US characterization of ovarian masses: A meta-analysis

PURPOSE: To compare the effectiveness of current ultrasonographic (US) tech niques for characterizing ovarian masses. MATERIALS AND METHODS: Through a MEDLINE literature search, articles with i maging-histopathologic correlation and data that allowed calculation of con tingency tables were identified. Results of morphologic assessment, Doppler US, color Doppler flow imaging, and combined techniques were compared. RESULTS: Among 89 data sets from 46 included studies (5,159 subjects), 35 s ets used morphologic information, 36 measured Doppler US indexes, 10 assess ed tumor vascularity with color Doppler flow imaging, and eight used combin ed techniques. Summary receiver operating characteristic curves revealed si gnificantly higher performance for combined techniques than for morphologic information (P = .003), Doppler US indexes (P = .003), or color Doppler fl ow imaging alone (P = .001). The Q* point (and 95% Cl) for combined techniq ues was 0.92 (0.87, 0.96) versus 0.85 (0.83, 0.88) for morphology, 0.82 (0. 78, 0.86) for Doppler US, and 0.73 (0.58, 0.87) for color Doppler flow imag ing. Morphologic assessment showed a trend toward better performance than c olor Doppler flow imaging (P = .09) or Doppler US indexes (P = .07). Dopple r US index results were better in earlier studies (P = .005). CONCLUSION: Combined US techniques and a diagnostic algorithm perform signi ficantly better than morphologic assessment, color Doppler flow imaging, or Doppler US indexes alone in characterizing ovarian masses.