GRAY-SCALE AND COLOR-FLOW DOPPLER CHARACTERIZATION OF UTERINE-TUMORS

The aim of this study was to investigate gray scale and color flow cha racteristics of a group of patients with a suspected uterine pathologi c condition. One hundred and twenty-two consecutive patients at the Wo men's Cancer Center, University of Minnesota, undergoing transvaginal sonography and color flow Doppler imaging for suspected uterine corpus abnormality made up the study group. After gray scale morphologic ass essment, color flow Doppler imaging of the tumor and uterus was perfor med, including the ipsilateral uterine artery. Malignant tumors were c onfirmed pathologically in all 35 patients who had them. In comparing patients with benign versus malignant tumors, gray scale morphologic a ssessment confirmed that malignant uterine tumors (31 endometrial canc ers and four sarcomas) were more likely to have a thickened echoic end ometrium (P = < 0.0001), be enlarged (P = 0.004), to be retroverted (P = 0.02), and to lack a subendometrial halo (P < 0.0001). Patients wit h four benign and 13 malignant tumors demonstrated increased flow when assessed by CFD. The calculated sensitivity of increased color flow i n predicting malignancy was 39%, with a specificity of 92%, a positive predictive value of 77%, and a negative predictive value of 71%. No d ifference existed between the benign and malignant groups for the syst olic, diastolic, and mean velocities and for the calculated pulsatilit y index and resistive index in both sampled uterine and intramyometria l or tumor vessels. Using a cutoff level of positivity of 1.0 for the pulsatility index and 0.6 for the lowest obtained resistive index, the sensitivity, specificity, positive predictive value and negative pred ictive value were 34%, 73%, 50%, and 58% for the pulsatility index and 23%, 74%, 39%, and 56% for the resistive index. Useful clinical infor mation was obtained from CFD in only 13 (15%) patients. Multivariate a nalysis failed to confirm an association between color flow findings a nd menopausal status or use of estrogen replacement therapy. This stud y confirms the clinical usefulness of transvaginal sonography in the a ssessment of uterine pathologic conditions and that CFD generally is u nhelpful in distinguishing benign from malignant uterine tumors.