DOPPLER SONOGRAPHY OF ADNEXAL MASSES - THE PREDICTIVE VALUE OF THE PULSATILITY INDEX IN BENIGN AND MALIGNANT DISEASE

OBJECTIVE. The purpose of this study was to determine whether pulsed D oppler sonography can be used to distinguish between benign and malign ant adnexal masses on the basis of pulsatility index. SUBJECTS AND MET HODS. In an 18-month period, all patients in whom an adnexal mass was detected at sonography had further evaluation of the mass by color and pulsed Doppler sonography. Ninety-nine patients with 102 masses that were surgically removed were included in the study. The pulsatility in dexes were calculated from the reproducible spectral waveforms generat ed from flow centrally or peripherally within or immediately adjacent to the mass. Each lesion was categorized on the basis of its gray scal e morphologic features as typically benign or indeterminate/malignant in appearance. RESULTS. Of the 102 adnexal masses, 89 were benign and 13 were malignant. In seven of the 89 benign lesions, no flow could be detected, and these were excluded from analysis. Of the remaining 82 benign lesions, 65 showed pulsatility indexes consistently equal to or greater than 1.0, and 17 showed pulsatility indexes of less than 1.0. Ten of the 13 malignant lesions had pulsatility indexes consistently less than 1.0, and three primary malignant tumors had their lowest pul satility indexes ranging between 1.1 and 1.8. Sixty-five of the 68 mas ses with pulsatility indexes equal to or greater than 1.0 were benign, for a positive predictive value of 96% for benign disease. Ten of the 27 masses with pulsatility indexes of less than 1.0 were malignant, f or a positive predictive value of 37% for malignant disease. Forty-fiv e masses were detected in perimenopausal and postmenopausal patients. In this group, the pulsatility index had a positive predictive value o f 88% for benign disease and 47% for malignant disease. In this study, 45 of 49 masses that had a typically benign sonographic appearance ha d pulsatility indexes equal to or greater than 1.0. All 49 masses had benign histology. In the remaining 46 masses with an indeterminate/mal ignant sonographic appearance, 20 of 23 with pulsatility indexes equal to or greater than 1.0 were benign, and 10 of 23 with pulsatility ind exes of less than 1.0 were malignant. CONCLUSION. Our results show a h igh positive predictive value of high-impedance flow in benign adnexal disease and a predominance of low-impedance flow in malignant adnexal disease. However, the pulsatility indexes showed considerable overlap between benign and malignant lesions, indicating that Doppler sonogra phy has severe limitations in the differentiation of benign from malig nant adnexal disease on the basis of low-impedance flow (pulsatility i ndex < 1.0).