FLOW CHARACTERISTICS IN BENIGN AND MALIGNANT GYNECOLOGIC TUMORS USINGTRANSVAGINAL COLOR-FLOW DOPPLER

Objective: To assess flow characteristics of benign and malignant gyne cologic tumors by transvaginal color now Doppler. Methods: Records of the Ultrasound Laboratory, Women's Cancer Center, University of Minnes ota were analyzed retrospectively. Gray scale findings were recorded a s either ''diagnostic'' or ''nondiagnostic.'' Color now assessment was performed on intratumor vessels or ovarian and/or uterine arteries. F low was recorded as either ''absent'' or ''present.'' Spectral analysi s allowed determination of the systolic, diastolic, and mean velocitie s and calculation of the pulsatility and resistance indices. Malignanc y was then predicted based upon color how findings alone, with maligna nt tumors demonstrating increased color flow and a pulsatility index o f at most 1.0 or a resistance index of at most 0.4. Color flow Doppler findings were then recorded as ''giving additional useful information '' that either confirmed questionable gray scale findings or changed t he gray scale sonographic diagnosis, or as ''not giving additional inf ormation'' over the gray scale diagnosis. Results: Two hundred thirty- one patients had gray scale sonography, and 167 also had color flow Do ppler performed. Gray scale sonographic findings were sufficient to ma ke a diagnosis in 156 (93%) of the scans. Color now Doppler findings a dded useful information in 49 scans (30%). Increased color flow was hi ghly significant (P < .0001), as was the calculated pulsatility index (P <.02) and resistance index (P <.008), in distinguishing benign from malignant tumors. Ovarian and uterine artery and intratumor assessmen ts of the systolic, diastolic, and mean velocities were not significan tly different between the benign and malignant tumors. Regression anal ysis confirmed the presence or absence of color flow as an independent predictor of malignancy or benignity (P <.0001). Conclusions: Our lar ge study confirms the overall accuracy of gray scale scanning. When us ed alone, color flow Doppler-although specific-lacks sensitivity and p redictive value as an independent predictor of malignancy. When findin gs were combined with those obtained from gray scale scanning, sensiti vity, specificity, and predictive value were improved to acceptable le vels. Significant differences existed between benign and malignant tum ors for calculated pulsatility index and resistance index, but neither was sufficiently sensitive, specific, or predictive to be used alone as sole criteria of malignancy prediction. Other now indices studied ( systolic, diastolic, and mean velocities) in general did not differ si gnificantly between groups. Physicians should be cautioned against usi ng color flow findings alone for clinical decision making. We recommen d a multiinstitutional study to investigate the multiple vascular asse ssments to determine the role of color flow Doppler in the preoperativ e prediction of pelvic tumors and in screening for gynecologic abnorma lity. (Obstet Gynecol 1994;83:125-30)