A NEW SONOMORPHOLOGIC SCORING SYSTEM (MAINZ SCORE) FOR THE ASSESSMENTOF OVARIAN-TUMORS USING TRANSVAGINAL ULTRASONOGRAPHY - PART I - A COMPARISON BETWEEN THE SCORING-SYSTEM AND THE ASSESSMENT BY AN EXPERIENCED SONOGRAPHER

Objective: The problem of an accurate sonographic assessment of ovaria n tumor status has not yet been solved. To what extent can the preoper ative assessment of adnexal tumors be improved on the basis of a maxim um number of sonographic tumor parameters included in the newly develo ped sonomorphologic Mainz Score? Materials and Methods: In a prospecti ve study 314 premenopausal patients with adnexal tumor underwent a tra nsvaginal sonographic examination performed by an experienced sonograp her. In parallel to the sonographic examination a new score including 10 different sonographic parameters was used to predict adnexal tumor status: 1. Total tumor structure, 2. tumor border, 3. wall thickness, 4. inner echos in cystic component, 5. septa, 6. shape of echo complex or of the completely solid tumor, 7. echogenicity of the echo complex or of the completely solid tumor, 8. acuostic phenomena behind tumor, 9. ascites, 10. detection of liver metastases/peritoneal carcinosis. Depending on the respective degree of expression, the individual chara cteristics were rated on a scale from 0 to 2. The total score obtained following addition of the points recorded for each parameters served to confirm the validity of the sonographic tumor status assessment. Th e first sonographer assessed the tumor status based on his experience and in the knowledge of all clinical parameters. The second sonographe r evaluated the tumor status based on the score. All preoperative ultr asonographic findings were compared with the postoperative histologic analysis. Results: A maximum number of 20 points may be obtained using the Mainz Score. Tumors with a total score of below 9 were rated as b enign and those with a score of above 9 as malignant. This resulted in a sensitivity of 96.4%, a specificity of 80.7%, a positive predictive value of 47.4%, and a negative predictive value of 99.6%. The predict ive value of the scoring-system was diminished by the presence of 30 f alse-positive cases, which were identified as inflammatory conglomerat e tumors, teratomas, endometrial cysts, cystadenomas and hemorrhagic c ysts. The experienced sonographer assessed 233 cases as benign and 24 cases as malignant. The findings were confirmed by the histological ex amination in 252 of 257 cases. No conclusive prediction of tumor statu s could be made in 57 tumors. However, the application of the Mainz Sc ore enabled an accurate prediction of the tumor status in 44 of the 57 cases. With the exception of septal thickness all assessment criteria of the score showed a statistically significant correlation between t he assigned score and the histologic finding, (p < 0.05). Conclusions: The use of the Mainz Score enables even less experienced sonographers to assess the status of premenopausal adnexal tumors with a high degr ee of accuracy. The score provides the experienced sonographer with a refined and improved method for the prediction of tumor status, especi ally in the presence of not readily assessable findings.