TRANSVAGINAL ULTRASOUND EXAMINATION OF OVARIAN MASSES IN PREMENOPAUSAL WOMEN

Objective: Two scoring systems based on trans-vaginal sonographic find ings of ovarian tumors were evaluated with respect to the prediction o f ovarian malignancy. Study design: In this retrospective study, 64 pr emenopausal non-pregnant patients with an ovarian tumor underwent tran s-vaginal sonography from 1991 to 1993. In each women a numerical scor e was calculated using two methods. Method A included four variables: inner wall structure, wall thickness, presence of septa and echogenici ty. The point scale ranged from 4 to 15 points. Method B included thre e morphological characteristics: volume, wall structure and septal str ucture, the point scale ranging from 0 to 12 points. The threshold val ues for predictability of malignancy were 9 and 5 points for methods A and B, respectively. Results: The mean age of the patients was 32.2 y ears (range 22-44). The mean gravidity was 2.6 (range 0-5) in 45 women , 19 women being nulliparous. Fifty-five masses were surgically proven to be benign and 9 women had primary malignant tumors. Sensitivity an d specificity for prediction of malignancy were 89% and 73%, respectiv ely, for method A, and 89% and 70%, respectively, for method B. Positi ve predictive value and negative predictive value for malignancy were 35% and 97% for method A and 29% and 64% for method B. The mean morpho logy scores on benign and malignant masses, calculated by method A, we re 6.94 +/- 2.36 S.D. and 12.0 +/- 2.4 S.D. (P < 0.01). The same score s, calculated by method B, were 4.16 +/- 1.16 S.D. and 9.44 +/- 2.96 S .D. (P < 0.01). We found a considerable overlap in the scores of diffe rent types of ovarian tumors. Conclusions: Both methods are easy to ap ply and provided explicit data. Method A was shown to be more effectiv e. The number of false positive results was relatively high. The most important single sonographic characteristic of the malignant masses ar e the wall structure abnormalities.