OVARIAN-CANCER SCREENING

OBJECTIVES: Our purpose was to investigate the blood flow characterist ics of benign and malignant ovarian tumors. Questions posed by our res earch were as follows: (1) Can malignant ovarian tumors be predicted b y color flow Doppler imaging? (2) What are the sensitivity, specificit y and positive and negative predictive values of such prediction? (3) Which color flow Doppler parameter is superior in its accuracy of pred iction? STUDY DESIGN: One hundred twenty-three consecutive patients se en for suspected pelvic masses were evaluated by transvaginal ultrason ography and color flow Doppler imaging. A morphologic assessment was i nitially performed, followed by color flow Doppler analysis. A compari son of findings between the benign and malignant tumors was made by an alyzing different thresholds of the intratumoral pulsatility and resis tance index values by means of receiver-operator characteristic curves . By calculation of the area index under each receiver-operator charac teristic curve the efficiency of the pulsatility and resistance index values in predicting malignancy was determined. RESULTS: Fifty-six ben ign and 23 malignant tumors were pathologically confirmed. Patients wi th malignant tumors were more likely to be postmenopausal and were old er than patients with benign tumors. Malignant tumors were more likely to be larger and to have either a complex or solid pattern. Absent co lor flow was more common in benign tumors, and increased color flow wa s found equally among benign and malignant tumors. There was no differ ence in systolic, diastolic, or mean velocities between benign and mal ignant tumors. The calculated pulsatility and resistance index Values were lower in patients with malignant tumors compared with those with benign tumors. No significant difference exists in performance of eith er the pulsatility or resistance index in predicting malignancy. The b est thresholds for predicting malignancy were obtained with a pulsatil ity index of 1.0 and resistance index of 0.6. CONCLUSIONS: Transvagina l ultrasonography is accurate in distinguishing benign from malignant ovarian tumors. Color flow Doppler findings are not specific enough to be used independent of gray-scale ultrasonography.