Premenopausal adnex masses: Diagnostic accuracy of sonography, magnetic resonance imaging, and positron emission tomography

Objective: We analyzed the diagnostic accuracy of imaging techniques for pr edicting the benign or malignant status of adnexal masses in premenopausal women. Methods: 64 premenopausal women referred for laparoscopic surgery for asymp tomatic and persisting adnexal masses were studied. Preoperatively the pati ents underwent magnetic resonance imaging (MRI), positron emission tomograp hy (PET) and sonography and Doppler sonography. The sensitivity, specificit y, and positive and negative predictive values of the imaging modalities we re calculated with contingency tables. Results: At surgery 58 patients had benign and 6 had malignant tumors (2 ca rcinomas and 4 tumors of low malignant potential [borderline tumors]). Sono graphic findings were suspicious for malignancy in 5 of 6 patients (sensiti vity: 76%). The combination of sonography and a semiquantitative scoring sy stem or Doppler sonography did not improve the diagnostic accuracy. MRI had the same sensitivity but higher specificity (86%) than sonography. PET det ected both carcinomas but only 1 of 4 borderline tumors (specificity: 75%). Conclusion: The sensitivity of PET for the early detection of ovarian cance r is poor. Negative MRI or PET findings do not rule out early ovarian malig nancy.