Combined transvaginal B-mode and color Doppler sonography for differentialdiagnosis of ovarian tumors: Results of a multivariate logistic regressionanalysis

Objective. Transvaginal sonography is limited in its ability to assess earl y stage cancers of the ovary as well as in distinguishing benign processes. As a method for characterization of tumor vascularization, color-coded Dop pler sonography may be able to improve the diagnostic accuracy of B-mode so nography. Methods. Preoperative transvaginal B-mode and Doppler sonography was perfor med in 63 patients with unclear adnexal lesions prior to operation. Using m ultiple logistic regression, the independent variables of each procedure we re selected and combined to yield a diagnostic Row chart. The diagnostic ac curacy of this decision matrix was tested on 257 patients with unclear adne xal tumors. Results. In the 63 adnexal tumors investigated, the diagnostic impact of is olated sonomorphological assessment with evidence of a "solid area" was 78% . Using Doppler sonography, the best discrimination was achieved by display ing the vascular distribution ("central vascularization"), Combining these independent significant variables of the two procedures raised the diagnost ic accuracy to 90% (sensitivity 86%, specificity 93%). The validity achieve d by this combination was confirmed by the independent application of this method to the 257 adnexal tumors with unclear malignancy status (diagnostic accuracy 93%, sensitivity 92%, specificity 94%). Conclusions. The combination of sonography and Doppler sonography achieves high and reproducible diagnostic accuracy in preoperative malignancy status assessment of adnexal tumors. The additional use of Doppler sonography can thus provide significant aid both for differential diagnostics of adnexal lesions and for the choice of surgical route in the case of an existing ind ication for operative therapy, (C) 2000 Academic Press.