Jl. Alcazar et al., THE ROLE OF TRANSVAGINAL ULTRASONOGRAPHY COMBINED WITH COLOR VELOCITYIMAGING AND PULSED DOPPLER IN THE DIAGNOSIS OF ENDOMETRIOMA, Fertility and sterility, 67(3), 1997, pp. 487-491
Objective: To assess the diagnostic accuracy of transvaginal ultrasono
graphy alone and combined with color velocity imaging and pulsed Doppl
er in differentiating ovarian endometriomas from other nonendometrioti
c masses. Design: Prospective study with pathological confirmation of
sonographic diagnosis. Setting: Department of Obstetrics and Gynecolog
y at a university hospital. Patient(s): A series of 78 consecutive pat
ients diagnosed as having an adnexal mass and scheduled for surgery, b
etween January 1995 and March 1996. Intervention(s): Transvaginal ultr
asonography and color velocity imaging and pulsed Doppler was performe
d before surgery in all patients. A total of 82 masses were diagnosed
(four patients had bilateral masses). CA-125 plasma levels were measur
ed in all patients. Ultrasound diagnosis was compared with definitive
histopathological diagnosis. Main Outcome Measure(s): The presence of
a round-shaped homogeneous cyst with low-level echoes was considered a
s sonographic diagnosis of ovarian endometrioma. The typical vascular
pattern from endometrioma was considered as ''pericystic flow at the l
evel of the ovarian hilius.'' The sensitivity, specificity, and positi
ve and negative predictive values were calculated for transvaginal ult
rasonography alone and combined with color velocity imaging and pulsed
Doppler. Result(s): Twenty seven (32.9%) of the 82 masses were proven
to be ovarian endometriomas. Morphological assessment diagnosed corre
ctly 24 (88.9%) of 27 endometriomas (false-positive rate: 9%). Typical
flow pattern was present in 90.5% of endometriomas (false-positive ra
te: 80%). CA-125 levels in patients with endometrioma (45.6 +/- 6.3 U/
mL; mean +/- SEM) were significantly higher than in patients with none
ndometriotic masses (26.5 +/- 5.5 U/mL). The sensitivity, specificity,
and positive and negative predictive values of transvaginal ultrasono
graphy alone and combined with color velocity imaging and pulsed Doppl
er were 88.9%, 91%, 84.2%, and 94.5%, and 76.2%, 88.9%, 82.4%, and 82.
4%, respectively. For CA-125 levels, using a cutoff greater than or eq
ual to 35 U/mL, these figures were 79.3%, 84.6%, 79.3%, and 84.6%, res
pectively. Conclusion(s): The use of color velocity imaging and pulsed
Doppler does not improve the diagnostic accuracy of transvaginal ultr
asonography alone in the diagnosis of ovarian endometrioma.