Preoperative discrimination between malignant and benign adnexal masses with transvaginal ultrasonography and colour blood flow imaging

Background: Ovarian cancer is one of the causes of death in women, and in a bout 70% of cases is recognized only in advanced stages. This study was und ertaken to evaluate distinctive values of transvaginal and color Doppler ul trasonography in differentiating malignant and benign adnexal masses throug h analysis of ultrasonic morphological features of malignancy and estimatio n of location and intensification of angiogenesis as well as values of resi stance of flow in examined masses. Patients and methods: 329 women with malignant and benign adnexal masses un derwent ultrasonographic and colour Doppler examination 1-5 days before sur gery (laparotomy, laparoscopy) thus allowing histological verification of d iagnosis. The ultrasonographic structure was assessed using a morphological scoring system devised by Sassone [4]. Jain [5] and Benacerraf [6]. Region s showing vasculature, especially within septae and solid parts of rumours were examined by means of transvaginal colour Doppler. Location and intensi fication of angiogenesis as well as resistance index (RI) were investigated . Sensitivity, specificity, PPV and NPV of both techniques were assessed. S tatistical analysis of obtained data were based on the Student's t test; p < 0.05 level was considered significant. Results: Postoperatively 255 (77.5%) benign and 74 (22.5%) malignant tumour s were seen. In the group of benign masses the average age of women was 42. 6+/-12.3 and in the malignant it was 53.1+/-12.6 (p<0.0001). The transverse dimension of benign lesions was 77.2+/-19, whereas for malignant it was 10 7.0+/-31 (p<0.0001). Benign rumours in 63.0% were cystic, in 26.0% mixed cy stic solid and in 11.0% solid echostructures while in malignant they were r espectively, 6.8%, 56.8% and 36.4% (p<0.0001). Doppler flow within the tumo ur was 74.5% in benign and 98.6% in malignant masses (p<0.0001). In benign lesions homogenous superficial or peripheral vasculature was visualized, an d in the majority of cases (82.7%) it was of medium intensification. Howeve r in malignant central, peripheral or mixed vascularisation, in the: majori ty intensified character was found. Average value of the resistance index i n all benign masses amounted to 0.77+/-0.14. however in malignant it was 0. 39+/-0.07 (p<0.0001). Conclusions: We contend that complete ultrasonographic estimation of ovaria n neoplasms outside the qualification of structural details should include Doppler analysis of vasculature parameters. Most important is the qualifica tion of resistance of flow, and location and intensification of vascularisa tion in examined masses which permit the differentiation of malignant and b enign lesions. Preoperatively recognizing malignant processes with colour D oppler ultrasonography shows higher accuracy, specificity and PPV.